Primary ovarian insular carcinoid in an infertile woman managed with fertility preservation: a case report.
- 1Department of Obstetrics and Gynecology, School of Medicine, Arash Women's Hospital, Tehran University of Medical Sciences, Eastern 162th St., Baghdarnia st., Resalat Highway, Tehranpars, Tehran, 1653915981, Iran.
- 2Department of Obstetrics and Gynecology, School of Medicine, Arash Women's Hospital, Tehran University of Medical Sciences, Eastern 162th St., Baghdarnia st., Resalat Highway, Tehranpars, Tehran, 1653915981, Iran. [email protected].
- 3Alborz Office of Universal Scientific Education and Research Network (USERN), Alborz University of Medical Sciences, Karaj, Iran.
Abstract
Background
Primary ovarian carcinoid tumors are uncommon neuroendocrine neoplasms, most often arising within mature cystic teratomas. Preoperative diagnosis is difficult because their imaging features may overlap with those of malignant epithelial ovarian tumors. Management is particularly challenging in young patients who desire fertility preservation, as evidence is limited and largely based on case reports.Case presentation
We report a 30-year-old nulligravid woman with a two-year history of primary infertility who presented with intermittent pelvic pain, menorrhagia, and a persistent enlarging right ovarian mass. Her ovarian reserve was favorable, and hysterosalpingography showed left proximal tubal obstruction with right tubal patency. Preoperative color Doppler transvaginal ultrasonography demonstrated a solid hypervascular right ovarian lesion classified as O-RADS 5, raising strong suspicion for malignancy. Primary laparotomy with staging was recommended, but the patient declined because of fertility-related concerns. She initially underwent laparoscopic right ovarian cystectomy/mass excision with preservation of the ovarian cortex. Frozen section suggested a neuroendocrine neoplasm. After final histopathological diagnosis and multidisciplinary review, embryo cryopreservation was performed, followed by definitive staging laparotomy including right oophorectomy, peritoneal washing cytology, omental biopsy, ipsilateral pelvic lymphadenectomy, and appendectomy. Histopathology and immunohistochemistry supported a well-differentiated primary ovarian insular carcinoid arising within a mature cystic teratoma, with findings most consistent with FIGO stage IA disease. Conventional postoperative imaging and gastrointestinal endoscopy did not identify an extragonadal primary tumor or metastasis. At 6 months, the patient remained disease-free.Conclusion
This case further illustrates that radiologically high-risk O-RADS 5 ovarian masses may ultimately represent rare, low-grade malignant neoplasms. Fertility-preserving management may be considered in carefully selected young patients after multidisciplinary evaluation, appropriate staging, and exclusion of metastatic disease. Longer follow-up is required before definitive oncologic conclusions can be made.
Related
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BibTeX
@article{mohammadzadeh2026primary,
title = {{Primary ovarian insular carcinoid in an infertile woman managed with fertility preservation: a case report.}},
author = {Maryam Mohammadzadeh and Hamidreza Mansour and Akram Ghahghaei-Nezamabadi and Ladan Kashani and Afsaneh Tehranian and Mona Alaeii and Mahdis Ebadi and Amirhossein Hajialigol},
journal = {BMC women's health},
year = {2026},
month = aug,
doi = {10.1186/s12905-026-04757-9},
url = {https://europepmc.org/article/MED/42972323},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Primary ovarian insular carcinoid in an infertile woman managed with fertility preservation: a case report.
AU - Maryam Mohammadzadeh
AU - Hamidreza Mansour
AU - Akram Ghahghaei-Nezamabadi
AU - Ladan Kashani
AU - Afsaneh Tehranian
AU - Mona Alaeii
AU - Mahdis Ebadi
AU - Amirhossein Hajialigol
PY - 2026
DA - 2026/08/06
JO - BMC women's health
DO - 10.1186/s12905-026-04757-9
UR - https://europepmc.org/article/MED/42972323
AB - Background Primary ovarian carcinoid tumors are uncommon neuroendocrine neoplasms, most often arising within mature cystic teratomas. Preoperative diagnosis is difficult because their imaging features may overlap with those of malignant epithelial ovarian tumors. Management is particularly challenging in young patients who desire fertility preservation, as evidence is limited and largely based on case reports.Case presentation We report a 30-year-old nulligravid woman with a two-year history of primary infertility who presented with intermittent pelvic pain, menorrhagia, and a persistent enlarging right ovarian mass. Her ovarian reserve was favorable, and hysterosalpingography showed left proximal tubal obstruction with right tubal patency. Preoperative color Doppler transvaginal ultrasonography demonstrated a solid hypervascular right ovarian lesion classified as O-RADS 5, raising strong suspicion for malignancy. Primary laparotomy with staging was recommended, but the patient declined because of fertility-related concerns. She initially underwent laparoscopic right ovarian cystectomy/mass excision with preservation of the ovarian cortex. Frozen section suggested a neuroendocrine neoplasm. After final histopathological diagnosis and multidisciplinary review, embryo cryopreservation was performed, followed by definitive staging laparotomy including right oophorectomy, peritoneal washing cytology, omental biopsy, ipsilateral pelvic lymphadenectomy, and appendectomy. Histopathology and immunohistochemistry supported a well-differentiated primary ovarian insular carcinoid arising within a mature cystic teratoma, with findings most consistent with FIGO stage IA disease. Conventional postoperative imaging and gastrointestinal endoscopy did not identify an extragonadal primary tumor or metastasis. At 6 months, the patient remained disease-free.Conclusion This case further illustrates that radiologically high-risk O-RADS 5 ovarian masses may ultimately represent rare, low-grade malignant neoplasms. Fertility-preserving management may be considered in carefully selected young patients after multidisciplinary evaluation, appropriate staging, and exclusion of metastatic disease. Longer follow-up is required before definitive oncologic conclusions can be made.
SN - 1472-6874
ER -