Recurrence of borderline ovarian tumour after fertility treatment

Abstract

Background Borderline ovarian tumours account for 10–20% of all epithelial ovarian tumours. As one-third of these tumours are seen in women less than 40 years of age, fertility remains a major concern in their management. Conservative surgery has been advocated in these cases. Fertility treatment has been successfully used in some of these cases with good results. However, the risk of tumour recurrence cannot be ignored. Case report A young nulliparous woman had fertility sparing surgery (bilateral salpingo-oophorectomy and omentectomy) for serous borderline ovarian tumours with noninvasive implants (stage IIIc). After 10 years of uneventful follow-up, she decided to undergo an in-vitro fertilization with donor oocytes. She received unopposed oestrogen stimulation for 12 days to prime the endometrium and developed ascites. Subsequent investigations revealed tumour recurrence in the form of low-grade serous adenocarcinoma. The carcinoma proved resistant to chemotherapy and pursued an aggressive course culminating in death within 6 months of diagnosis. Conclusion Borderline ovarian tumours can recur in an aggressive manner even after a prolonged follow-up. Large clinical trials with longer follow-up are needed to evaluate the safety of controlled ovarian hyperstimulation after conservative surgery for borderline ovarian tumours.