2022-RA-761-ESGO Advanced ovarian cancer imitating deep infiltrating endometriosis. Radical resection and reconstructive surgery of the anterior abdominal wall

Introduction/Background Endometriosis is a disease affecting approximately 10–15% of the female population of reproductive age. Malignant transformation affects 0.7–1% of cases. In women diagnosed with ovarian cancer, endometriosis is present in up to 30% of patients. Methodology The case of a 36-year-old patient initially diagnosed with pelvic and abdominal wall endometriosis with final diagnosis of advanced low-grade serous ovarian cancer in stage FIGO IVB. The diagnostic methods used and the extent of surgery with reconstruction of the anterior abdominal wall were described. Results Patient with history of laparoscopic excision of benign ovarian cyst and caesarean section was presented to the gynecologist because of abdominal pain that worsened during menstruation. MRI (figure 1A) and core needle biopsy of the abdominal lesion and colonoscopy were performed. Histopathological report revealed low-grade serous carcinoma originating from the ovary. Complete surgical debulking was performed. Modified Ramirez surgical technique was used to approximate the borders of the fascia (figure 1B,C) and hernia mesh was applied (figure 1D). Conclusion Incidence of ovarian cancer under the age of 40 is very rare. Endometriosis as a benign disease affecting approximately 10–15% of the female population of reproductive age may pose a risk of malignant transformation in 0.7–1% of cases. Endometriosis related ovarian neoplasms (ERONs) develop mainly from the endometrial epithelium of ovarian cysts. In contrast, in women already diagnosed with ovarian cancer, endometriosis foci are present in up to 30% of cases. Histology of endometriosis-associated ovarian cancer is mainly clear cell carcinomas (40–55%) and only less than 10% are serous carcinomas. Patients with low-grade serous ovarian cancer have a limited response to chemotherapy (approximately 23%), thus surgery is the most important element of treatment. The presented case showed that oncological vigilance should be maintained even in young women with symptoms suggestive of endometriosis.