Report on Bilateral Endometrioid Carcinoma of the Ovary in Pregnancy: Diagnostic and Treatment Challenges

Document Type : Case report

Authors

1 Assistant Professor, Department of Gynecology Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Fellowship of Gynecology Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

10.22038/ijogi.2025.86638.6378

Abstract

Introduction: Endometrioid tumors of the ovary are rare epithelial ovarian tumors. They are extremely rare during pregnancy and may be mistaken for other more common conditions due to physiological changes in the ovary and increased hormone levels, leading to delays in diagnosis and treatment. This article reports a case of the diagnosis and treatment of bilateral endometrioid carcinoma during pregnancy.
Case Presentation: The patient was a 34-year-old woman, gravida 2 para 1 (ND), at 17 weeks of gestation, presented to the Gynecologic Oncology Clinic of Ghaem Hospital with complaints of hypogastric pain and progressive enlargement of bilateral ovarian masses detected on routine prenatal ultrasound. In the most recent transvaginal ultrasound (TVS) of the uterus and adnexa, bilateral ovarian masses were observed—measuring 65 × 85 mm in the right ovary and 95 × 86 mm in the left ovary—with solid components and categorized as O-RADS 5. Laboratory evaluation revealed an elevated CA-125 level. The patient underwent bilateral cystectomy via laparotomy, and histopathological examination confirmed endometrioid adenocarcinoma. She subsequently received six cycles of paclitaxel plus carboplatin (T+C) chemotherapy during pregnancy. The pregnancy continued uneventfully to term, and at term gestational age, the patient underwent cesarean section followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy and surgical staging (TAH-BSO-staging).
Conclusion: Endometrioid tumors of the ovary during pregnancy, especially when bilateral and diagnosed in advanced stages, require a careful and multidisciplinary approach to management. Timely diagnosis, the use of appropriate imaging tools, and tumor markers can aid in accurate diagnosis and effective treatment. Surgery in the second trimester of pregnancy is recommended as the primary treatment method, and continuous follow-up is essential to monitor the condition of the mother and fetus. The presence of capsule rupture is considered a risk factor for metastasis.

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References

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The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 8
October 2025
Pages 84-92

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