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Left ovarian torsion in a patient with hyperstimulated ovaries, postovulation induction, presenting with acute left-sided pain. A, Enlarged left ovary demonstrates minimal vascularity of concern in a patient who has undergone ovulation induction. B, Enlarged hyperstimulated right ovary demonstrates increased vascularity, which is consistent with a hyperstimulated ovarian status.
Source publication
Ultrasound is a valuable diagnostic tool, which can be used to stratify pregnant women with adnexal masses into a conservative management protocol versus those that require further diagnostic and management decisions. Familiarity with the natural history and sonographic features of common adnexal lesions, such as simple cysts, hemorrhagic cysts, en...
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Les tumeurs germinales constituent une variété rare de tumeurs ovariennes, représentant 1% de tous les cancers ovariens. Elles touchent préférentiellement les femmes jeunes, âgées généralement de moins de 30 ans. Elles sont généralement curables si elles sont diagnostiquées et traitées précocement. Les tératomes immatures de l’ovaire sont des tumeu...
Citations
... The variability in the detection rates of adnexal masses in pregnant women can be attributed to the dynamic and progressive nature of these masses throughout pregnancy. When simple cysts ≥3 cm diagnosed in the first trimester were analyzed, the prevalence of adnexal mass significantly decreased from 5% at <10 weeks to 1.5% at 12-14 weeks [14]. Accordingly, 45% of the masses detected at the end of first trimester measured >5 cm and had complex structure [13]. ...
Purpose
This study aims to analyze the experience of a tertiary health center about the management of adnexal masses that have been diagnosed during pregnancy or detected accidentally during cesarean delivery.
Methods
This is a retrospective review of 160 women who underwent concurrent surgery for adnexal mass during cesarean section, 24 women who delivered vaginally and subsequently had surgery due to the prenatal diagnosis of adnexal mass and 10 women who underwent surgery for adnexal mass during pregnancy. Corresponding to the delivery and surgery times, 200 women who had no diagnosis of pregnancy-associated adnexal mass served as controls.
Results
The women in the control group and study groups had statistically similar gestational age at delivery, birth weight and preterm delivery (p > 0.05 for all). Miscarriage was significantly more frequent in women undergoing surgery for adnexal mass during pregnancy (p = 0.001). The women who had surgery for adnexal mass during pregnancy, at the time of cesarean section and following delivery were statistically similar with respect to surgery type and histopathological diagnosis (p > 0.05 for both). Malignancy was detected in none of the patients who underwent surgery for adnexal mass during pregnancy. Acute abdomen was the indication for the emergency surgery in six patients (3.5%) who had surgery for adnexal mass during pregnancy. Four patients (2.4%) had surgery for adnexal mass during pregnancy due to the high index of suspicion for malignancy.
Conclusion
The risk of malignancy was relatively lower in this cohort of adnexal masses detected during pregnancy and cesarean delivery. Surgical management of adnexal masses should be postponed to postpartum period as such management leads to an increased risk of miscarriage. Unless there is a need for emergent surgery or cancer staging, vaginal delivery should be encouraged in women diagnosed with adnexal mass during pregnancy.
... Manifestam-se na forma de cistos de dimensões amplas (entre 5-20 cm) com delgadas estruturas de revestimento. Os cistadenomas do tipo seroso são mais frequentes, geralmente exibem múltiplas cavidades e ocorrem bilateralmente em aproximadamente 20% dos casos (11,12). ...
Os cistos ovarianos serosos, caracterizados pelo revestimento de células epiteliais serosas, podem se manifestar durante a gravidez e representam uma das categorias principais de lesões ovarianos. Apresentamos o caso de uma paciente primigesta de 23 anos, no segundo trimestre da gestação, que apresentou desconforto respiratório e dor abdominal. Exames de imagem revelaram uma formação cística multiloculada de grande dimensão. Em virtude do tamanho do cisto e dos sintomas, optou-se por uma intervenção cirúrgica. A análise anatomopatológica subsequente revelou um cistoadenoma seroso ovariano, os quais são conhecidos por compor cerca de 40-50% das formações anexiais epiteliais benignas. Durante a gravidez, a incidência de cistos ovarianos aumenta, sendo os serosos uma das variedades mais comuns nesse contexto. O diagnóstico diferencial de massas abdominais em gestantes inclui uma variedade de causas. A combinação de achados de imagem, avaliação clínica e análise anatomopatológica são importantes para definição diagnóstica e do manejo. A intervenção cirúrgica pode ser considerada quando os cistos serosos gigantes causam desconforto significativo ou risco de complicações, levando em conta os riscos e benefícios para a mãe e o feto. Em resumo, o cistoadenoma seroso gigante em gestantes é uma ocorrência rara, porém notável. Seu diagnóstico, monitoramento e manejo demandam uma abordagem multidisciplinar.
... On the other hand, hemorrhagic cysts have diverse appearances, which depend on the time of detection and the amount of hemorrhagic 7 content inside the cyst; a reticular pattern is characteristic of hemorrhagic cysts. In addition, retracting blood clots are observed as solid components with concave outer margins and angularities [30]. On MRI, functional cysts show high signal intensity on T1-weighted (T1WI) and low to high signal intensity on T2-weighted images (T2WI). ...
... Hyperreactio luteinalis is a rare hypersensitivity reaction to hCG in patients without a history of ovulation induction. According to the literature, up to 60% of cases occur in singleton pregnancies with normal hCG levels, and the remaining cases show elevated hCG levels associated with fetal hydrops or high-order pregnancies [30]. Hyperandrogenism has been suggested to be associated with hyperreactio luteinalis [35]. ...
... The risk of torsion increases during pregnancy [24], with an overall incidence reported 9 as 1%. According to the literature, 60% of ovarian torsion occurs in the first half of pregnancy, followed by the puerperium, and rarely occurs in the latter half [30]. Occasionally, ovarian torsion may resolve spontaneously, but surgical intervention may be required in unresolved cases, those with secondary complications, or those with clinical symptoms such as abdominal pain. ...
Adnexal masses detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good oncological outcomes. Computed tomography is the most common and useful diagnostic imaging modality for diagnosing adnexal masses; however, it is contraindicated in pregnant women because of the teratogenic effect of radiation on the fetus. Therefore, ultrasonography (US) is commonly used as the main alternative for the differential diagnosis of adnexal masses during pregnancy. Additionally, magnetic resonance imaging (MRI) can assist in the diagnosis when US findings are inconclusive. As each disease has characteristic US and MRI findings, understanding these features is important for the initial diagnosis and subsequent treatment. Thus, we thoroughly reviewed the literature and summarized the key findings of US and MRI to apply these in real-world clinical practice for various adnexal masses detected during pregnancy.
... On review, if the cysts are persistent, further follow-ups are necessary to plan for surgical management. For asymptomatic cysts of size greater than 10 cm, because of the substantial risk of torsion, malignancy, and labor obstruction, surgical removal is reasonable [12,13]. It is necessary for the clinician to make a careful decision about when to operate, as too early or too late interventions can lead to adverse maternal and fetal outcomes. ...
Introduction
Large cystic masses are rare in pregnancy. Corpus luteum cysts and theca lutein cysts are common are most common among all. Ovarian masses are usually discovered as an incidental finding during routine obstetric ultrasonography. Management depends upon the size of the mass, and the symptoms produced by the mass.
Case presentation
Our case describes an incidental finding of a large ovarian cyst during the second trimester, in a 24-year-old female patient. Per abdominal examination revealed a huge mass in the epigastrium, left hypogastrium, and left lumbar region, along with 20 weeks sized uterus. Ultrasonography revealed a cystic mass of 11.9 cm × 11.7 cm X 15.9 cm, with multiple septations and cystic areas. After other baseline investigations, she was planned for surgical removal of the mass. Upon histopathologic examination after surgical excision, the mass was found to be mucinous cystadenoma.
Discussion
Large ovarian masses are uncommon during pregnancy. The most common complications of ovarian masses in pregnancy are torsion, rupture, infection, or malpresentation of the fetus. Surgical management can be done if the mass presents with acute symptoms like torsion, or if the size of the mass is greater than 5 cm. Non-obstetric surgery for cyst removal can be done electively during the second trimester, or irrespective of the period of gestation if there are acute symptoms.
Conclusion
Large ovarian masses are usually rare during pregnancy. It is necessary to properly evaluate the case of ovarian masses during pregnancy, to decide the appropriate line of management.
... The overall incidence of malignancy in an adnexal mass noted in pregnancy is 1-8%. However, masses that persist into the second trimester are at risk for torsion, rupture, or labour obstruction [7][8][9]. Ultrasonography has been extensively used as a front-line investigation for ovarian masses showing benefits like reasonable and simply available but the precision of ultrasonography is extremely based on the spectator's experience and outcomes may vary from surgeon to surgeon [10]. American College of Radiology illustrated that for women with a false pregnancy test in whom a gynecologic aetiology for pelvic pain is suspected, ultrasonography is the recommended primary imaging modality [11]. ...
Introduction: Adnexal masses consist of anomalies which can be noticed in any age of women. These abnormalities determine different features during reproductive age, entail surgical treatment, and are monitored with clinical and laboratory findings. Adnexal masses may result from benign or malignant lesions of ovarian, tubal, and para tubal origin, as well as pregnancy-related causes such as ectopic pregnancy. The study intends to evaluate the adnexal masses by laparoscopy among patients admitted to Bangabandhu Sheikh Mujib Medical University from March 2016 to August 2016. Methods: This cross-sectional study was carried out at Bangabandhu Sheikh Mujib Medical University, Dhaka. The sample was collected by the purposive consecutive sampling method. Subjects were selected by appropriate inclusion criteria. Data were collected after appropriate verbal consent from the guardian of patients and the result was subjected to standard statistical evaluation and was analyzed by the SPSS programme. Result: This study shows the average age was 27.82 years. Regarding parity majority (31, 62.0%) were nulliparous women and the majority (31, 62.0%) were from a lower-middle-class families. The primary complaints in the study group (27, 54.0%) were dysmenorrhoea followed by infertility (21, 42%). Eighteen women (18, 36.0%) complained of dyspareunia. Twenty-six patients (26, 52.0%) had tender mass. Size of the uterus, twenty-two (22, 44%) patients had an enlarged uterus. The commonest finding was tubo-ovarian mass in thirteen (13, 26.0%) patients followed by an endometriotic cyst in twelve patients (12, 24%). The findings of diagnostic laparoscopy, maximum (22, 44.0%) were enlarged uterus followed by fourteen patients (14, 28.0%) who had ovarian cysts. Conclusion: This study observed laparoscopic findings are far way better than ultrasonography. As a result, laparoscopy is a gold standard for the estimation of patients with pelvic adnexal masses.
... These tumors have a high mortality rate owing to late detection, with 67% of the patients already having progressive disease at the time of diagnosis [1]. A recent study reported that ovarian tumors are found in 2% to 10% of pregnant women [2][3][4]. Most ovarian tumors detected during pregnancy are reported to disappear in late pregnancy, and those less than 5 cm are reported to disappear at a rate of 71% to 89% [3,5,6]. ...
... Most ovarian masses are discovered incidentally during routine ultrasound examinations in pregnant women [4,[34][35][36]. Previously, the detection rate of such masses was low because of the lack of techniques for early detection [34]. ...
... Previously, the detection rate of such masses was low because of the lack of techniques for early detection [34]. However, the incidence and detection rate of ovarian masses significantly increased with the application of ultrasonography in antenatal care [4,34,37]. ...
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 (SR), IOTA logistic regression (LS) models, and IOTA assessment of different NEoplasias in the adneXa (ADNEX). Other researchers have also evaluated the malignancy of ovarian masses before surgery using scoring systems such as the Sassone score, pelvic mass score (PMS), DePriest score, Lerner score, and Ovarian-Adnexal Reporting and Data System (O-RADS). 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.
... Більшість придаткових утворень, діагностованих під час вагітності, є випадковими знахідками, виявленими під час рутинних досліджень вагітності [7,10,12,22]. ...
Annotation. According to various estimations, the incidence of adnexal neoplasms during pregnancy makes up from 0.19% to 8.8%. Most of cases are diagnosed in the first trimester and their incidence gradually decreases as the period of pregnancy grows. Depending on their size and location, ovarian tumors may be related to an adverse obstetrical result caused by mechanical influence. They increase the risk of abortion (from 0 to 6%), preterm labor (from 5.8% to 10.4%) and mechanical impediment to labor. Aim – studying the peculiarities of the course of labor and the condition of the newborn of women affected by benign ovarian tumors. We have conducted a complex examination of 67 pregnant women with benign ovarian tumors and tumor-like growths found before pregnancy or in the first trimester of gestation (basic group) and 50 women presenting no ovarian neoplasms or any other severe gynecological or somatic pathology (reference group). To identify the risk factors, the basic group was divided into 2 subgroups. The condition of fetuses was assessed with the use of automated cardiotocography analysis based on the Dawes/Redman criteria, with the calculation of the short-term variability (STV). The mean and standard deviation (M ± m) were evaluated at a significance level of p <0.05. Categorical variables are presented as the absolute number of cases in the group and the frequency in percent – n (%). Tests for differences between independent samples in the case of quantitative variables were performed using Student’s t test, the Mann-Whitney rank test, and in the case of categorical variables using Fisher’s exact test. The obtained results suggest that the course of labor in women affected by benign ovarian neoplasms is characterized by an increased incidence of complications. A significant difference has been established in the incidence of cesarean sections (35.8% vs 8.0% in the reference group, р<0.05), preterm labor (28.4% vs. 6.0%, р<0.05), fetal distress (19.4% vs. 8.0%, р<0.05) and preterm rupture of membranes (17.9% vs. 6.0%, р<0.05). The incidence of almost all complications of labor in Subgroup 1 significantly exceeds the figures from the reference group and the incidence of preterm labor and fetal distress is also higher in comparison with Subgroup 2. The presence of extragenital pathology is a well-known risk factor for perinatal complications, which is also confirmed by our research. A high level of comorbidity of benign ovarian neoplasms with various extragenital diseases also accounts to a certain degree for gestational complications. Thus, pregnancy in women affected by ovarian tumors implies an increased risk of obstetrical and perinatal complications, in particular, threats of miscarriage and preterm labor. The studies of this issue lack systematization, are often controversial and fragmentary. There has been practically no research on the risk factors for such complications and the ways of their prognostication and prevention.
... 4 Most pregnancy-associated cysts, such as corpus luteal and follicular cysts, resolve by gestational age 14-16 weeks and are hormonally responsive, allowing conservative management. 5 By gestational age 16-20 weeks, up to 96% of masses resolve spontaneously. Resolution of cysts are less likely when larger than 5 cm or of complex morphology. ...
The frequency of adnexal mass in pregnancy ranges from 2% to 10%, dermoid cyst is the most common ovarian germ cell tumor during pregnancy which could be asymptomatic or symptomatic, management through laparoscopy must be considered as it provides several advantages, including reduced postoperative pain, analgesic use, hospitalization time and better cosmetic result. Here we are reporting a case of an unbooked 35 years old primigravida at 16 weeks and 4 days gestation with history of retention of urine. Ultrasound showed a live foetus of 16 weeks gestation with bilateral mild maternal hydroureteronephrosis and complex cystic mass of 13×10 cm in right lumbar region suggestive of ovarian mass. Patient was clinically stable, hence exploratory laparoscopy was taken up the next day. Intraoperatively, dermoid cyst was found in the right ovary. Right ovarian cystectomy was performed. She had an uneventful postoperative period and discharged. She was monitored for the rest of the pregnancy and it was uneventful. She had spontaneous full term normal vaginal delivery of female baby weighing 2.8 kg. Although the patient was clinically stable, large ovarian cyst are predisposed for future complications, hence antenatal diagnosis and appropriate intervention is crucial for good outcome.
... A very careful decision must be made with regard to performing an operation in adequate time, obviously not too early (because of the risk of loss of luteal function by the ovary before the fourth month of gestation and miscarriage) and not too late (progression of malignancy, preterm labor, ovarian torsion, rupture or bleeding). An adnexal tumor found incidentally during cesarean section should be removed [47,48]. The general ovarian tumor consensus management is that surgery is needed when the adnexal mass is: ...
Simple Summary
Nowadays, the number of malignancies diagnosed during pregnancy is increasing. Despite the fact that diagnosis is occurring on a global scale, their number is still too limited to prepare proper standards of treatment. These problems appear specifically in the least developed countries. The aim of our review is to bring ovarian cancer (OC) as a complication of pregnancy to the attention of doctors and other medical professionals who have to cope with these rare cases. We noted that a variety of malignancies can be included under the heading “ovarian cancer”, and we describe obstetric and patient outcomes, which depend on the histopathology of the tumor. We focus on the current recommendations for diagnostics and treatment, and present future possibilities for the management of OC.
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.
... En los casos con sintomatología de abdomen agudo, la decisión sobre el tratamiento quirúrgico debe tomarse de forma inmediata. Al elegir el momento óptimo para la cirugía, debe considerarse la función lútea y el riesgo de aborto espontáneo antes de la semana 13 de embarazo, al igual que la mayor posibilidad de complicaciones como torsión o rotura del tumor o progresión de la neoplasia maligna por retraso en el tratamiento (29). ...
The most common gynecological malignancies during pregnancy are cervical cancer, followed by malignant ovarian tumors. During pregnancy, gynecological examination is limited and the rate of misdiagnosis is higher. Although the appearance of ovarian tumors during pregnancy is relatively common, most of them are functional and resolve spontaneously. Treatment during pregnancy is related to factors such as tumor size, histological type, gestational age, lymph node involvement and willingness of women to continue the pregnancy. In early-stage malignant tumors, surgery should be planned preferably after 16 weeks of pregnancy and chemotherapy can be administered from the second trimester as in non-pregnant patients. Prognosis is not affected by pregnancy. The result of pregnant woman with ovarian cancer is similar to non-pregnant patients. Keywords: Ovarian cancer, Pregnancy, Management, Diagnosis, Treatment. 332
