Immature Teratoma of the Ovary During Pregnancy

Immature teratoma of the ovary is a rare entity in comparison with other ovarian cancers. The reported incidence is under 1%. The occurrence of this tumor with a coexisting pregnancy is exceedingly rare. Only a few scattered case reports are recorded in the world literature. A 30-year-old gravida 2 pregnant woman was referred for evaluation of painless bleeding at 28 weeks' gestation. Ultrasound examination revealed a normal fetus and no placental pathology. In addition, the presence of a large mixed echogenic mass in the left adnexa measuring 14 × 10 cm was noted. Ascites was absent. Doppler examination of the tumor showed a peripheral low resistance and poor vascular flow. Vaginal bleeding stopped on the second day, and the patient remained asymptomatic. Conservative management was decided upon, and an elective cesarian section was done at the 34th week. A 2430-g normal male infant was delivered, and a left salpingo-oophorectomy and surgical staging procedure were performed. Surgical stage was designated as FIGO stage Ia. Gross examination demonstrated a 340-g tumor with an intact capsule. Histologic evaluation indicated a high-grade immature ovarian teratoma with abundant nests of neuroepithelial tissue. The patient started postoperative chemotherapy consisting of six cycles of carboplatin and bleomycin on day 1 and etoposide on days 1 and 2. Surgical conservative treatment in these cases is discussed.