Disease-free survival following total pelvic exenteration in localized platinum-resistant recurrent ovarian clear cell carcinoma: a case report

Background: Ovarian clear cell carcinoma is highly resistant to chemotherapy and carries a particularly poor prognosis when recurrence is platinum-resistant. Although surgery is generally not recommended for recurrent epithelial ovarian cancer, aggressive surgical resection may be beneficial in cases of localized recurrence. This report describes a case of platinum-resistant recurrent ovarian clear cell carcinoma treated with total pelvic exenteration and small bowel resection, in which the patient remained recurrence-free for 14 months postoperatively. Case: A 37-year-old woman was diagnosed with recurrent ovarian clear cell carcinoma after initial surgery and chemotherapy. Imaging revealed a 70 mm pelvic mass with suspected invasion of the rectum, small intestine, and vagina, with no evidence of distant metastasis. The lesion progressed despite two cycles of gemcitabine-based chemotherapy. As the recurrence was considered localized, the patient underwent total pelvic exenteration with small bowel resection, ileal conduit urinary diversion, and sigmoid colostomy. Pathological examination confirmed recurrent clear cell carcinoma infiltrating the bladder, rectum, sigmoid colon, and small intestine. Genetic panel testing revealed high microsatellite instability and an elevated tumor mutational burden. Fourteen months post-surgery, the patient remained disease-free without receiving postoperative chemotherapy. Conclusions: This rare case describes successful long-term disease control in a young patient with platinum-resistant, locally recurrent ovarian clear cell carcinoma, in whom complete surgical resection was achieved through total pelvic exenteration and small bowel resection. This favorable outcome highlights the potential role of radical surgery in carefully selected cases of localized recurrence without evidence of distant metastasis.

Ovarian clear cell carcinoma; Platinum-resistant recurrence; Total pelvic exenteration; Small bowel resection; MSI-high

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