A CASE OF OVARIAN CLEAR CELL CARCINOMA IN PREGNANT WOMAN: CLINICAL PRESENTATION AND MANAGEMENT

The adnexal masses are uncommon during pregnancy. They are usually picked up incidentally during antenatal scans. Most of the adnexal masses are benign and resolve spontaneously. The incidence of ovarian clear cell carcinoma (OCCC) is rare during pregnancy. OCCC is strongly linked with the history of endometriosis. Here is such an example of OCCC in women with a history of endometriosis. Here we present a 42-year-old primiparous woman who had incidental nding of complex ovarian cyst on her dating scan. Her CA-125 was 58 units. The MRI scan at 18 weeks of gestation showed 9.9*9.9*9.7cms complex cyst with endometrioma features. The patient underwent left salpingo-oophorectomy with peritoneal biopsy and washings at 20 weeks of gestation. There was no evidence of metastatic disease intra-op. The histology conrmed grade 3 OCCC. Following multi-disciplinary team (MDT) discussion, [patient was offered three different options of management involving the combination of chemotherapy, caesarean section and completion surgery. According to the patient's wishes, an elective caesarean section was performed at 35 weeks of gestation. The mother and baby were healthy in the immediate post-op period. She was later booked for 3-6 cycles of combination chemotherapy followed by completion surgery in the post-partum period. The patient will be under constant follow up till 5 years after completion surgery. This case report shows the importance of constant supervision of adnexal masses during pregnancy which leads to early intervention in the disease process. In management of these types of rare cases, it is necessary to formulate a new set of guidelines.