Recurrence of Ovarian Cancer with Placental Metastasis: A Case Report

Abstract

A 39-year-old primiparous Japanese female was admitted to the obstetrical emergency department of our hospital because of respiratory distress resulting from a large amount of pleural effusion, soon after a caesarean delivery (CD) at another hospital. While she was undergoing the CD, a giant ovarian tumour was identified. However, the tumour could not be removed at that facility and she was transferred to our hospital. Three days after the CD, a left salpingo-oophorectomy was performed with the purpose of controlling pleural and peritoneal effusions. Based on her past treatment history and the information gathered from this surgery, recurrence of ovarian cancer was considered the final diagnosis. Earlier, at the age of 37 years, she had been diagnosed with stage IC ovarian adenocarcinoma arising from a mature cystic teratoma detected after a right salpingo-oophorectomy. These kinds of situations of accidental detection of recurrent advanced ovarian cancer in a newly pregnant patient in the emergency department are rare. Amongst them, we have identified an extremely rare case showing placental metastasis. The important lesson learnt from this case report is that detailed medical interviews and physical examinations are crucial when a pregnant woman visits a hospital without a letter of referral, especially in the third trimester of pregnancy.

Keywords: Ovarian cancer; Placental metastasis; Pregnancy; Recurrence; Sudden examination.

Fig. 1

Contrast-enhanced computed tomography. a An abdominal scan showing a 24-cm solid tumour in the upper left side of the uterus and enlargement of the para-aortic lymph nodes (arrows). b A chest can showing a large amount of right-sided pleural effusion. c An abdominal scan showing a large amount of peritoneal effusion and a metastatic tumour at the 5th lib (arrow).

Fig. 2

Pathological findings of the right ovary resected at the age of 37. a Tumour cells (arrow with black line) arising from a mature cystic teratoma (arrow with dashed line) (haematoxylin-eosin stain, magnification ×4). b The tumour was mainly composed of a well-differentiated type of adenocarcinoma (arrow with solid line in a), while a poorly differentiated type of the cells (i.e., signet-ring cells) was observed (haematoxylin-eosin stain, magnification ×20; inset: magnification ×40).

Fig. 3

a Macroscopic findings of the left ovary resected at our hospital. b Pathological findings of the left ovary resected at our hospital. The left ovarian tumour was composed of poorly differentiated adenocarcinoma, the characteristics of which were identical to those observed in the previously resected right ovarian tumour (magnification ×20). c Macroscopic findings of the placenta. A white nodule measuring 1 × 1 cm was observed in the specimen. d Pathological findings of placenta. Characteristics and appearance of cancer cells observed in the placenta were similar to those observed in the ovarian tumours (magnification ×40).