TITLE:
A Case Report: Puerperal Ovarian Cancer in a Patient with a Prior History of Fertility Treatment and Ovarian Endometrial Cyst
AUTHORS:
Masaru Nagashima, Yukiko Katagiri, Chizu Aoki, Tsuyoki Kugimiya, Yoshihiro Yoshida, Michiko Saigusa, Kazuo Masaki, Kazutoshi Shibuya, Mineto Morita
KEYWORDS:
Puerperal, Ovarian Cancer, Sterility, Assisted Reproductive Technology, Endometriosis
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.9,
June
25,
2014
ABSTRACT:
Introduction: It has been
suggested the relationship between infertility treatment and ovarian cancer.
Furthermore, endometriosis that is one of the causes of the infertility tends
to develop into endometrioid adenocarcinoma and clear cell carcinoma in many
studies. Case: A 38-year-old woman underwent laparoscopic enucleation of
bilateral ovarian endometrial cysts at 29 and 33 years old. She then received
11 sessions of artificial insemination and 7 cycles of ovarian stimulation, egg
collection,in vitrofertilization, and embryo transfer at
multiple medical institutions before conceiving and giving birth to her first
child. After naturally conceiving her second child, she presented at our
hospital for pregnancy/delivery management with a right ovarian tumor. She
underwent abdominal right adnexectomy for a mucinous cystic tumor of borderline
malignancy at 36 years old (17 weeks of pregnancy with the second child). After
vaginal delivery at 38 weeks, a 1-month postpartum checkup revealed a left
adnexal mass and ascites. Further workup led to a diagnosis of left ovarian
cancer. The cancer was diagnosed by ovarian biopsy as unresectable stage-IIIc
endometrioid carcinoma. Despite chemotherapy, the patient developed liver
metastasis during treatment and died due to worsened general condition 9 months
after childbirth. In addition to ovarian endometrial cyst, repeated cycles of
injury and repair of the ovarian surface epithelium are also suggested to
mediate the development of epithelial ovarian cancer. Conclusion: Evaluation of
long-term outcome and follow-up of patients who have undergone fertility
treatment should be addressed.