Adnexal masses in pregnancy are not rare. The ovaries must be evaluated during routine first trimester obstetric ultrasound examination. In cases where an adnexal mass is identified and found to persist after 16 weeks of gestation, surgical evaluation is mandatory if malignancy is suspected. In the case of confirmed malignancy at surgery, re-staging after delivery is recommended and, for early-stage ovarian cancer, pelvic and para-aortic lymphadenectomy is performed. Lymph-node dissection can lead to short- and long-term complications, which could undermine the quality of life of patients. We describe the case of a 25-year-old pregnant woman with a right adnexal mass, which had not regressed after 16 weeks of gestation. The patient underwent laparoscopic right salpingo-oophorectomy, with definitive histological diagnosis of ovarian endometrioid cancer. During cesarean section, at 37 weeks of gestation and with no complication for the newborn, a re-staging was performed, involving left ovarian and peritoneal biopsies, appendectomy, omentectomy, para-aortic lymph-node dissection, and right pelvic lymphadenectomy, with every effort made to reduce long-term complications related to lymph node dissection. After 18 months the patient is disease free. To our knowledge, this is the first case of unilateral lymphadenectomy for early epithelial ovarian cancer reported in the literature.
Citation: Gallo C.,Bitonti G.,Rita Palumbo A.,Morelli M.,Di Carlo C., Unilateral pelvic and para-aortic lymphadenectomy following cesarean section in a pregnant woman with endometrioid ovarian cancer. A case report, EGO European Gynecology and Obstetrics (2021); 2021/03:129–132 doi: 10.53260/EGO.213033
Published: September 1, 2021