Clear Cell Adenocarcinoma Treatment Regardless of Treatment Protocol

Abstract

Background Epithelial ovarian cancer is the leading cause of death among gynaecological diseases and ranks 5th in cancer mortality among women in Lithuania. The highest incidence and mortality rates are in postmenopausal women. According to the treatment methodology in Lithuania first choice surgery is total hysterectomy with bilateral adnexectomy, peritoneal biopsy and omentectomy. Chemotherapy is administered before surgery to improve tumor resectability or after to reduce the risk of recurrence. Case Report A 32 year-old female came to the emergency room complaining about spasmodic pain in the right iliac region and groin for several days. Serohemorrhagic fluid was found during diagnostic pelvic puncture. Primary differential diagnosis was argued between hemoperitonium caused by ovarian apoplexion and ascites. After 2 days of hospitalization given the patient's satisfactory condition and request patient was discharged for outpatient treatment and prescribed antibiotics. After 3 weeks patient came back for a checkup. During ultrasound it was found that pelvic and abdominal cavities were obturated with a multi-chamber structure of no less than 240x140 mm in size that had a solid area/mass with active circulation and was filled with liquid. In addition, several hypoechoic growths without circulation up to 53x37 mm in size were visible at the walls of the mass. The final conclusion stated a tumor of unknown progression in the left ovary. Laparotomic left salpingo-oophorectomy, peritoneal biopsy and omentectomy were performed. Pathohystological examination results identified an ovarian clear cell adenocarcinoma. Due to young age and plans of conception patient was referred for fertility specialist consult and cryopreservation of gametes or embryos before proceeding with chemotherapy. Conclusions Each clinical situation requires individual approach and consideration of patient‘s age, medical history and requests. In rare cases treatment deviating from first choice protocol should be considered.