Mamta Bhat

Unusual presentation of an aggressive ovarian malignancy in a young pregnant woman

Cancer during pregnancy is uncommon. Symptoms caused by new cancers in pregnancy can be difficult to recognise leading to a delay in diagnosis and treatment. Ovarian cancer during pregnancy poses a further diagnostic challenge due to the vague symptoms that it can present, along with difficulty in the interpretation of tumour markers. Presentation with acute abdominal pain, in the presence of an ovarian cyst, can be misdiagnosed as benign conditions such as ovarian torsion or haemorrhage. We present a case of a highly aggressive small-cell ovarian carcinoma diagnosed in the third trimester of pregnancy. Ultrasound and MRI scans provided some information on the complex nature of the ovarian cyst. She underwent laparotomy with salpingo-oophorectomy, which was followed by Caesarean birth 2 weeks later at 34+ weeks’ gestation. There was a rapid progression of disease between the two surgeries. Despite starting chemotherapy soon after, she became unwell after two cycles due to disease progression and suspected sepsis. She was unable to continue further treatment. She spent her last few days at home with her family. The final histology with specific stains confirmed the diagnosis of ovarian small cell carcinoma hypercalcaemic type.