gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Advanced Ovarian Cancer (OC) with Mainly Extraovarian Manifestation in a 22-Year Old Pregnant Patient: Diagnostic Issues

Meeting Abstract

  • corresponding author presenting/speaker Antje Kristina Belau - Universitätsklinikum Greifswald, Deutschland
  • Katja Bartz - Universitätsklinikum Greifswald
  • Britta Hinken - Universitätsklinikum Greifswald
  • Guenther Schwesinger - Universitätsklinikum Greifswald
  • Guenter Koehler - Universitätsklinikum Greifswald

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPE370

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Belau et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Malignant ovarian tumors affect all ages. In young women carcinomas are infrequent in this age group. OC associated with pregnancy is rare and presents a diagnostic challenge.

Case report: In January 2004, a 22-year G2P1 was admitted at 36 weeks gestation with the admitting diagnosis of incarcerated umbilical hernia. The patient was 9 months status post laparoscopy at another hospital. At that time, a cystic lesion had been removed from the small bowel mesentery. A remnant remained on the inferior vena cava. Histologic analysis had shown a serous, papillary, solid, exophytic and focally proliferating borderline cystadenoma. The patient declined further work up. We intended to repair the hernia in conjunction with primary Cesarean section. Intraoperatively, disseminated peritoneal carcinosis was detected. What had appeared to be an umbilical hernia was actually metastatic tumor at the laparoscopic entry site. Histologic analysis of intraoperative biopsies revealed glandular-papillary G3 OC. In the early puerperium, the patient underwent re-laparotomy. The extensive surgical procedure resulted in optimal cytoreduction. Despite advanced disease spread, both ovaries were normal in size and had only small amounts of tumor attached. The patient underwent adjuvant polychemotherapy: initially 5 cycles of carboplatin (AUC 5) combined with Paclitaxel (175mg/m2 BSA) q 3 weeks. Disease progression was noted as early as after the fifth cycle. Therefore, the regimen was changed to Topotecan d1-5. Further disease progression was observed under this therapy. In November 2005, a fifth dose of Myocet was administered. Staging revealed no change. Re-assessment of the original histopathologic specimen showed that the lesion had in fact been a metastasis from the ovarian tumor described above.

Conclusions: In young women with an intraabdominal tumor, an ovarian source needs to always be considered. Comprehensive diagnostic measures are mandatory. Pregnancy may shroud OC, which is usually not associated with major symptoms. In the case presented here, primary extraovarian disease as it is known to occur with G3 tumors worsened the already unfavorable course and delayed the diagnosis. Although advanced disease must have been present at the onset of the patient’s pregnancy, it was not recognized during prenatal checkups, probably because the ovaries seemed relatively unremarkable and because the previous diagnosis remained unknown.