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Bruno M, Capanna G, Stanislao V, Ciuffreda R, Tabacco S, Fantasia I, Di Florio C, Stabile G, D’Alfonso A, Guido M, Ludovisi M. Ultrasound Features and Clinical Outcome of Patients with Ovarian Masses Diagnosed during Pregnancy: Experience of Single Gynecological Ultrasound Center. Diagnostics (Basel) 2023; 13:3247. [PMID: 37892068 PMCID: PMC10606809 DOI: 10.3390/diagnostics13203247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The number of adnexal masses detected during pregnancy has increased due to the use of first-trimester screening and increasingly advanced maternal age. Despite their low risk of malignancy, other risks associated with these masses include torsion, rupture and labor obstruction. Correct diagnosis and management are needed to guarantee both maternal and fetal safety. Adnexal masses may be troublesome to classify during pregnancy due to the increased volume of the uterus and pregnancy-related hormonal changes. Management should be based on ultrasound examination to provide the best treatment. The aim of this study was to describe the ultrasound features of ovarian masses detected during pregnancy and to optimize and personalize their management with the expertise of gynecologists, oncologists and sonographers. (2) Methods: Clinical, ultrasound, histological parameters and type of management (surveillance vs. surgery) were retrospectively retrieved. Patient management, perinatal outcomes and follow-up were also evaluated. (3) Results: according to the literature, these masses are most frequently benign, ultrasound follow-up is the best management, and obstetric outcomes are not considerably influenced by the presence of adnexal masses. (4) Conclusions: the management of patients with ovarian masses detected during pregnancy should be based on ultrasound examination, and a centralization in referral centers for ovarian masses should be considered.
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Affiliation(s)
- Matteo Bruno
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Giulia Capanna
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Veronica Stanislao
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Raffaella Ciuffreda
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Sara Tabacco
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Ilaria Fantasia
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Christian Di Florio
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Guglielmo Stabile
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Angela D’Alfonso
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Maurizio Guido
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Manuela Ludovisi
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
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Paratubal Cystectomy in a Pregnant Woman Using the Single-Incision Laparoscopic Surgery (SILS) Technique. Case Rep Obstet Gynecol 2022; 2022:2802767. [PMID: 35875340 PMCID: PMC9303160 DOI: 10.1155/2022/2802767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The proliferation of prenatal ultrasound has enhanced the detection of adnexal masses during pregnancy. The presentation necessitates a clear approach to investigation and treatment that balances both maternal and fetal risk. Laparoscopy is a safe approach to surgical management in the pregnant patient, and SILS may contribute to minimising perioperative complications. Case Presentation. We present the case of a 21-year-old female in her second trimester of pregnancy presenting with a large 20 cm right adnexal cyst. We proceeded with laparoscopic cystectomy via the SILS technique. There were no intraoperative complications, and she recovered well postoperatively. Conclusion Laparoscopic resection of adnexal lesions is safe during pregnancy and should be favoured over the open approach. SILS minimises incision sites and has potential for reduction in perioperative morbidity.
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Galatis D, Kiriakopoulos N, Komiotis I, Benekos C, Micha G, Kalopita K, Gripiotis I, Kondylios A, Parthenis C, Strongylos A, Papapostolou T, Monastiriotis A. Paracentesis of an Ovarian Cyst During Second-Trimester Pregnancy. Cureus 2021; 13:e19610. [PMID: 34956747 PMCID: PMC8674457 DOI: 10.7759/cureus.19610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
A common issue is that modern obstetricians are required to manage ovarian cysts during pregnancy. Most lesions are benign and will spontaneously resolve, with a few exceptions. Management practices include conservative observation or surgery. Asymptomatic women with an ovarian cyst larger than 5 cm should undergo serial ultrasounds up to 16 weeks of pregnancy and, if the mass does not regress, further management with imaging or surgery is to be considered. This article presents a case of an ovarian cyst sized 21 cm in a second-trimester pregnancy and its management. Paracentesis was performed due to persisting symptoms. The procedure was performed with no complications for the mother and no adverse effects for the fetus. The patient was discharged in good health.
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Affiliation(s)
- Dionysios Galatis
- Fifth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Nikolaos Kiriakopoulos
- Fifth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Ioannis Komiotis
- Fifth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Christos Benekos
- Fifth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Georgia Micha
- Department of Anesthesiology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Konstantina Kalopita
- Department of Anesthesiology, General and Maternity Hospital of Athens, Athens, GRC
| | - Ioannis Gripiotis
- Department of Anesthesiology, General and Maternity Hospital of Athens, Athens, GRC
| | - Antonios Kondylios
- Sixth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Christos Parthenis
- First Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Antonios Strongylos
- Fifth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Thalis Papapostolou
- Fifth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
| | - Argyrios Monastiriotis
- Fifth Department of Obstetrics and Gynecology, Helena Venizelou, General and Maternity Hospital, Athens, GRC
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Ultrasonographic ovarian mass scoring system for predicting malignancy in pregnant women with ovarian mass. Obstet Gynecol Sci 2021; 65:1-13. [PMID: 34902893 PMCID: PMC8784942 DOI: 10.5468/ogs.21212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/21/2021] [Indexed: 11/24/2022] Open
Abstract
During routine antenatal ultrasound examinations, an ovarian mass can be found incidentally. In clinical practice, the differential diagnosis between benign and malignant ovarian masses is essential for planning further management. Ultrasound imaging has become the most popular diagnostic tool during pregnancy, with the recent development of ultrasonography. In non-pregnant women, several methods have been used to predict malignant ovarian masses before surgery. The International Ovarian Tumor Analysis (IOTA) group reported several scoring systems, such as the IOTA simple rules, IOTA logistic regression models, and IOTA assessment of different NEoplasias in the adneXa. Other researchers have also evaluated the malignancy of ovarian masses before surgery using scoring systems such as the Sassone score, pelvic mass score, DePriest score, Lerner score, and Ovarian-Adnexal Reporting and Data System. These researchers suggested specific features of ovarian masses that can be used for differential diagnosis, including size, proportion of solid tissue, papillary projections, inner wall structure, locules, wall thickness, septa, echogenicity, acoustic shadows, and presence of ascites. Although these factors can also be measured in pregnant women using ultrasound, only a few studies have applied ovarian scoring systems in pregnant women. In this article, we reviewed various scoring systems for predicting malignant tumors of the ovary and determined whether they can be applied to pregnant women.
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Hakoun AM, AbouAl-Shaar I, Zaza KJ, Abou-Al-Shaar H, A Salloum MN. Adnexal masses in pregnancy: An updated review. Avicenna J Med 2021; 7:153-157. [PMID: 29119081 PMCID: PMC5655645 DOI: 10.4103/ajm.ajm_22_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these masses become symptomatic due to their size, location, and impingement of adjacent structures. Several diagnostic modalities can be utilized for the detection of adnexal masses with different sensitivity and specificity rates. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Tumor size, site, and the trimester of mass detection are all crucial in management. In this account, we review adnexal masses discovered in pregnancy, the diagnostic modalities utilized for detecting these lesions, their differential diagnosis, and management strategies.
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Affiliation(s)
| | - Iyad AbouAl-Shaar
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled J Zaza
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Abstract
Importance Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians. Objective The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy. Evidence Acquisition This was a literature review using primarily PubMed and Google Scholar. Results Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy. Conclusions and Relevance Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.
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Gerasimova AA, Klimenko PA. Sonographic features of ovarian tumors in pregnant women before surgical intervention and chemotherapy. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The problem of ovarian tumor differential diagnosis is solved using comprehensive ultrasound examination at different levels of efficiency. However, ultrasound imaging is an operator-dependent technique due to subjective interpretation of results. The study was aimed to assess the ultrasound signs of benign and malignant ovarian germ cell tumors (OGCTs) in pregnant women in order to determine the feasibility of surgical treatment and chemotherapy. The study was carried out using the logistic regression models. A group of 199 pregnant women with benign and malignant OGCTs were enrolled. Of them, 183 patients had benign, and nine patients had malignant tumors. In order to assess menstrual function and fertility, seven pregnant women were enrolled, who had previously received treatment for malignant OGCTs. Pre-operative assessment results were compared with morphological assessment data. Organ-preserving surgical treatment was performed (unilateral adnexectomy); if necessary, the patients received cisplatin-based chemotherapy. Perinatal outcomes were assessed. The median observation time between the malignant OGCT detection and the end of the study was 66 months (12–240 months). It was found that comprehensive ultrasound examination and logistic regression models (sensitivity 100%, specificity 92.3%, overall accuracy 92.8%) enabled differential diagnosis of benign and malignant OGCTs. The number of unnecessary surgical procedures in patients with benign OGCTs was been limited, the pregnancy and childbirth outcomes were improved. Nine pregnant women received organ-preserving surgical treatment for malignant OGCTs, and three patients received chemotherapy after surgery, which allowed the patients to realize their reproductive potential.
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Affiliation(s)
- AA Gerasimova
- Center for Family Planning and Reproduction, Moscow, Russia
| | - PA Klimenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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Cagino K, Li X, Thomas C, Delgado D, Christos P, Acholonu U. Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:1171-1182.e2. [PMID: 33515746 DOI: 10.1016/j.jmig.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies. DATA SOURCES We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020. METHODS OF STUDY SELECTION There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709). TABULATION, INTEGRATION, AND RESULTS Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p = .31 and OR 0.95; 95% CI, 0.47-1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p = .06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p = .09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; p = .05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion = 0.02 vs 0.07 and pooled proportion = 0.02 vs 0.14, respectively). CONCLUSION Laparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.
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Affiliation(s)
- Kristen Cagino
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr).
| | - Xuan Li
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr)
| | - Charlene Thomas
- Department of Population Health Sciences (Dr. Christos and Ms. Thomas)
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center (Ms. Delgado), NewYork-Presbyterian Weill Cornell Medical Center, New York, New York
| | - Paul Christos
- Department of Population Health Sciences (Dr. Christos and Ms. Thomas)
| | - Uchenna Acholonu
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr)
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Franciszek Dłuski D, Mierzyński R, Poniedziałek-Czajkowska E, Leszczyńska-Gorzelak B. Ovarian Cancer and Pregnancy-A Current Problem in Perinatal Medicine: A Comprehensive Review. Cancers (Basel) 2020; 12:E3795. [PMID: 33339178 PMCID: PMC7765590 DOI: 10.3390/cancers12123795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15-5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords "ovarian cancer", "ovarian malignancy", "adnexal masses", "ovarian tumor" and "pregnancy" was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother's decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Lubelskie Region, Poland; (R.M.); (E.P.-C.); (B.L.-G.)
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Extraovarian dysgerminoma in a pregnant woman: an extremely rare finding. Curr Probl Cancer 2020; 45:100667. [PMID: 33129566 DOI: 10.1016/j.currproblcancer.2020.100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/11/2020] [Accepted: 10/10/2020] [Indexed: 11/20/2022]
Abstract
Extraovarian germ cell tumors are very rare and their occurrence during pregnancy is exceptional. In this case report an abdominal mass was shown by ultrasonography, during a routine monitoring of a 26-year-old pregnant woman. The patient was left under radiological control in the following months in order to bring the pregnancy to term. A few months after the delivery, the patient underwent surgery and a diagnosis of extraovarian (abdominal) dysgerminoma was made. To the best of our knowledge, there are only 3 other case reports describing an extra-gonadal dysgerminoma occurring during pregnancy. The aim of this study was to report an extremely rare tumor, whose management can be challenging first because this neoplasm has some differences from its ovarian and testicular counterparts. Furthermore, the occurrence during pregnancy makes the multidisciplinary approach mandatory since 3 distinct but not independent entities are involved (tumor, mother and fetus).
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11
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Gerasimova AA, Shamarakova MV, Klimenko PA. Borderline ovarian tumors in pregnancy. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Borderline ovarian tumors (BOTs) are common in women in their reproductive years. In more than one-third of patients tumors are detected at the age of 15–29, the average age at initial diagnosis is 40. The study was aimed to improve methods for BOTs diagnosis in pregnancy and to determine the possibilities of organ preservation treatment. A group of 300 pregnant women with various tumor-like formations and ovarian tumors was examined. Of them, 25 patients had borderline epithelial tumors (22 patients had serous and 3 patients had mucinous tumors). Ultrasound examination together with blood serum CА-125, sFas, VEGF and IL6 level assessment were performed prior to surgery. The results obtained were compared with the results of morphological studies. Organ preservation and radical surgical treatment were carried out, and chemotherapy, if necessary. Perinatal outcomes were studied when performing the cross-comparison. It was discovered, that ultrasonography and logistic regression analysis made it possible to distinguish between benign ovarian tumors, BOTs and malignant ovarian tumors. The levels of VEGF above the 500 pg/ml, IL6 above the 8.1 pg/ml and CА-125 above the 300 U/ml indicated the high probability of malignant ovarian tumors in pregnant women. Only the morphological study of ovarian tissue, obtained regardless of surgical methods, ensured understanding of the ovarian tumor’s true nature during pregnancy. At the same time, in three pregnant women with ovarian tumors, the morphological examination revealed some tissue areas common both for BOTs and malignant ovarian tumors. Thus, the predominance of the tumor early stages, relatively mild course and, favorable prognosis in patients with BOTs make it possible to use gentle surgical treatment making it possible to preserve menstrual function and fertility.
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Affiliation(s)
- AA Gerasimova
- Center for Family Planning and Reproduction, Moscow, Russia
| | - MV Shamarakova
- Center for Family Planning and Reproduction, Moscow, Russia
| | - PA Klimenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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12
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D'Ambrosio V, Brunelli R, Musacchio L, Del Negro V, Vena F, Boccuzzi G, Boccherini C, Di Donato V, Piccioni MG, Benedetti Panici P, Giancotti A. Adnexal masses in pregnancy: an updated review on diagnosis and treatment. TUMORI JOURNAL 2020; 107:12-16. [PMID: 32180534 DOI: 10.1177/0300891620909144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adnexal masses are not common in pregnancy. They are often discovered incidentally during routine ultrasound examinations. In general, 24%-40% of the cases are benign tumors; up to 8% are malignant tumors. Adnexal masses are usually asymptomatic, but sometimes can be responsible for abdominal or pelvic pain. Transvaginal and transabdominal ultrasound is essential to define the morphology of pelvic masses and to distinguish between benign and malignant cases. Magnetic resonance imaging can be a complementary examination when ultrasound findings are equivocal and a useful additional examination to better define tissue planes and relations with other organs. Patient counseling can be challenging because there is no clear consensus on the management of adnexal masses during pregnancy. Treatment options consist of observational management (in case of asymptomatic women with reassuring instrumental findings) or surgery (via laparoscopy or laparotomy). Surgery can be offered as a primary tool when cancer is suspected or when acute complications such as ovarian torsion occur.
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Affiliation(s)
- Valentina D'Ambrosio
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Lucia Musacchio
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Valentina Del Negro
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gaia Boccuzzi
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Boccherini
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Grazia Piccioni
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
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13
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Maggen C, Wolters VERA, Cardonick E, Fumagalli M, Halaska MJ, Lok CAR, de Haan J, Van Tornout K, Van Calsteren K, Amant F. Pregnancy and Cancer: the INCIP Project. Curr Oncol Rep 2020; 22:17. [PMID: 32025953 PMCID: PMC7002463 DOI: 10.1007/s11912-020-0862-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Cancer diagnosis in young pregnant women challenges oncological decision-making. The International Network on Cancer, Infertility and Pregnancy (INCIP) aims to build on clinical recommendations based on worldwide collaborative research. RECENT FINDINGS A pregnancy may complicate diagnostic and therapeutic oncological options, as the unborn child must be protected from potentially hazardous exposures. Pregnant patients should as much as possible be treated as non-pregnant patients, in order to preserve maternal prognosis. Some approaches need adaptations when compared with standard treatment for fetal reasons. Depending on the gestational age, surgery, radiotherapy, and chemotherapy are possible during pregnancy. A multidisciplinary approach is the best guarantee for experience-driven decisions. A setting with a high-risk obstetrical unit is strongly advised to safeguard fetal growth and health. Research wise, the INCIP invests in clinical follow-up of children, as cardiac function, neurodevelopment, cancer occurrence, and fertility theoretically may be affected. Furthermore, parental psychological coping strategies, (epi)genetic alterations, and pathophysiological placental changes secondary to cancer (treatment) are topics of ongoing research. Further international research is needed to provide patients diagnosed with cancer during pregnancy with the best individualized management plan to optimize obstetrical and oncological care.
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Affiliation(s)
- Charlotte Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Vera E R A Wolters
- Department of Gynecology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ, USA
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Michael J Halaska
- Faculty Hospital Kralovske Vinohrady and 3rd Medical, Faculty, Charles University, Prague, Czech Republic
| | - Christianne A R Lok
- Centre for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jorine de Haan
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.
- Centre for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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Mukhopadhyay A, Shinde A, Naik R. Ovarian cysts and cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:58-72. [DOI: 10.1016/j.bpobgyn.2015.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/27/2022]
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15
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Gorkem U, Efeturk T, Sahiner IT, Bas Y, Dolapcı M, Gungor T. A rare case of paratubal cystadenoma during pregnancy. J Surg Case Rep 2016; 2016:rjv169. [PMID: 26795915 PMCID: PMC4720920 DOI: 10.1093/jscr/rjv169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Paratubal cysts (PTCs) are generally incidentally detected in pregnancy. However, paratubal cystadenomas in pregnant women are very rare cases who are reported individually. An unusually giant case of paratubal cystadenoma in a pregnant woman is presented here. A 27-year-old woman presented to our department for a routine pregnancy checkup. A giant cystic mass accompanying a 17-week gestation was detected on examination. During laparotomy, a huge right-sided PTC was resected. Histopathological evaluation revealed a benign cystadenoma originating in the ipsilateral paratubal space. PTCs are often denoted as being benign. Neoplastic transformation or malign potential will change the course of follow-up and the patients' prognosis. Treatment with surgical excision in the second trimester can safely prevent such associated adverse conditions. In conclusion, gynecologists should be careful for causes of adnexal masses in a woman with an intrauterine pregnancy. PTCs also tend to show accelerated growth patterns during pregnancy.
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Affiliation(s)
- Umit Gorkem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Tunay Efeturk
- Department of Obstetrics and Gynecology, Hitit University Education and Research Hospital, Çorum, Turkey
| | - I Tayfun Sahiner
- Department of General Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Yılmaz Bas
- Department of Pathology, Hitit University Education and Research Hospital, Çorum, Turkey
| | - Mete Dolapcı
- Department of General Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Tayfun Gungor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hitit University, Çorum, Turkey
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16
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Aliyu LD. Rare causes of acute abdomen in pregnancy: “ultrasound to the rescue”. A review of two cases. CASE REPORTS IN PERINATAL MEDICINE 2015. [DOI: 10.1515/crpm-2015-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Acute abdomen in pregnancy poses special challenge to the pregnant woman, her unborn infant, and the attending physician. The problems are multifactorial, as the physiological changes in pregnancy mask some of the clinical signs that can be elicited in making accurate diagnosis. Some diagnostic modalities are not feasible in pregnancy because of their effects on the fetus. Another dilemma is that two lives are at stake. It becomes even more challenging when one is faced with rare causes. For these reasons, the choice of diagnostic modality becomes critical. The chosen diagnostic modality should not only be readily available, non-invasive, least hazardous to the mother and fetus, but should also provide adequate information to enable accurate diagnosis. Ultrasonography provides such an opportunity and should be utilized whenever the need arises. We present two cases of acute abdomen in pregnancy managed at Abubakar Tafawa Balewa University Teaching Hospital: one was seen in the third trimester and the other in the first trimester, each with its peculiar presentation. The review is meant to alert obstetricians on the critical role of ultrasound in enhancing accurate diagnosis in the face of a complex clinical condition like acute abdomen in pregnancy.
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Affiliation(s)
- Labaran Dayyabu Aliyu
- Perinatal Medicine Unit, Department of Obstetrics and Gynecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi, Nigeria
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17
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Abstract
The diagnosis of a gynecological malignancy during pregnancy is rare but not uncommon. Cancer treatment during pregnancy is possible, but both maternal and fetal interests need to be respected. Different treatment plans may be justifiable and multidisciplinary treatment is advised. Clinical trials are virtually impossible, and current evidence is mainly based on small case series and expert opinion. Individualization of treatment is necessary and based on tumor type, stage, and gestational age at time of diagnosis. Termination of pregnancy is not necessary in most cases. Surgery and chemotherapy (second trimester and onwards) are possible types of treatment during pregnancy. Radiotherapy of the pelvic area is not compatible with an ongoing pregnancy. This article discusses the current recommendations for the management of gynecological malignancies (cervical, ovarian, and vulvar cancers) during pregnancy.
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Topçu HO, İskender CT, Ceran U, Kaymak O, Timur H, Uygur D, Danışman N. Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion. Diagnostics (Basel) 2015; 5:1-9. [PMID: 26854140 PMCID: PMC4665548 DOI: 10.3390/diagnostics5010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/20/2014] [Indexed: 11/25/2022] Open
Abstract
We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.
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Affiliation(s)
- Hasan Onur Topçu
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Can Tekin İskender
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Ufuk Ceran
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Oktay Kaymak
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Hakan Timur
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Dilek Uygur
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
| | - Nuri Danışman
- Zekai Tahir Burak Women's Health Education and Research Hospital, 1549 Cadde, Hardem Apartmanı, B Blok, Daire 12 Çiğdem-Çankaya, Ankara 06300, Turkey.
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Sonek JD, Cuckle HS. What will be the role of first-trimester ultrasound if cell-free DNA screening for aneuploidy becomes routine? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:621-630. [PMID: 25449114 DOI: 10.1002/uog.14692] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- J D Sonek
- Department of Obstetrics and Gynecology, Wright State University, Dayton, OH, USA
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Lim J, Lim G, Lim JY, Athanasias P, Doulotis I. WITHDRAWN: Rare occurrence of chemical peritonitis: A case report of laparoscopic management of ruptured dermoid cyst in pregnancy and the literature review. Int J Surg Case Rep 2014. [DOI: 10.1016/j.ijscr.2014.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Brown J, Boruta D. Laparoscopic Management of Pelvic Masses in Pregnancy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Groszmann Y, Howitt BE, Bromley B, Feltmate CM, Benacerraf BR. Decidualized endometrioma masquerading as ovarian cancer in pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1909-1915. [PMID: 25336477 DOI: 10.7863/ultra.33.11.1909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To identify the sonographic features of decidualized endometriomas in patients treated at a single institution and to determine whether sonographic findings can distinguish these lesions from malignant ovarian tumors during pregnancy. METHODS We conducted a retrospective cohort study that included pregnant women with a histologic diagnosis of decidualized endometrioma between January 1, 2005, and December 1, 2012, and had an ovarian cyst or mass seen preoperatively on obstetrical sonography. Sonographic characteristics of these masses were retrospectively evaluated using the International Ovarian Tumor Analysis Group definitions for adnexal masses. RESULTS Seventeen patients with 22 adnexal masses were included in our study. Nine of 22 lesions (41%) were classified as unilocular solid, and 14 of 22 (64%) had solid components, of which 12 of 14 (86%) had substantial blood flow. Septations were present in 8 of 22 masses (36%). Cyst sizes varied from 30 to 120 and 32 to 270 mm at the initial and follow-up scans, respectively. Eight patients had no follow-up scans and underwent surgery within 3 weeks of diagnosis. The other 9 patients (14 masses), had follow-up scans and underwent surgery from 3 to 34 weeks after their initial scans. Eight of these masses showed no notable change in size or appearance, and 1 became smaller. CONCLUSIONS There were no characteristic sonographic features identified to distinguish decidualized endometrioma from ovarian malignancy. However, lesions showing no change in size over 4 weeks or lacking solid components and vascularity are more likely to be benign rather than malignant and may justify delaying surgery until delivery or postpartum.
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Affiliation(s)
- Yvette Groszmann
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.).
| | - Brooke E Howitt
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Bryann Bromley
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Colleen M Feltmate
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Beryl R Benacerraf
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
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Basta P, Bak A, Roszkowski K. Cancer treatment in pregnant women. Contemp Oncol (Pozn) 2014; 19:354-60. [PMID: 26793018 PMCID: PMC4709394 DOI: 10.5114/wo.2014.46236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/08/2014] [Indexed: 12/17/2022] Open
Abstract
In general, strategies for the treatment of cancer in pregnancy should not differ significantly from the treatment regimens in non-pregnant women. However, this is difficult due to either the effects of anticancer drugs on the developing foetus or the possibility of long-term complications after the exposure to drugs and radiation. The decision about the introduction and continuation of treatment in the event of pregnancy should be preceded by a detailed analysis of the potential benefits and risks. There are no data to suggest that pregnancy termination alters the biological behaviour of the tumour or patient prognosis in the presence of appropriate antineoplastic therapy. All patients should be given appropriate advice and informed that there are insufficient scientific data to determine any generally accepted consensus. It is very important to always respect the will of the patient, and the moral judgment of the physician should have no impact on the decisions taken by the woman. If the woman decides to undergo active treatment and maintain her pregnancy, it is necessary to carry out consultations with experts in the field appropriate to the type of cancer. This paper presents a basic review of the literature on the targeted therapies currently used in selected cancers diagnosed during pregnancy: breast cancer, cervical cancer, Hodgkin's disease, melanoma, thyroid cancer, ovarian cancer, and colorectal cancer.
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Affiliation(s)
- Pawel Basta
- I Department of Surgery, Jagiellonian University, Medical College, Krakow, Poland
- Department of Gynaecology and Oncology, Lukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Anna Bak
- Department of Radiotherapy, Lukaszczyk Oncology Centre, Bydgoszcz, Poland
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Surampudi K, Nirmalan PK, Gundabattula SR, Chandran JB. Management of adnexal masses in pregnancy: our experience from a tertiary referral perinatal centre in South India. Arch Gynecol Obstet 2014; 291:53-8. [PMID: 25063249 DOI: 10.1007/s00404-014-3395-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 07/22/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Adnexal masses in pregnancy are often incidentally detected during sonography and most resolve spontaneously by early second trimester. This study aimed to look at the prevalence and management of adnexal masses in pregnancy at a tertiary care referral perinatal hospital. METHODS This is a retrospective study of all women with adnexal masses (excluding ectopic gestations and non-gynaecological lesions) identified pre-pregnancy or during pregnancy (antepartum/intrapartum) from January 2006 to August 2013 at the study institute. RESULTS The study identified 252 women (0.6, 95 %, CI: 0.5, 0.7) with adnexal masses and mean (SD range) age of 27.1 (4.21, 18-39) years. Majority (80 %) of the masses were diagnosed incidentally. 170 (67.5 %) women were offered conservative management and cysts resolved in half of them. 87 (34.5 %) women had adnexal surgery and 15.1 % were operated during the antepartum period because of persistent abdominal pain or suspicious sonographic findings. Three (1.2 %) malignancies and five (2.0 %) borderline ovarian tumours were diagnosed on histopathological examination. 16 (6.3 %) women were lost to follow-up antenatally. Pregnancy carried to term in 175 (69.4 %) women. Perinatal mortality rate was 31.1/1,000 total births (caused by prematurity). Complications encountered were torsion (7.1 %), malignancy (1.2 %), rupture (0.4 %) and infection (0.4 %). CONCLUSION Although conservative management was appropriate in the majority of cases, the study identifies the need to standardize diagnosis, investigations and management for a better evaluation of outcomes.
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Affiliation(s)
- Kameswari Surampudi
- Department of Gynaecology, Fernandez Hospital, Fernandez Hospital Unit 1, 4-1-1230, Bogulkunta, Hyderabad, Andhra Pradesh, 500001, India
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25
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26
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Abdullah Agha MM, Opara E. Acute abdominal distension in early pregnancy from torted ovarian serous cystadenoma. J OBSTET GYNAECOL 2013; 34:88. [PMID: 24359062 DOI: 10.3109/01443615.2013.823386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M M Abdullah Agha
- Department of Obstetrics and Gynaecology, Wexham Park Hospital , Slough , UK
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Gynecologic malignancy in pregnancy. Obstet Gynecol Sci 2013; 56:289-300. [PMID: 24328018 PMCID: PMC3784125 DOI: 10.5468/ogs.2013.56.5.289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 12/20/2022] Open
Abstract
Gynecologic malignancy during pregnancy is a stressful problem. For the diagnosis and treatment of malignancy during pregnancy, a multidisciplinary approach is needed. Patients should be advised about the benefits and risk of treatment. When selecting a treatment for malignancy during pregnancy, the physiologic changes that occur with the pregnancy should be considered. Various diagnostic procedures that do not harm the fetus can be used. Laparoscopic surgery or laparotomy may be safely performed. The staging approach and treatment should be standard. Systemic chemotherapy during the first trimester should be delayed if possible. Radiation therapy should preferably start postpartum. Although delivery should be delayed preferably until after 35 weeks of gestation, termination of pregnancy may be considered when immediate treatment is required. Subsequent pregnancies do not increase the risk of malignancy recurrence.
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Telli E, Yalcin OT, Ozalp SS, Hassa H. Surgical intervention for adnexal masses during pregnancy. BMJ Case Rep 2013; 2013:bcr-2013-010324. [PMID: 23814228 DOI: 10.1136/bcr-2013-010324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus.
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Affiliation(s)
- E Telli
- Department of Obstetrics and Gynecology, Osmangazi University, School of Medicine, Eskisehir, Turkey.
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Squamous cell carcinoma arising in an ovarian mature cystic teratoma complicating pregnancy. Obstet Gynecol Sci 2013; 56:121-5. [PMID: 24327990 PMCID: PMC3784097 DOI: 10.5468/ogs.2013.56.2.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 06/21/2012] [Accepted: 07/16/2012] [Indexed: 11/08/2022] Open
Abstract
Mature cystic teratomas of the ovary (MCT) are usually observed in women of reproductive age with the most dreadful complication being malignant transformation which occurs in approximately 1% to 3% of MCTs. In this case report, we present a patient with squamous cell carcinoma which developed from a MCT during pregnancy. The patient was treated conservatively without adjuvant chemotherapy and was followed without evidence of disease for more than 60 months using conventional tools as well as positron emission tomography-computed tomography following the initial surgery. We report this case along with the review of literature.
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Gaspar-Oishi MA, Kawelo RM, Bartholomew ML, Aeby T. Transvaginal ovarian cystectomy for adnexal torsion during pregnancy. J Minim Invasive Gynecol 2012; 19:255-8. [PMID: 22381973 DOI: 10.1016/j.jmig.2011.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 11/18/2011] [Accepted: 11/24/2011] [Indexed: 11/19/2022]
Abstract
Ovarian torsion requiring surgical intervention in pregnancy is rare. Herein is reported a case of ovarian torsion that was managed by transvaginal ovarian cystectomy in a 27 week gravid patient.
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Affiliation(s)
- Maria A Gaspar-Oishi
- Department of Obstetrics, Gynecology and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, HI 96826, USA.
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Abstract
Adnexal masses are often seen in the gravid patient. With current advances in technology, an increased number of adnexal masses are incidentally discovered on antenatal screening ultrasonography examinations. Sonography is the first-line imaging modality for any adnexal mass. However, further evaluation with magnetic resonance imaging (MRI) may be critical for diagnosis. For example, MRI can determine whether a mass contains fat, which can be useful in the diagnosis of a teratoma. Characteristic features of nonneoplastic and neoplastic ovarian lesions seen on sonography and MRI will be discussed. Radiologic features that help distinguish benign from malignant neoplasms will be described. Additional lesions specific to the gravid state must be considered in the differential diagnosis when appropriate, such as hyperstimulated ovaries, hyperreactio luteinalis, theca lutein cyst, and luteomas.
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Affiliation(s)
- Margaret Yacobozzi
- Department of Radiology, Tufts School of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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Sousa-Santos R, Coelho D, Oliveira P. 1st trimester incidental abdominopelvic mass: Ganglioneuroma in pregnancy. J OBSTET GYNAECOL 2012; 32:307-9. [DOI: 10.3109/01443615.2011.647733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gezginç K, Karataylı R, Yazıcı F, Acar A, Çelik Ç, Çapar M. Ovarian cancer during pregnancy. Int J Gynaecol Obstet 2011; 115:140-3. [DOI: 10.1016/j.ijgo.2011.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/23/2011] [Accepted: 07/26/2011] [Indexed: 11/29/2022]
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Balthazar U, Steiner AZ, Boggess JF, Gehrig PA. Management of a persistent adnexal mass in pregnancy: what is the ideal surgical approach? J Minim Invasive Gynecol 2011; 18:720-5. [PMID: 21840773 DOI: 10.1016/j.jmig.2011.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 06/29/2011] [Accepted: 07/08/2011] [Indexed: 10/16/2022]
Abstract
STUDY OBJECTIVE To compare short-term and pregnancy-related outcomes of laparoscopy with laparotomy for management of a persistent second-trimester adnexal mass. DESIGN Retrospective cohort study of pregnant women at 14 weeks or more of gestation undergoing laparoscopy or laparotomy for management of an adnexal mass (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Women of reproductive age with a persistent adnexal mass at 14 weeks or more of gestation. INTERVENTION Removal of adnexal mass via laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS Between 1990 and 2008, 101 pregnant women underwent treatment of a persistent adnexal mass at 14 weeks or more of gestation at our institution. Fifty women underwent laparoscopy, and 51 underwent laparotomy. Similar demographic and adnexal mass characteristics were identified between the 2 surgical groups. Eight patients in the laparotomy group experienced postoperative complications, compared with none in the laparoscopy group (p < .02). Mean surgical estimated blood loss and length of hospital stay were significantly less in the laparoscopy group compared with the laparotomy group: 17.5 mL vs 100 mL (p < .001) and 0.7 days vs 2.78 days (p < .001), respectively. There were no observed differences in pregnancy-related outcomes between the 2 groups. CONCLUSION Minimally invasive surgery is a reasonable approach to management of a second-trimester adnexal mass in gravid women. Laparoscopy enables a shorter hospital stay, decreased blood loss, and fewer postoperative complications without seeming to have a negative effect on pregnancy-related outcomes. While these findings are reassuring, larger studies are encouraged to continue to evaluate this issue.
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Affiliation(s)
- Ursula Balthazar
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7570, USA.
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Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011; 205:97-102. [PMID: 21571247 DOI: 10.1016/j.ajog.2011.01.050] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/18/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
With widespread use of ultrasound in early pregnancy, incidental adnexal masses are detected frequently. This article reviews the differential diagnosis, appropriate evaluation, and current treatment options for adnexal masses in pregnancy. With the increased sophistication of ultrasound, observation has become a more viable option. However, for those masses suspicious for malignancy, at risk for torsion, or clinically symptomatic, surgical management is warranted. With increasing numbers of successful laparoscopic procedures reported in pregnancy, laparoscopy appears to be a safe option with trained and experienced providers.
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Acute abdomen caused by adnexal torsion in the first trimester of pregnancy: a case report. SRP ARK CELOK LEK 2011; 139:239-41. [PMID: 21618867 DOI: 10.2298/sarh1104239t] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. The clinical and laboratory findings are non-specific. In this paper we present a case of adnexal torsion in the first trimester of pregnancy. CASE OUTLINE On admission, the patient presented signs of acute abdomen.The pain started few hours prior to admission, and was predominantly localized, occasionally irradiating to the central parts of the lower abdomen, accompanied by nausea and vomiting. Ultrasound revealed viable intrauterine pregnancy and right adnexal mass with small amount of free fluid in the Douglas pouch. After short preoperative evaluation, laparotomy and adnexectomy were performed. Surgery and postoperative followup were uneventful, and histopathology reported torquated corpus luteum cysts. CONCLUSION The diagnosis of adnexal torsion during pregnancy is difficult, and occasionally remains a diagnostic dilemma. Surgery is inevitable, must be prompt, and comprises adnexectomy.
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Abstract
Background. Ovarian cancer is very rare in pregnancy. It is mainly of epithelial origin, low grade and low malignant potential. Case report. We presented a patient in which ultrasound confirmed the presence of clearly limited tumor in the left ovary when she was eight weeks pregnant. The results of 4D Color Doppler showed a central type of tumor vascularisation with resistance index (IR) less than 0.5. The Consultancy Board in Gynecology of the Institute for Oncology and Radiology of Serbia decided to remove the patient's left adnexa and intensively monitor the pregnancy period. The operation (Adnexectomia lateralis sinistra) was performed at 18th week of gestation. Histopathological analysis showed adenocarcinoma invasivum, endometroid well-differentiated type (histological grade I, nuclear grade 2). In 37th week of gestation, the patient gave birth to a male child by cesarean section. In the next 3 years the patient had no subjective interference, laboratory tests and ultrasonographic findings were normal. Conclusion. Ovarian cancer in pregnancy is usually asymptomatic and diagnosed during routine clinical and ultrasound examination. The color Doppler technique have particular importance in the diagnosis of pathological blood supply in tumors and in indication of malignant ovarian mass.
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Marret H, Lhommé C, Lecuru F, Canis M, Lévèque J, Golfier F, Morice P. Guidelines for the management of ovarian cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 149:18-21. [DOI: 10.1016/j.ejogrb.2009.12.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 11/26/2009] [Accepted: 12/01/2009] [Indexed: 11/29/2022]
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Amant F, Brepoels L, Halaska MJ, Gziri MM, Van Calsteren K. Gynaecologic cancer complicating pregnancy: An overview. Best Pract Res Clin Obstet Gynaecol 2010; 24:61-79. [DOI: 10.1016/j.bpobgyn.2009.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 08/05/2009] [Indexed: 11/26/2022]
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Marret H, Lhommé C, Lécuru F, Canis M, Léveque J, Golfier F, Morice P. [French recommendations for ovarian cancer management during pregnancy]. ACTA ACUST UNITED AC 2009; 37:752-63. [PMID: 19709917 DOI: 10.1016/j.gyobfe.2009.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evaluation of the fetus using prenatal ultrasound has resulted in increased detection of asymptomatic adnexal masses during pregnancy. Such masses are rarely malignant (1/10 000 to 1/50 000 pregnancies), but the possibility of borderline or cancer must be considered. It is a common assumption by both patients and physicians that if an ovarian cancer is diagnosed during pregnancy, treatment necessitates sacrificing the well-being of the fetus. However, in most cases, it is possible to offer appropriate treatment to the mother without placing the fetus at serious risk. The care of a pregnant woman with cancer involves evaluation of sometimes competing maternal and fetal risks and benefits. These recommendation approaches attempt to balance these risks and benefits; however, they should be considered advisory and should not replace specific interdisciplinary consultation with specialists in maternal-fetal medicine, gynecologic oncology, and pediatrics, as well as imaging and pathology, as needed. Second level ultrasound including Doppler is needed. MRI is not often necessary, and CA 125 is of low contribution. We suggest surgery be performed after 15 SA for ovarian masses which (1) persist into the second trimester, (2) are greater than 5 to 10 cm in diameter, or (3) have solid or mixed solid and cystic ultrasound characteristics. During antepartum surgical staging and debulking, homolateral salpingo-oophorectomy and peritoneal cytology and exploration are necessary. Women found to have advanced stage epithelial ovarian cancer should consider having completion of the debulking of the reproductive organs at the conclusion of the pregnancy. If chemotherapy is indicated, we recommend delaying administration, if possible, after the delivery or at least after 20 SA in order to minimize the potential fetal toxicity.
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Affiliation(s)
- H Marret
- Service de gynécologie, hôpital Bretonneau, centre hospitalo-universitaire de Tours, 37044 Tours cedex 1, France.
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Türkçüoğlu I, Meydanli MM, Engi˙n-Üstün Y, Üstün Y, Kafkasli A. Evaluation of histopathological features and pregnancy outcomes of pregnancy associated adnexal masses. J OBSTET GYNAECOL 2009; 29:107-9. [DOI: 10.1080/01443610802678804] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, Arici A. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril 2009; 91:1895-902. [DOI: 10.1016/j.fertnstert.2008.02.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 02/04/2008] [Accepted: 02/04/2008] [Indexed: 11/25/2022]
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Amant F, Van Calsteren K, Halaska MJ, Beijnen J, Lagae L, Hanssens M, Heyns L, Lannoo L, Ottevanger NP, Vanden Bogaert W, Ungar L, Vergote I, du Bois A. Gynecologic Cancers in Pregnancy. Int J Gynecol Cancer 2009; 19 Suppl 1:S1-12. [DOI: 10.1111/igc.0b013e3181a1d0ec] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hasiakos D, Papakonstantinou K, Kontoravdis A, Gogas L, Aravantinos L, Vitoratos N. Adnexal torsion during pregnancy: report of four cases and review of the literature. J Obstet Gynaecol Res 2009; 34:683-7. [PMID: 18840181 DOI: 10.1111/j.1447-0756.2008.00907.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. It is frequently associated with ovarian stimulation for in vitro fertilization (IVF) or with ovarian masses, mainly of functional origin. The clinical, laboratory and imaging findings are non-specific. The authors present four cases with adnexal torsion diagnosed during the first trimester of pregnancy. The clinical picture, the mode of diagnosis, and the therapeutic approach are discussed. In two cases, the adnexa was removed, because there was extensive hemorrhage and ischemia. In the other two cases, unwinding of the adnexa was carried out and the ovary was preserved. The diagnosis of adnexal torsion is difficult, especially during pregnancy, and occasionally remains a diagnostic dilemma. It necessitates a prompt surgical intervention, because any delay leads to irreversible ovarian necrosis, so that adnexectomy is ultimately required.
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Affiliation(s)
- Dimitris Hasiakos
- 2nd Department of Obstetrics and Gynecology, University of Athens, School of Medicine, Aretaieion Hospital, Athens, Greece
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Abstract
Pelvic masses develop commonly in women of all ages and states of health. Despite the variety of masses that exist, general guidelines for diagnosis and management allow most masses to be treated in a generalist setting. This article is intended to guide non-obstetric and non-gynecologic physicians through diagnosis and treatment of nonmalignant pelvic masses. It includes information on physical examination, appropriate imaging techniques, laboratory tests, and variations in treatment for adolescents and pre- and postmenopausal women. It also addresses referral guidelines for suspected malignant masses.
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Affiliation(s)
- Spencer P Barney
- Department of Obstetrics and Gynecology, University of New Mexico Health Science Center, 2211 Lomas Blvd. NE, Albuquerque, NM 87131, USA.
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Amant F, Van Calsteren K, Vergote I, Ottevanger N. Gynecologic oncology in pregnancy. Crit Rev Oncol Hematol 2008; 67:187-95. [PMID: 18296060 DOI: 10.1016/j.critrevonc.2008.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 01/16/2008] [Indexed: 11/19/2022] Open
Affiliation(s)
- Frédéric Amant
- Gynecologic Oncology, Leuven Cancer Institute (LKI), Department of Obstetrics and Gynecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
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Schaberg FJ, Prinz RA, Chen EL, Caceres A, Chi DS, Ryder BA, Ng T, Santi Aragona M, Wotkowicz C, Libertino JA. Incidental findings at surgery-part 2. Curr Probl Surg 2008; 45:388-439. [PMID: 18452760 DOI: 10.1067/j.cpsurg.2008.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Frank J Schaberg
- Associate Professor of Surgery (Clinical), Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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Sayin NC, Inal HA, Varol FG. Pregnancies complicated by adnexal masses: a case series. Arch Gynecol Obstet 2008; 278:573-7. [PMID: 18379809 DOI: 10.1007/s00404-008-0622-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 02/28/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adnexal masses>or=5 cm in diameter are rare during pregnancy. MATERIALS AND METHODS We present our experience on six pregnant women with adnexal masses diagnosed and operated during pregnancy and/or at the time of cesarean section. RESULTS Carefully selected cases with a unilateral mass and a solid component with normal tumor marker result can be followed until term and adnexectomy can be performed during cesarean section. On the contrary, gross adnexal masses, even with normal tumor marker levels should be operated when diagnosed, but these women might deliver small for gestational age infants. CONCLUSION By depending upon restricted criteria according to tumor markers, ultrasound or other radiological imaging techniques, some patients with an adnexal mass carrying an important risk factor for malignancy may be overlooked.
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Affiliation(s)
- N Cenk Sayin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Kadin Hastaliklari ve Doğum A.D, 22030, Edirne, Turkey.
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