Salpingo-oophorectomy for twisted ovarian dysgerminoma in a prestigious pregnancy: challenges and outcomes. A case report

Abstract

Introduction: Cancer during pregnancy is uncommon. Symptoms caused by ovarian dysgerminoma in pregnancy can be difficult to recognize, leading to a delay in diagnosis and treatment. In addition, treatment of twisted ovarian dysgerminoma in pregnancy to improve the maternal and perinatal outcomes is the main challenges that confront obstetricians and gynecologic oncologists because surgery often results in preterm labor and delivery. Case presentation: A 29-year-old woman primigravida came with severe lower abdominal pain. An intrauterine foetus at 19 weeks of gestation and an enlarged left ovarian mass measuring 15.3 × 10.3 × 8 cm were discovered by pelvic ultrasonography. A left salpingo-oophorectomy was performed, and the histology revealed an ovarian dysgerminoma. She had a spontaneous vaginal delivery at term. Discussion: Dysgerminoma is the most frequent malignant ovarian germ cell tumor in females. Due to physiological changes, it may be a challenge to diagnose ovarian torsion in early pregnancy. In addition, the treatment of large ovarian tumors in pregnancy is a challenge because surgery often results in preterm labor and delivery. Fertility-sparing surgery is acceptable in young women. Chemotherapy for ovarian dysgerminoma is recommended for International Federation of Gynecology and Obstetrics (FIGO) stages II, III, and IV. Conclusion: There are many challenges when performing salpingo-oophorectomy for a large twisted ovarian tumor in early pregnancy. The decision must balance the risks of surgery against the possibility of losing the pregnancy and the urgency of acting to protect the mother's health. The management depends on the gestational age, tumor stage, and the patient's desire to continue the pregnancy.