OP07.07: Role of Ultrasound in Advanced Ovarian Cancer Staging During Pregnancy: a Case Report

A 34-year-old nulliparous Caucasian woman at 25 weeks of gestational age was referred to our Center for a pelvic mass. She complained abdominal pain and dyspnea, and serum levels of oncological marker was: Ca 125 175 UI/mL (reference range: 0-35 U/ml). Both an abdominal and transvaginal ultrasound examinations were performed showing ascites, thickened omentum adherent to the anterior abdominal wall (suggesting the presence of carcinomatosis in the omentum), and an enlarged, vascularised right ovary with irregular margins and inhomogeneous echostructure. A laparoscopy confirmed the presence of disease in the omentum (“omental cake”), but no other disease was visualised in the upper abdomen. The pelvis was not explored during surgery due to the presence of abdominal adhesions. Therefore, an ultrasound guided biopsy on the omentum was performed and the histology was positive for an ovarian Müllerian carcinoma. After two cycles of carboplatin/paclitaxel-based chemotherapy, the serum value of CA125 was 80 U/mL and the ultrasound examination at 32 weeks showed a progression of abdominal peritoneal disease. A Caesarean section at 33 weeks of gestation was planned and a debulking surgery after delivery was performed. Final histological report was positive for a low grade ovarian carcinoma FIGO stage III C. After surgery, the patients underwent other four cycles of chemotherapy followed by letrozole. At birth the newborn weighed 1880g, with an Apgar of 7-9. He is growing up without any health problem after two years. The present case demonstrated that ultrasound examination plays a role in the diagnosis and management of women with ovarian cancer during pregnancy.