A Case Report: Puerperal Ovarian Cancer in a Patient with a Prior History of Fertility Treatment and Ovarian Endometrial Cyst

DOI: 10.4236/ojog.2014.49078   PDF   HTML     3,140 Downloads   4,205 Views  


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 vitro fertilization, 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.

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Nagashima, M. , Katagiri, Y. , Aoki, C. , Kugimiya, T. , Yoshida, Y. , Saigusa, M. , Masaki, K. , Shibuya, K. and Morita, M. (2014) A Case Report: Puerperal Ovarian Cancer in a Patient with a Prior History of Fertility Treatment and Ovarian Endometrial Cyst. Open Journal of Obstetrics and Gynecology, 4, 550-556. doi: 10.4236/ojog.2014.49078.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Tomao, F., Lo Russo, G., Spinelli, G.P., Stati, V., Prete, A.A., Prinzi, N., Sinjari, M., Vici, P., Papa, A., Chiotti, M.S., Benedetti Panici, P. and Tomao, S. (2014) Fertility Drugs, Reproductive Strategies and Ovarian Cancer Risk. Journal of Ovarian Research, 7, 51. http://dx.doi.org/10.1186/1757-2215-7-51
[2] Rizzuto, I., Behrens, R.F. and Smith, L.A. (2013) Risk of Ovarian Cancer in Women Treated with Ovarian Stimulating Drugs for Infertility. Cochrane Database of Systematic Reviews, 13, CD008215.
[3] Lyttle, B., Bernardi, L. and Pavone, M.E. (2014) Ovarian Cancer in Endometriosis: Clinical and Molecular Aspects. Minerva Ginecologica, 66, 155-164.
[4] Nezhat, F.R., Pejovic, T., Reis, F.M. and Guo, S.W. (2014) The Link between Endometriosis and Ovarian Cancer: Clinical Implications. International Journal of Gynecological Cancer, 24, 623-628.
[5] Whittemore, A.S., Harris, R. and Itnyre, J. (1992) Characteristics Relating to Ovarian Cancer Risk: Collaborative Analysis of 12 US Case-Control Studies. Invasive Epithelial Ovarian Cancer Group. American Journal of Epidemiology, 136, 1175-1220.
[6] Fathalla, M.F. (1971) Incessant Ovaulation: A Factor in Ovarian Neoplasia? Lancet, 17, 163.
[7] Rossing, M.A., Daling, J.R., Weiss, N.S., et al. (1994) Ovarian Tumors in a Cohort of Infertile Women. The New England Journal of Medicine, 331, 771-776.
[8] Nezhat, F., Datta, S., Hanson, V., et al. (2008) The Relationship of Endmetriosis and Ovarian Malignancy: A Review. Fertility and Sterility, 90, 1559-1570.
[9] Brinton, L.A., Melton, L.J., Malkasian Jr., G.D., et al. (1989) Cancer Risk after Evaluation for Infertility. American Journal of Epidemiology, 129, 712-722.
[10] Chapron, C., Vercellini, P., Barakat, H., et al. (2002) Management of Ovarian Endometriomas. Human Reproduction Update, 8, 591-597. http://dx.doi.org/10.1093/humupd/8.6.591
[11] Brinton, L.A., Sakoda, L.C., Sherman, M.E., et al. (2005) Relationship of Benign Gynecologic Diseases to Subsequent Risk of Ovarian and Uterine Tumors. Cancer Epidemiology, Biomarkers Prevention, 14, 2929-2935. http://dx.doi.org/10.1158/1055-9965.EPI-05-0394
[12] Kobayashi, H. (2005) Chocolate Ovarian Cyst and Malignant Transformation. Acta Obstetricia et Gynecologica Scandinavica Japonzca, 57, N351-N355.
[13] Konishi, I., Ito, K. and Horiuchi, A. (2006) Characteristics and Prognosis of Ovarian Cancer Arising from Endometriosis. Clinical Gynecology and Obstetrics, 60, 134-139.
[14] Yoshikawa, H., Jimbo, H., Okada, S., et al. (2000) Prevalence of Endometriosis in Ovarian Cancer. Gynecologic and Obstetric Investigation, 50, 11-17. http://dx.doi.org/10.1159/000052873
[15] Kobayashi, H. (2005) Adenomyosis/Endometriosis: Chocolate Ovarian Cyst and Malignant Transformation. Acta Obstetricia et Gynecologica Scandinavica Japonzca, 57, 351-355.

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