What happened, in summary

A 39-year-old woman was found to have a large left ovarian mass during a routine pregnancy ultrasound in May 2023. She had surgery during pregnancy, but the tumor was initially interpreted as a granulosa cell tumor. Additional surgery was performed later in pregnancy and at delivery, when tumor deposits were also found outside the ovary.

After delivery, specialist review still found the diagnosis difficult. She received 3 cycles of chemotherapy and had a partial response, followed by cytoreductive surgery to remove visible disease. She then completed 3 more cycles of chemotherapy. By July 2024, scans and tumor markers showed a complete response.

About 6 months later, a growing mass appeared in her abdominal scar. Imaging showed widespread recurrence involving the liver, spleen, bones, lymph nodes, and abdominal wall. Molecular testing found SMARCA4 and TP53 alterations and established the diagnosis of small cell carcinoma of the ovary, hypercalcaemic type, a rare aggressive ovarian cancer.

Her condition deteriorated quickly and she was not well enough for further intensive chemotherapy. She received palliative care and died from progressive disease in January 2025, about 20 months after the cancer was first discovered.