Management of Bilateral Borderline Ovarian Tumor in a 26-year-old Patient in a Resource-Limited Setting

Abstract

<i>Background</i>: borderline ovarian tumors are rare epithelial tumors, more common before the age of 40, with challenging preoperative diagnosis. Our aim is to describe the management of a case in a resource-limited context in Burkina Faso. <i>Case report:</i> a 26-year-old primigravida with a 4-year-old child presented with an abdominal mass evolving over one year in the context of secondary amenorrhea. Clinical examination revealed weight loss, cutaneous-mucosal pallor, increased abdominal volume with tender deep palpation, and an irregular, mildly firm mass around the umbilicus extending to the iliac fossae, with a depressed area along the midline. Speculum examination was normal. On vaginal examination, the cervix was unremarkable, the uterus was of normal size, but the lateral fornices and Douglas pouch were filled. Further investigations revealed microcytic hypochromic anemia and a borderline normal CA 125 level. The rest of the laboratory tests were normal. Abdominal and pelvic ultrasound and CT revealed a strong suspicion of a bilateral ovarian tumour, with no signs of secondary localisation. MRI was not available. The diagnosis of probably malignant bilateral ovarian tumour was retained, and laparotomy was indicated. When the parietal peritoneum was opened, two ovarian tumours with a budding appearance occupied the entire lower half of the abdomen. A part of the omentum was in contact with both masses. Bilateral adnexectomy, total hysterectomy and partial omentectomy were performed in the absence of an extemporaneous histological study. Histological study of the surgical specimens concluded that the tumour was borderline ovarian. Follow-up at 3 years showed no signs of recurrence or tumour extension. <i>Conclusion</i>: borderline ovarian tumours are managed surgically, and the choice of conservative or radical surgery is not easy when there is a desire to have children, and when the ovaries are bilaterally involved. Fortunately, the vital prognosis is favourable.