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

Jelena M. Štulić; Lazar Nejković

doi:10.2298/VSP191010103S

Jelena M. Štulić Clinic for Obstetrics and Gynecology “Narodni Front”, Belgrade, Serbia
Lazar Nejković Clinic for Obstetrics and Gynecology “Narodni Front”, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP191010103S

Keywords: diagnosis;, fertility preservation;, gynecologic surgical procedures;, histological techniques;, incidental findings;, neoplasm staging;, ovarian neoplasms;, ultrasonography.

Abstract

Introduction. Ovarian carcinoma is the fifth leading cause of death in women. In 3–14% of cases, it occurs in women under 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. Preserving fertility is safe for grade 1 and 2 of the International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian carcinomas. A sparing operation involves salpingoophorectomy 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 severe pain in the lesser pelvis. An ultrasound examination revealed 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 satisfied 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.

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