[An enlarged ovary during pregnancy; perform surgery or not?]

In a 35-year-old gravida II para I at 8 weeks gestation a structure of approximately 5 cm across with varying echogenicity was identified by accident at the side of her right ovary. The findings were believed to be related to previously diagnosed endometriosis and therefore no surgical intervention was performed during pregnancy. Serum CA 125 level was increased. After delivery an endometrioid adenocarcinoma of the right ovary, FIGO stage 1C and histologically grade 3, was diagnosed, followed by a staging laparotomy and chemotherapy. Initially this resulted in a complete remission. After 7 months a relapse occurred, for which once more chemotherapy and later experimental treatment was started. In case of a tumour persisting after the 16th week of gestation, larger than 8-10 cm and/or with echodense/multilocular characteristics and/or with a persistently elevated serum CA 125 level, surgery during gestation ought to be considered.