Acute Abdomen Secondary to Ruptured Epithelial Ovarian Cancer during Pregnancy: The Relevance of Teamwork

Abstract

Acute abdomen secondary to epithelial ovarian cancer rupture during pregnancy is a rare event. Our aim is to present how the work of a coordinated multidisciplinary team in a case of ruptured epithelial ovarian cancer during pregnancy is feasible to obtain the best results possible. A 34-year-old woman during the 37th week of her first gestation presented with an acute abdomen. During laparotomy, a ruptured 16.5-cm left ovarian tumor was detected; the tumor was extirpated and sent to pathologic evaluation. In the meantime, a Kerr cesarean section was performed, and a healthy female neonate was born. The tumor was diagnosed as a cystadenocarcinoma; therefore, the family and the combined surgical team (obstetricians and a surgical oncologist) decided to complete a definitive radical ovarian cancer surgery: hysterectomy, right salpingo-oophorectomy, lymphadenectomy, omentectomy and appendectomy. The patient's postoperative evolution was uneventful, and she was sent to adjuvant chemotherapy.

Resumo

O abdome agudo secundário à ruptura do câncer do ovário epitelial durante a gravidez é um evento raro. Nosso objetivo é apresentar como o trabalho de uma equipe multidisciplinar coordenada em um caso de ruptura do câncer de ovário epitelial durante a gravidez é viável para obter os melhores resultados possíveis. Uma mulher de 34 anos de idade, durante a 37^a semana de sua primeira gestação, apresentou um abdome agudo. Durante a laparotomia, foi detectado um tumor ovariano esquerdo com ruptura de 16,5 cm; O tumor foi extirpado e enviado para avaliação patológica. Enquanto isso, uma cesariana de Kerr foi feita, e uma recém-nascida saudável nasceu. O tumor foi diagnosticado como um cistoadenocarcinoma; então, a família e a equipe cirúrgica combinada (obstetras e oncologista cirúrgico) decidiram concluir uma cirurgia radical definitiva do câncer de ovário: histerectomia, salpingo-ooforectomia direita, linfadenectomia, omentectomia e apendicectomia. A evolução pós-operatória da paciente foi sem intercorrências, e ela foi enviada para quimioterapia adjuvante.

Keywords

acute abdomen - epithelial ovarian cancer - ovarian cancer - pregnancy - ruptured epithelial ovarian cancer

Palavras-chave

abdome agudo - câncer de ovário epitelial - cancro do ovário - gravidez - ruptura do câncer

Informed Consent

Informed consent was obtained from the patient.

Contributions

All of the manuscript authors made substantial contributions to the conception, design, development, and draft of the article, and all read and agreed with the manuscript's final version submitted to RBGO.

• References

• 1 Nair U. Acute abdomen and abdominal pain in pregnancy. Curr Obstet Gynaecol 2005; 15 (06) 359-367
• 2 Salani R, Billingsley CC, Crafton SM. Cancer and pregnancy: an overview for obstetricians and gynecologists. Am J Obstet Gynecol 2014; 211 (01) 7-14
• 3 Goh W, Bohrer J, Zalud I. Management of the adnexal mass in pregnancy. Curr Opin Obstet Gynecol 2014; 26 (02) 49-53
• 4 Gottheil S, McGee J. Endometrioid ovarian carcinoma during pregnancy presenting with acute rupture. J Obstet Gynaecol Can 2013; 35 (11) 1020-1022
• 5 Malhotra N, Sumana G, Singh A, Deka D, Mittal S. Rupture of a malignant ovarian tumor in pregnancy presenting as acute abdomen. Arch Gynecol Obstet 2010; 281 (05) 959-961
• 6 Grimm D, Woelber L, Trillsch F, Keller-v Amsberg G, Mahner S. Clinical management of epithelial ovarian cancer during pregnancy. Eur J Cancer 2014; 50 (05) 963-971
• 7 Blake EA, Kodama M, Yunokawa M. , et al. Feto-maternal outcomes of pregnancy complicated by epithelial ovarian cancer: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 2015; 186: 97-105
• 8 Saeed Z, Shafi M. Cancer in pregnancy. Obstetrics, Gynaecol Reprod Med 2011; 21 (07) 183-189
• 9 Cooke L, Shafi MI. Cancer in pregnancy. Obstetrics, Gynaecol Reprod Med 2013; 23 (10) 317-319