A 32-year-old female visi...

A 32-year-old female visited a tertiary obstetrician during her ninth week of pregnancy. The patient had previously given birth normally nine years ago without any complications. She experienced occasional left-sided, lower abdominal pain as her only symptom. There were no signs of virilization or any relevant gynecological history. The physical examination did not reveal any significant findings. The woman had recently relocated to Australia from Vietnam, six months before becoming pregnant. An initial ultrasound performed in Vietnam revealed an ovarian mass. However, an abdominal/pelvic CT scan, directed by her doctor without knowledge of the early pregnancy, showed a left ovarian cyst measuring 100 × 80 × 80 mm, with solid nodules along the cyst wall. There was no evidence of ascites, and the right ovary appeared normal, with no lymph node enlargement or peritoneal enhancement (Figure 1). The initial consultation also indicated an elevated Ca 125 level of 265 kU/L. A gestational dating ultrasound confirmed the presence of a well-defined left ovarian mass measuring 102 × 94 × 71 mm, characterized by an irregular and solid outer border, along with a large central cystic component measuring 82 × 62 × 52 mm. Only a small amount of pelvic fluid was observed, and no vascularity was detected.