When to say “no” to a patient with an ovarian tumour and in poor general condition?

Abstract

Neuroendocrine tumours (NET) originating from the ovary are very rare, constituting about 0.52–1.7% of all NETs. Primary carcinoids constitute about 0.1% of ovarian tumours and 0.3% of all carcinoids. They rarely show hormonal activity. They are most often diagnosed post-operatively, based on pathomorphological examination using immunohistochemical methods. Due to the small number of cases, most information on the management of patients with this diagnosis comes from retrospective studies and case reports.

This paper presents a case report of a 63-year-old woman who was admitted to the department of surgical gynaecology with the diagnosis of a 15-cm right ovary tumour. Her general condition was poor due to severe respiratory failure and severe tricuspid valve insufficiency. The clinical picture and the performed echocardiographic examination aroused the suspicion of carcinoid heart disease (Hedinger syndrome — a cardiological syndrome of carcinoids). Due to the determination and cooperation of a multidisciplinary medical team, despite a very bad prognosis, the patient underwent surgery. Immediately after the operation, the patient’s condition was critical, but it gradually improved. In the postoperative pathomorphological examination, a highly differentiated neuroendocrine tumour (grade 1 – G1) was diagnosed at stage IA according to the FIGO classification. The patient was referred to the endocrinology department, where receptor scintigraphy was performed without revealing other tumour changes. The patient did not require adjuvant therapy. Making a decision about surgical treatment of a patient in poor physical condition with a possibly reversible cause of heart failure was the right thing to do, and it allowed her to return to normal physical activity.