Abstract
Fertility sparing surgery is advocated for reproductive-age women with benign and borderline ovarian tumors. The hormonal milieu of pregnancy may, however, complicate the decision making process. The patient presented in the third trimester with a rapidly growing tumor that was diagnosed as benign steroid cell tumor by intraoperative frozen section. Fertility-sparing surgery with right oophorectomy and partial left oophorectomy was performed. The final pathology examination demonstrated signet cells staining positive for mucin, which is pathognomonic for Krukenberg tumors. Krukenberg cells were overlooked in the frozen section due to the predominance of hormonally active luteinized ovarian stroma cells. This case highlights the challenges associated with fertility sparing surgery in women presenting with ovarian tumors in pregnancy and the limitations of frozen section in providing an accurate diagnosis.
Highlights
Gynecologic tumors are rare and account for approximately 3% of all cancers in reproductive-aged women [1]
We describe a case of a Krukenberg tumor that presents as a steroid cell tumor in pregnancy and discuss the management options of this rare tumor in pregnancy
Her daughter remained well and healthy. This case highlights the complex decision-making process that is needed in order to offer Fertilitysparing surgery (FSS) to preserve fertility in reproductiveage women diagnosed with ovarian tumors during pregnancy. It illustrates the pitfalls of frozen section to provide an accurate intraoperative diagnosis, which might affect the decision of treatment at the time of surgery
Summary
Gynecologic tumors are rare and account for approximately 3% of all cancers in reproductive-aged women [1]. FSS is advocated for early-stage borderline ovarian tumors, even when the tumor is bilateral or recurrent [2]. FSS is advocated for early epithelial ovarian cancers, but there is no consensus as to the grade of the tumor that is eligible (FIGO stage 1, grade 1 and grade 2 in highly selected patients, grade 3 has been considered) [3]. With preponderance of steroid cell tumors in young adults, FSS is advocated for tumors that lack malignant features [4,5]. The balance between the risk of cancer recurrence and ovarian preservation by FSS is delicate and complicated by the inability to accurately predict the long-term malignant potential of the tumor. An abdominal computed tomography scan confirmed bilateral ovarian masses (Figure 1C) and revealed no evidence of intraperitoneal metastasis or omental caking. In the immediate postpartum period, the patient’s abdomen grew increasingly tense and distended
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