| Abstract [eng] |
Ovarian cancer is the most life-threatening oncological disease of women, most common in postmenopausal women, and is usually diagnosed at an advanced stage due to its asymptomatic and secretive growth. The most common histological type of ovarian cancer is serous papillary carcinoma. The second most common is endometrioid ovarian carcinoma, which usually occurs at a younger age, is associated with endometriosis, and is more commonly diagnosed in Lynch II syndrome at an early stage and has a good prognosis. In early-stage, low-grade endometroid ovarian cancer, a woman’s fertility can be maintained, and adjuvant chemotherapy may be avoided. The aim of this work is to describe the case of ovarian cancer (endometrioid ovarian adenocarcinoma) during pregnancy and to emphasize the importance of thorough staging of the disease, to discuss treatment options, risk factors and the possibility of maintaining fertility. This work analyzes a clinical case of a 28-year-old woman who underwent ovarian cystectomy at 14 weeks of gestation and was diagnosed with moderately differentiated endometrioid ovarian adenocarcinoma, pT1bN0M0, FIGO IB. The patient was counseled at a Level III facility at 17 weeks of gestation. Tumor paraffin blocks were reviewed at the State Pathology Center and was refined to well-differentiated endometrioid ovarian adenocarcinoma. Further radiological staging of the disease was postponed after delivery because, regardless of the results, the patient would still have continued the pregnancy. Radiological staging of the disease was initiated 2 months after delivery due to possible tumor spread. In a pelvic, abdominal, and thoracic computed tomography study, there were no clear signs of distant tumor spread. Because the histological type of the tumor is similar to endometrial adenocarcinoma, diagnostic hysteroscopy and endometrial biopsy were performed a month later to rule out the spread of the tumor in the endometrium or endometrial cancer in the ovaries. Malignant process in the uterine mucosa has not been identified, chronic endometritis has been diagnosed. After a month and a half, the patient underwent scheduled laparoscopic ovarian and peritoneal biopsy/resection, infrared omentectomy. All studies confirmed low-grade endometrioid ovarian carcinoma, pT1bN0M0, FIGO stage IB. The patient was left for follow-up care and genetic testing for Lynch syndrome was recommended. Endometrioid ovarian adenocarcinoma is the second most common histological type of epithelial ovarian cancer. It is most common in young women, usually diagnosed at an early stage and has a good prognosis. The symptoms are nonspecific, and the histology of the tumors is indistinguishable from endometrial cancer of the uterus. Comprehensive radiological and surgical staging of the disease allows accurate identification of cancer differentiation and stage that determines the course of treatment, survival, and fertility of patients. The symptoms, course, diagnostic and treatment tactics of ovarian cancer, the possibility of maintaining female fertility and the prognosis of the disease depend on the histological type of primary ovarian cancer, its differentiation, stage, spread to the lymph nodes and timely diagnosis (detailed radiological and surgical stage). Early-stage, low-grade ovarian endometrioid adenocarcinoma can be treated surgically with partial ovarian resection without the need for adjuvant chemotherapy to preserve female fertility. Radical cytoreductive surgery should be used in patients with ovarian cancer who are no longer planning to become pregnant. Due to the possibility of recurrence of the cancer process, periodic monitoring of the woman is recommended according to a schedule. |
