#387 : Enlightening the Management of Chocolate Cysts Before IVF Treatment: Case Reports of 3 Young Endometriosis-Associated Ovarian Cancer Patients with Ovulation Induction History

Abstract

Background and Aims: Endometriosis is a common estrogen-dependent disease that occurs mostly in women of childbearing age and is characterized by ectopic growth of endometrial glands and stroma. Endometriosis may present as malignant transformation and the two most common malignancies in this situation are ovarian clear cell carcinoma and endometrioid adenocarcinoma. Rare cases of endometriosis-associated ovarian cancer (EAOC) after in-vitro fertilization (IVF) treatment were reported before, and the relationship between the usage of ovulation induction medications and the development of ovarian cancer is controversial. This study aims to summarize the characteristics of EAOC patients with IVF treatment history. Method: All history, clinical data, imaging data, operative documents, and follow-up of 3 cases of endometriosis-associated ovarian cancer with IVF treatment history were reviewed, among the 793 patients undergoing surgeries for ovarian malignancy at the Gynecology Department, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, from 2019 to 2022. Results: 3 EAOC patients under the age of 40 who had undergone controlled ovarian hyperstimulation (COH) for IVF treatment were identified in the cases review. The 3 infertility women underwent 3, 4, and 6 cycles of ovulation induction and achieved 1, 0, and 1 time of pregnancy, respectively. Unfortunately, none of them reached a pregnancy outcome over 12 weeks. After staging surgery, the 3 patients were diagnosed with Stage IA clear cell carcinoma, Stage IIB clear cell carcinoma, and Stage IIB adenosquamous carcinoma, respectively. The latter two patients had undergone two times of needle aspiration and sclerosis for chocolate cysts, and the surgical records also showed more severe abdominal adhesion and poor prognosis. Conclusion: Patients with endometriosis cysts need to be very careful when seeking IVF treatment, especially in the order of treatment of cysts and ovulation induction. Repeated needle aspiration and sclerosis for ovarian cysts are not recommended.