Al-Ojaimi (2005) reported a 32-year-old Bahraini lady with a large fetal intra-abdominal cyst detected antenatally on ultrasound examination at 16 weeks of gestation. There was no significant family or previous medical history. The cyst was simple anechoic, increasing in size and causing progressive displacement of the fetal thoracic organs. A successful intrauterine needle aspiration was carried out under ultrasound guidance at 30 weeks gestation without maternal or fetal morbidity. Cytology of the cyst fluid showed luteinized granulosa cells and biochemistry demonstrated high concentrations of estradiol, progesterone, and testosterone that confirmed the etiology of the cyst as ovarian. Amniocentesis resulted in a normal female karyotype (46, XX). There was no evidence of recurrence following aspiration and no further need for postnatal surgery.

Junaid (1996) reviewed and classified 301 cases of primary ovarian neoplasms encountered in four Kuwaiti hospitals between 1984 and 1989. The most common tumor was benign cystic teratoma. Although germ cell tumors were more prevalent than epithelial tumors, the majority (76%) of malignant tumors were epithelial. Intriguingly, the percentage of epithelial tumors in patients <20-year-old was higher in Kuwait than what is recorded internationally.

[Junaid, HTA. Ovarian tumors in Kuwait. Med Princ Pract. 1996; 5(4):192-7.]

Fatima et al. (2000) reported an uncommon presentation of ovarian tumor with deep venous thrombosis in a 45-year old female. The patient presented with left femoral vein thrombosis, and while on anticoagulant therapy, developed extensive right popliteal vein thrombosis, confirmed by Doppler flow studies. Clinically, she had tense swelling of both legs, and abdominal examination revealed an intraperitoneal mass (7x8 cm) arising from pelvis, which was firm, non tender, with restricted movement. Ultrasound scan showed the mass to be rising from the right ovary, while the left ovary and uterus were normal. Tumor marker CA125 was raised (153.5), and CT abdomen and pelvis confirmed the ultrasound findings. There were no lymph nodes and the liver and spleen were normal. The thrombophilic profile was normal. As she was started on heparin infusion and antibiotics, she developed pulmonary embolism and became tachycardic, with poor air entry on the right side. ABG revealed O2 of 84%, PCO2 of 39% and O2 saturation of 90%. The diagnosis was confirmed by lung perfusion scan which showed segmental perfusion defect in right mid zone and left lower zone. Further emboli were prevented by insertion of an inferior vena cava filter. After stabilizing the patient on heparin infusion, retrograde ureteric catheterization and staging laparotomy with debulking was performed to reveal a large right ovarian tumor (10x12 cm) with an intact capsule and no evidence of peritoneal metastasis. Peritoneal washings for cytology from POD, para colic gutters, and sub diaphragmatic areas were done, and all pelvic and abdominal contents were examined. This was followed by total abdominal hysterectomy with bilateral salpingo-oopherectomy and infracolic omentectomy. The histological diagnosis of the tumor was a clear cell adenocarcinoma stage 1 A (FIGO). Postoperatively, the limb swelling subsided and the patient was discharged after 12 days on warfarin for three months and to be followed up with CA125 tumor marker and CT scans.

[Fatima A, Kuruvilla M, Sharma U. Uncommon presentation of malignant ovarian tumor. Oman Med J. 2000; 17(2):57-8.]

Ejeckam et al. (1994) indicated that gynecological malignancies constitute 6.88% (144 of 2092) of all malignant lesions in Qatar over a 15 year period (1979-1993). Cancer of the cervix was the most common with 54.86% followed by ovarian cancer 22.91%, endometrium 15.97%, vulva and vagina 2.75%, and 2.08% respectively. As in some other developing countries, cervical and ovarian neoplasms tend to occur in the younger age group. Increasing number of pregnancies seems to protect against ovarian cancer.

Jawad et al. (1998) reported a 38-week-gestation female fetus with an abdominal cystic mass. The physical examination revealed a mobile abdominal mass. Post-delivery ultrasound confirmed the diagnosis of a right-sided cystic pelvic mass with echogenic findings. On repeat ultrasound at the ages of 3 and 5 months, the cystic lesion was reported to be on the left side of the pelvis and had increased in size to 4.2-3.7 cm. The parents consented to laparoscopic examination and possible removal of the lesion, which was achieved successfully. The postoperative course was smooth and the baby was discharged home on the second postoperative day. Histologic examination of the cyst showed extensive necrosis and autolysis with widespread calcifications and no evidence of malignancy.