title: A rare case of ovarian cancer in pregnancy complicated by pulmonary embolus and myocardial infarction: management dilemmas.
abstract: Malignant ovarian neoplasms diagnosed during pregnancy at advanced stages are very rare. The clinical course and prognosis of pregnant patients diagnosed with epithelial ovarian cancer is similar to that of non-pregnant patients. We describe our management of a woman diagnosed with FIGO IIIc ovarian cancer at Caesarean section. Immediately after surgery she suffered a pulmonary embolus and a myocardial infarction. She showed signs of a severe pulmonary hypertension (59 mmHg). Four weeks later the pulmonary hypertension was still moderate but, despite her critical status, she underwent primary debulking surgery (PDS). This was performed under extensive anaesthesiological monitoring. Through this rare case, we show that despite the complex initial status of a critically ill patient, PDS can still remain the mainstay of treatment in patients with advanced ovarian cancer as most patients are able to tolerate even extensive debulking surgery without the need for neoadjuvant chemotherapy.
authors.affiliation: Department of Gynaecological Oncology Charite Comprehensive Cancer Centre, Charite - Universitaetsmedizin Berlin, Berlin, Germany saranasser27@gmail.com.
authors.forename: Sara
authors.initials: S
authors.lastname: Nasser
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: von Heymann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Aarne
authors.initials: A
authors.lastname: Feldheiser
authors.affiliation: Department of Obstetrics, St. Joseph Hospital Berlin Tempelhof, Berlin 12101, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Schäfer-Graf
authors.affiliation: Institute of Pathology, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Klempert
authors.affiliation: Department of Radiology, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pöllinger
authors.affiliation: Department of Cardiology, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Krackhardt
authors.affiliation: Department of Obstetrics, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Henrich
authors.affiliation: Department of Gynaecological Oncology Charite Comprehensive Cancer Centre, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.affiliation: Department of Gynaecological Oncology Charite Comprehensive Cancer Centre, Charite - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Pietzner