Iota Model for Surgical Management of Ovarian Tumors: A Case from Mongolia

Abstract

ABSTRACT: Preoperative assessment of ovarian pathology is essential to ensure that patients with ovarian cancer receive appropriate treatment and achieve optimal clinical outcomes. The International Ovarian Tumor Analysis (IOTA) collaboration has developed standardized ultrasound-based methods for characterizing adnexal lesions. Complementing imaging, intraoperative frozen section histological analysis a rapid diagnostic technique introduced in 1905 provides results within 15–30 minutes and plays a pivotal role in surgical decision-making, particularly for reproductive-age women requiring fertility-preserving interventions. This approach demonstrates diagnostic accuracy of 94%, with 75% sensitivity and 100% specificity for ovarian tumors. Although ovarian cancer is relatively rare among women of reproductive age, it frequently presents at advanced stages, often necessitating radical surgery. Integrating preoperative and intraoperative diagnostic strategies offers a comprehensive framework for individualized surgical management, optimizing outcomes while preserving fertility where feasible. 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 tumors. Fertility preserving approaches are increasingly viable and ethically significant for younger patients desiring future pregnancy. Here, we present a 38-year-old woman diagnosed with high grade serous ovarian carcinoma who underwent fertility sparing surgery guided by intraoperative frozen section histology and subsequently conceived and delivered healthy twins. Methods: A 38-year-old woman presented with acute left lower abdominal pain. Her obstetric history was gravida 3, para 2, including one miscarriage, with no conception over the past 10 years. Imaging revealed a multiloculated 13.6 cm left ovarian mass with vascularity and a honeycomb appearance. Serum CA-125 level was 60 U/mL. Laparoscopic surgery included left salpingo oophorectomy, right ovarian wedge biopsy, omental biopsy, and peritoneal cytology. Intraoperative frozen section analysis revealed a left mucinous borderline tumor with intraepithelial carcinoma and mucinous borderline changes on the right. The uterus and right adnexa were preserved. Results: Final histology confirmed Stage IB mucinous borderline carcinoma of the left ovary and a right borderline tumor. The patient completed six cycles of chemotherapy with cyclophosphamide and cisplatin. She remained disease-free for two years and spontaneously conceived three yearspostoperatively. On 7 March 2025, she delivered healthy twins via emergency caesarean section at 36–37 weeks due to pre-eclampsia, twin gestation, and a history of uterine scarring. Conclusion: Intra operative frozen section histology enables rapid and reliable assessment of ovarian malignancy, allowing informed fertility preserving surgical decisions without compromising oncological safety. This case illustrates successful application in bilateral mucinous borderline ovarian tumors, resulting in spontaneous conception and healthy twin delivery. Fertility sparing surgery guided by frozen section histology can be safely implemented in tertiary care hospitals in Mongolia, highlighting its potential to improve reproductive and oncological outcomes in young women with early stage ovarian tumors and supporting the development of national clinical protocols.