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Jadkar, et al.: Management of ovarian adenocarcinoma in an IVF pregnancyMOGS Chronicles | Volume 1 | Issue 1 | September 2024 5masses. Features indicating malignancy include large size, solid or complex appearance, internal septations, irregular borders, increased vascularity, and low blood flow resistance. However, ultrasound cannot reliably differentiate between benign and low malignant potential tumors, necessitating further imaging, such as MRI, which is safe in the second and third trimesters and may reveal extraovarian spread.[9]CA125 is produced by 80%u201390% of EOCs, but its levels may be elevated during pregnancy or due to complications such as HELLP syndrome, preeclampsia, or miscarriage.Elevated inhibin, human chorionic gonadotropin, and alpha-fetoprotein may suggest germ cell or sex cordstromal ovarian tumors. Managing malignant tumors during pregnancy is challenging, as both maternal and fetal health must be carefully considered.[10]Surgical resection is indicated in case of ovarian tumours during pregnancy that are sized >7 cm, suggestive of malignancy and are associated with clinical symptoms. Patients with advanced stage disease require chemotherapy, which should be avoided in the first trimester.[11] It is possible to administer chemotherapy from 14 weeks gestational age onwards with specific attention to prenatal care. The European Society of Medical Oncology guidelines suggest that the decision to administer chemotherapy during pregnancy should align with the same protocols used for non-pregnant patients. The current standard adjuvant chemotherapy regimen for treating epithelial ovarian carcinoma is a combination of Carboplatin and Paclitaxel.[12] Reports indicate that administering carboplatin during the second trimester has no significant adverse effects on the foetus.[13]This case of EOC during pregnancy emphasizes the impact of chemotherapy on pregnancy outcomes. The use of multi-agent chemotherapy during pregnancy is becoming increasingly common. Early-stage ovarian carcinoma diagnosed during pregnancy should be treated promptly without unnecessary delays.ConclusionThe association of ovarian malignancy with pregnancy is rare. The timing of delivery in patients with ovarian cancer depends on both the cancer stage and gestational age.Treatment decisions should involve a multidisciplinary team, including gynecologists, oncologists, and neonatologists. This case highlights that the primary focus should be on ensuring the patient%u2019s prognosis and quality of life. While chemotherapy during the second trimester appears to be relatively safe, the potential risks of this treatment approach must still be carefully considered.DeclarationConflict of interestNone.DisclosureNone.Informed consentInformed consent was taken from the patientReferences1. Palmer J, Vatish M, Tidy J. Epithelial ovarian cancer in pregnancy: A review of the literature. BJOG 2009;116:480-91.2. Behtash N, Karimi Zarchi M, Modares Gilani M, Ghaemmaghami F,Mousavi A, Ghotbizadeh F. Ovarian carcinoma associated with pregnancy: A clinicopathologic analysis of 23 cases and review of the literature. BMC Pregnancy Childbirth 2008;8:3.3. Nick AM, Schmeler K. Adnexal masses in pregnancy. Perinatology 2010;1:13-9.4. Zhao XY, Huang HF, Lian LJ, Lang JH. Ovarian cancer in pregnancy: A clinicopathologic analysis of 22 cases and review of the literature.Int J Gynecol Cancer 2006;16:8-15.5. Yakasai IA, Bappa LA. Diagnosis and management of adnexal masses in pregnancy. J Surg Tech Case Rep 2012;4:79-85.6. Elhalwagy H. Management of ovarian masses in pregnancy. Trends in Urology Gynaecology and Sexual Health 2009;14:14-8.7. Huang HP, Fang CN, Kan YY. Chemotherapy for ovarian mucinous cystadenocarcinoma during pregnancy: A case report. Eur J Gynaecol Oncol 2004;25:635-6.8. Takeuchi T, Suzuki S, Hayashi Z, Shinagawa T, Araki T. Primary ovarian tumor undergoing surgical management during pregnancy.J Nippon Med Sch 2002;69:39-42.9. de Haan J, Verheecke M, Amant F. Management of ovarian cysts and cancer in pregnancy. Facts Views Vis Obgyn 2015;7:25-31.10. Han SN, Verheecke M, Vandenbroucke T, Gziri MM, Van Calsteren K,Amant F. Management of gynecological cancers during pregnancy.Curr Oncol Rep 2014;16:415.11. Skrzypczyk-Ostaszewicz A, Rubach M. Gynaecological cancers coexisting with pregnancy - a literature review. Contemp Oncol (Pozn) 2016;20:193-8.12. Amant F, Calsteren KV, Halaska MJ, Gziri MM, Hui W, Lagae L, et al. Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: An observational study. Lancet Oncol 2012;379:558, 570, 580.13. Mendez LE, Mueller A, Salom E, Gonzales-Quintero VH. Paclitaxeland carboplatin chemotherapy administered during pregnancy foradvanced epithelial ovarian cancer. Obstet Gynecol 2003;5:1200-2.Figure 6: Cytoreductive surgery, hysterectomy with omentectomy was doneFigure 7: HIPEC with Cisplatin 64mg.