“ Ovarian cancer during pregnancy is uncommon, and high-grade serous carcinoma diagnosed during early gestation is particularly rare .”
BUFFALO, NY — October 8, 2026 — A new case report was published in Volume 13 of Oncoscience on September 24, 2026, titled “ High-grade serous carcinoma of the ovary presenting as a complex cystic mass at 10 weeks of gestation: A case report .”
The report describes a rare case of high-grade serous ovarian carcinoma diagnosed in a 35-year-old woman at just 10 weeks of pregnancy. The case highlights the challenges of identifying ovarian malignancy during early gestation, when symptoms can resemble normal pregnancy-related changes, and underscores the importance of early evaluation, appropriate imaging, and multidisciplinary decision-making.
The case report was led by first author Chanderdeep Sharma from the All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India . Corresponding author Shri Ram Rundla is also affiliated with the same institution.
Ovarian cancer during pregnancy is uncommon, with an estimated incidence ranging from one in 12,000 to one in 47,000 pregnancies. High-grade serous carcinoma (HGSC), an aggressive form of epithelial ovarian cancer, is particularly rare during early pregnancy. Diagnosis can be difficult because symptoms such as abdominal bloating, discomfort and nausea may overlap with normal pregnancy-related changes. These challenges can delay recognition of a potentially serious malignancy.
In the reported case, the patient presented with lower abdominal pain and progressive abdominal distension lasting approximately two weeks. She had previously delivered two children and had no reported personal or family history of malignancy. Clinical examination identified a palpable pelvic mass, prompting further investigation.
Ultrasonography confirmed a viable pregnancy and revealed a large, 10 × 13 cm complex solid-cystic mass in the left adnexa, the region surrounding the ovary. The mass contained internal septations and solid components and was accompanied by ascites, an abnormal accumulation of abdominal fluid, and omental nodularity. These findings raised concern for ovarian malignancy.
Laboratory testing also showed an elevated cancer antigen 125 (CA-125) level of 332 U/mL. Although CA-125 may rise naturally during early pregnancy and cannot independently establish an ovarian cancer diagnosis, its elevation alongside suspicious imaging findings supported the need for further evaluation.
Given the concern for advanced malignancy, the clinical team performed contrast-enhanced computed tomography after counselling the patient about potential maternal benefits and fetal risks and obtaining informed consent. The scan confirmed the complex adnexal mass, ascites and peritoneal nodularity, suggesting possible spread beyond the ovary.
The case was reviewed by a multidisciplinary team involving gynecologic oncology, radiology and anesthesia specialists. The clinicians considered the suspected advanced disease, the potential threat to maternal health and the implications of treatment for the ongoing pregnancy. After detailed counselling and discussion of available options, the patient, who had completed her reproductive plans, chose definitive surgical management.
During staging laparotomy, surgeons identified a large solid-cystic tumor arising from the left ovary, along with ascites and multiple nodules involving the omentum and peritoneum. Intraoperative frozen-section analysis suggested epithelial ovarian carcinoma. The surgical team subsequently performed a total abdominal hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy, removing the uterus, both ovaries and fallopian tubes, and part of the omentum.
Final histopathological examination confirmed high-grade serous carcinoma, classified as FIGO stage IIIB. The tumor showed characteristic malignant features, including marked nuclear abnormalities and frequent atypical cell divisions. Immunohistochemical testing demonstrated strong nuclear positivity for WT1, a marker that supported the diagnosis of serous ovarian carcinoma.
Following an uneventful postoperative recovery, the patient received adjuvant chemotherapy with paclitaxel and carboplatin. At the reported one-year follow-up, she remained disease-free and continued regular surveillance.
The case also raises important considerations about treatment timing during pregnancy. Surgical intervention for suspected ovarian malignancy during pregnancy is generally postponed until the second trimester when feasible. However, when imaging suggests advanced malignancy and maternal health may be at risk, intervention during the first trimester may be necessary. The authors emphasize that such decisions require individualized assessment, informed consent and coordination among relevant specialists.
The report also discusses the potential role of hereditary cancer susceptibility. High-grade serous ovarian carcinoma is frequently associated with alterations involving TP53, while inherited BRCA1 and BRCA2 mutations can influence cancer risk and treatment options. Genetic counselling and BRCA testing were recommended for the patient because of her relatively young age at diagnosis. However, testing could not be performed because of logistical constraints, leaving her genetic status unknown.
“ Early imaging, appropriate surgical planning, and multidisciplinary decision-making are essential for optimal maternal outcomes .”
As a single-patient case report, the findings cannot establish how frequently high-grade serous ovarian carcinoma occurs during pregnancy or determine which treatment approach produces the best outcomes across different clinical circumstances. Nevertheless, the case provides an example of the diagnostic and treatment decisions involved when a potentially advanced ovarian malignancy is discovered during early gestation.
Overall, the report underscores the importance of thoroughly evaluating suspicious adnexal masses during pregnancy, particularly when complex imaging features, ascites and elevated tumor markers raise concern for malignancy. Early recognition, coordinated specialist care and individualized treatment planning may be essential to protecting maternal health in these uncommon and challenging clinical situations.
DOI: https://doi.org/10.18632/oncoscience.675
Correspondence to: Shri Ram Rundla – shriram.rundla@gmail.com , (ORCID 0009-0003-9896-9206 )
Abstract video: https://www.youtube.com/watch?v=gVfKMuhZqoM
Keywords: high-grade serous carcinoma, ovarian cancer, pregnancy, complex adnexal mass, WT1
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High-grade serous carcinoma of the ovary presenting as a complex cystic mass at 10 weeks of gestation: A case report
24-Sep-2026
Authors have no conflicts of interest to declare.