Micropapillary Serous Borderline Ovarian Tumor in Early Pregnancy: Is Conservative Surgery Still a Viable Option?

Abstract

With the advent of improved sonographic techniques, it is quite common to find ovarian masses during pregnancy. Most of these are benign and are usually managed conservatively. It is rare to find a malignant ovarian tumor in pregnancy with a reported incidence of 1 in 12,000 to 1 in 47,000. Up to 8% of the adnexal masses could be borderline in nature. We present a case of a 29-year-old woman whose ultrasound in early first trimester (5 weeks) identified a solid-cystic ovarian mass with a raised CA125, suspicious of ovarian malignancy. She did not have any symptoms arising from this mass. She underwent a laparotomy and unilateral salpingo-oophorectomy at 6 weeks gestation. Frozen section was reported as borderline papillary serous ovarian tumor and hence omentectomy was done to complete the staging. Histology confirmed micropapillary variant of serous borderline tumor with a few foci of stromal micro-invasion. She was staged as FIGO stage IC. She was managed conservatively with regular follow-up at the antenatal clinic. She delivered a healthy baby at term by cesarean section. She is currently free of disease and is on regular follow-up at the gynae-oncology clinic. We wish to highlight that although borderline ovarian tumors (BOTs) in general have a very favorable prognosis, those diagnosed during pregnancy can be associated with aggressive features. The micropapillary variant of the serous BOT has the potential of malignant transformation and may represent an early stage in the continuum of development of low-grade serous tumors of the ovary. These patients should be closely followed up to detect any recurrence or progressive disease early.




J Med Cases. 2016;7(9):406-410
doi: http://dx.doi.org/10.14740/jmc2617w