IOTA Model For Surgical Management of Ovarian Tumors: A Case From Mongolia

Abstract

Sergelen Purev, Ureltsetseg Batdelger*, Batbold Tseleejav, Bolortuya Batbayar, Michidmaa Narangerel, Beulah Jambaldorj, Byambajargal Sarantuya, Odonchimeg Dagvajantsan, Gulgaim Kabyenkye, Shiilegpagam Sanligsuren, Tugsbayar Nanzaddorj and Nyamtsetseg Buyankhishig

Preoperative assessment of ovarian pathology is crucial for ensuring that patients with ovarian cancer receive appropriate treatment and achieve optimal clinical outcomes. To facilitate this, the International Ovarian Tumor Analysis (IOTA) collaboration has developed standardized ultrasound based methods for describing adnexal lesions. Complementing imaging, frozen section histological analysis, a rapid diagnostic technique first introduced in 1905, provides results within 15–30 minutes and plays a pivotal role in intraoperative decision making, especially for reproductive age women requiring fertility preserving surgical strategies. This method has demonstrated a diagnostic accuracy of 94%, with 75% sensitivity and 100% specificity for ovarian tumors. Although ovarian cancer is relatively uncommon among women of reproductive age, it frequently presents at an advanced stage, often necessitating radical surgical intervention. Together, these preoperative and intraoperative diagnostic strategies provide a comprehensive approach for tailoring surgical management, optimizing patient outcomes, and supporting fertility preservation when appropriate.

Background: This report details a case of successful twin pregnancy following fertility sparing surgery guided by frozen section histology in a patient with bilateral mucinous borderline ovarian tumours. Fertility preserving approaches have become increasingly viable and ethically significant for younger patients desiring future pregnancy. This report presents the case of a 38 year old woman diagnosed with high grade serous ovarian carcinoma who underwent fertility sparing surgery guided by intraoperative frozen section histology; she successfully conceived and delivered a healthy child postoperatively.

Methods (Case Presentation): A 38 year old woman presented with acute left lower abdominal pain. Her reproductive history was gravida 3, para 2, with one miscarriage and no conception for the past 10 years. Imaging revealed a multiloculated, 13.6 cm left ovarian mass with vascularity and a honeycomb appearance. Her serum CA-125 level was 60 U/mL. The patient underwent laparoscopic surgery, which included a left salpingo oophorectomy, a wedge biopsy of the right ovary, an omental biopsy, and peritoneal cytology. Intraoperative frozen section analysis revealed a mucinous borderline tumour with intraepithelial carcinoma on the left ovary and mucinous borderline changes on the right. The uterus and right adnexa were preserved.

Results: Final histology confirmed a left Stage IB mucinous borderline carcinoma and a right borderline tumour. The patient subsequently completed six cycles of chemotherapy with cyclophosphamide and cisplatin. She remained diseasefree for two years and conceived spontaneously three years postoperatively. On 7 March 2025, she delivered healthy twins via emergency caesarean section at 36–37 weeks of gestation due to pre eclampsia, twin gestation, and a history of uterine scarring.

Conclusion: Intraoperative frozen section histology enables rapid and reliable assessment of ovarian malignancy, allowing surgeons to make informed fertility preserving decisions without compromising oncological safety. This case illustrates the successful application of this approach in a patient with bilateral mucinous borderline ovarian tumours, resulting in spontaneous conception and the delivery of healthy twins. Importantly, it demonstrates that fertility-sparing surgery guided by frozen section histology can be safely and effectively implemented in specialized tertiary-care hospitals in Mongolia, highlighting its potential to improve reproductive and oncological outcomes in young women with early-stage ovarian tumours. This experience provides a valuable reference for clinical practice and may support the development of national protocols for the fertility-preserving management of ovarian tumours.

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