A Rare Case of High Grade Serous Adenocarcinoma of the Ovary Discovered in Pregnancy

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

In 2025, ovarian cancer was the second most common gynecologic malignancy and cause of gynecologic cancer death in the U.S. [15]. It is rare in pregnancy, with an incidence of 0.018-0.11 per 1000 pregnancies [8]. Symptoms are vague and may include vaginal bleeding, abdominal bloating, early satiety, pain, and bowel or bladder changes [3]. Without screening, diagnosis relies on symptom recognition, which often delays detection until advanced stages. In pregnancy, incidental findings on early ultrasound can allow earlier detection [8]. However, this case involved advanced-stage disease, initially believed to be non-gynecologic in origin. Advanced stage ovarian cancer is treated with a combination of chemotherapy and cytoreductive surgery. This case highlights how ovarian cancer may present in pregnancy and provide insight to treatment for advanced stage disease intrapartum and postpartum.

A 31-year-old G3P2002 female presented at 34w0d with right upper quadrant abdominal pain and blurry vision. Postprandial pain with nausea and loss of appetite was present, despite a ten-pound weight gain in 2 days. She previously had hemolysis elevated livery enzymes and low platelets syndrome (HELLP) in her first pregnancy and prior term vaginal deliveries were uncomplicated. She was transferred to maternal fetal medicine for evaluation. Examination revealed dyspnea, abdominal pain, and pitting edema of the lower abdominal wall. Fetal tachycardia, elevated urine protein creatinine ratio, hypoalbuminemia, ketonuria, metabolic acidosis, elevated amylase and normal HELLP labs were noted. A pelvic ultrasound showed large volume maternal ascites. After diagnostic paracentesis, cytology demonstrated adenocarcinoma. A left lower lobe infiltrate was found on chest x-ray, and MRI showed extensive peritoneal carcinomatosis in the abdomen and pelvis. CA 125 was markedly elevated at 1601 U/mL.

Ovarian cancer is rare in pregnancy and is often diagnosed at earlier stages due to increased prenatal ultrasound imaging. Given the nonspecific nature of associated symptoms, maintaining a high index of suspicion is essential. Treatment depends on gestational age and patients' desires. Advanced disease significantly affects prognosis. More studies are needed to define prognosis following antenatal cancer treatment. This case highlights symptom recognition in pregnancy which may be masked by other conditions of pregnancy bringing awareness and impacting survival rates.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2006

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