Challenges of Fertility Sparing Ovarian Surgery Imposed by Krukenberg Tumors in Pregnancy

Fertility sparing surgery is advocated for reproductive-age women with benign and borderline ovarian tumors. The hormonal milieu of pregnancy may, however, complicate the decision making process. The patient presented in the third trimester with a rapidly growing tumor that was diagnosed as benign steroid cell tumor by intraoperative frozen section. Fertility-sparing surgery with right oophorectomy and partial left oophorectomy was performed. The final pathology examination demonstrated signet cells staining positive for mucin, which is pathognomonic for Krukenberg tumors. Krukenberg cells were overlooked in the frozen section due to the predominance of hormonally active luteinized ovarian stroma cells. This case highlights the challenges associated with fertility sparing surgery in women presenting with ovarian tumors in pregnancy and the limitations of frozen section in providing an accurate diagnosis.