Incidental finding of an ovarian epithelial tumor, adequate approach and fertility preservation - A case report

Abstract

Introduction. Ovarian carcinoma is the fifth leading cause of death in women. In 3-14% of cases, it occurs in women un-der the age of 40 who intend to have children. Studies have shown a high survival rate if the tumor is diagnosed and treated at an early stage, with a 5-year survival rate of 91.2%, which makes a conservative treatment a valid option. Preserv-ing fertility is safe for grade 1 and 2 of the International Fed-eration of Gynecology and Obstetrics (FIGO) stage I epithe-lial ovarian carcinomas. A sparing operation involves sal-pingoophorectomy on the tumor side, multiple biopsies of suspected sites, blind biopsies and infracolic omentectomy, as well as cytological analysis of the wash. Case report. A 25-year-old patient, G0, P0, went to the gynecologist due to se-vere pain in the lesser pelvis. An ultrasound examination re-vealed a cystic hypoechoic alteration in the right ovary of about 5 × 6 cm, suspected for torsion, and the patient was urgently operated. A right cystectomy was performed. The histopathological finding of the surgically removed cyst was: Endometrioid adenocarcinoma of the ovary, histological grade 2 (HG2) and nuclear grade 2 (NG2), without lymphovascular invasion and no penetration of the capsule, submitted in parts. As the surgery performed did not reveal the degree of ovarian malignant tumor spreading, the FIGO stage could not be determined, and a second operation was necessary to stage the disease according to the FIGO protocol for ovarian cancer. Conclusion. Fertility preservation in patients with malignant ovarian epithelial tumors is a major challenge. The intense desire of the patient to have children has to be satis-fied without reducing the success of treatment for this type of disease. The staging of the disease spreading is of paramount importance in order to make an adequate decision regarding the treatment. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.