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28 MOGS Chronicles | Volume 1 | Issue 1 | September 2024IntroductionUterine smooth-muscle tumors (leiomyomas or myomas), with a prevalence rate of up to 70%, are the most common benign uterine tumors in women during their reproductive years.[1]Although they are benign and can be asymptomatic, around 30% of fibroids cause profuse menstrual bleeding, irregular uterine bleeding, pelvic discomfort and pain due to pressure on adjacent organs and structures, obstetric complications such as infertility, recurrent abortions or preterm labour.[2]While hysterectomy is the primary indication for this pathology, considering age of incidence and related symptoms, for the fertile age population, the preferred surgical intervention is myoma removal with uterine preservation.[3]Case ReportDiscussing about the dilemmas and difficulties faced in a case of 37 years old, with history of two abortions (P0A2), married since 15 years with secondary infertility presented with complaints of palpable abdominal mass and heavy menstrual flow.On per abdomen examination uterus was almost 30%u201332 week of size, non-tender, ballotable, side to side mobility was present [Figure 1]. On per speculum examination cervix was deviated to right side. On per vaginal examination uterus was around 30%u201332 weeks, anteverted, bilateral fornices were free and non tender, Hingorani%u2019s sign was negative. On ultrasonography transabdominal and MRI was suggestive of 18.6 %u00d7 13 %u00d7 Save the Uterus! A Case of Large Fibroid with InfertilityKrutika Ramdin, Reena WaniDepartment of Obstetrics and Gynecology, Dr. R. N. Cooper Hospital, Juhu, Mumbai, Maharashtra, IndiaAddress for correspondence: Krutika Ramdin, Department of Obstetrics and Gynecology, Dr. R. N. Cooper Hospital, Juhu, Mumbai, Maharashtra, India. Mobile: +91-7506732966. E-mail: drkrutikaramdin1@gmail.comCase ReportAbstractThe occurrence of gynaecologic cancers during pregnancy is rare, affecting approximately 4 to 8 in 100,000 pregnancies. Among these, ovarian cancer is the second most common, complicating 1 in 15,000 to 32,000 pregnancies. We present a case of a 34-year-old primigravida diagnosed with advanced ovarian adenocarcinoma during her third trimester. Initial ultrasound revealed a large complex mass, and subsequent biopsy confirmed adenocarcinoma. A multidisciplinary approach led to six cycles of neoadjuvant chemotherapy with Carboplatin and Paclitaxel, significantly improving fetal conditions. An elective caesarean section at 36 weeks resulted in the delivery of a healthy baby. Following surgery, histopathological examination confirmed bilateral ovarian adenocarcinoma. The patient underwent additional chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). After nine cycles of adjuvant chemotherapy, follow-up scans indicated no recurrence. This case highlights the importance of a coordinated multidisciplinary approach in managing ovarian cancer during pregnancy, emphasizing timely interventions to optimize maternal and fetal outcomes.Keywords: %u200aFibroid, Leiomyoma, Cystic degeneration, Hydro dissectionFigure 1: Pre-operative image of abdomen with myomaFigure 2: Intraoperative Single myoma of size 30%u201332 weeks