2010, Number 03
PDF size: 349.29 Kb.
ABSTRACTBackground: The finding of adnexal masses during pregnancy is an exceptional event. Its reported incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses.
Objective: Describe a case series of patients with adnexal mass and pregnancy.
Material and methods: We retrospectively reviewed the medical records of patients who had diagnosis of pregnancy and adnexal over a period of five years.
Results: The incidence was 0.22%. The mean age was 26 ± 7.3 years, mean gestational age was 17 ± 6.6 weeks. The diagnosis was established by ultrasound (USG) in 95% of cases, 48% had cystic characteristics, the mean diameter of the tumor was 99 ± 42 mm. Cistectomy was performed during pregnancy or trans-cesarean section in 30% and 58% of patients respectably. The mean tumor size was 118 mm (range 2 a 40 mm), weight 1,370 g (range 10 a 5,800 g). The most frequent histological diagnosis were serous cyst (40%), mature teratoma (28%), mucinous (6%), malignancy (4%). There were not complications related to the surgical procedure.
Conclusions: The USG constitute a safe method for the diagnosis, but the image method with the highest positive predictive value is the MRI. Tumor markers (CA-125, AFP, GCH-B,DHL, ACE), are not useful during pregnancy. If the tumor doesn’t achieve surgical criteria the recommended follow up is clinical observation and USG. If surgery is decided, it should be performed between 16 a 23 weeks of pregnancy, and it’s recommended to send the tumor to histological diagnosis, in case of malignancy the surgery will continue according to the tumor stage. The time and delivery route will be decided by the obstetrician.
Giuntoli R, Vang R, Bristow R. Evaluation and management of adnexal masses during pregnancy. ClinObstet Gynecol 2006;49:492-505.
Sherard G, Hodson C, Williams J, et al. Adnexal masses and pregnancy: a 12 year experience. Am J Obstet Gynecol 2003;189:358-363.
Villagran G, Perucca E, Corvalan M, et al. Experiencia de masas anexiales que complican el embarazo. Rev Chilena Obstet Ginecol 2002;67:296-299.
Leiserowitz GS, Xing G, Cress R, et al. Adnexal masses in pregnancy: How often are they malignant? Gynecol Oncol 2006;101:315-321.
Gjelsteen AC, Ching BH, Meyermann M, et al. CT,MRI,PET,PET/ CT, and ultrasound in the evaluation of obstetric and gynecologic patients. Surg Clin North Am 2008;88:361-390.
Hill L, Connors D, Nowak A, Tush B. The role of ultrasonography in the detection and management of adnexal masses during the second and third trimesters of pregnancy. Am J Obstet Gynecol 1998;179:703-707.
Leiserowitz G. Managing Ovarian masses during pregnancy. Obstet Gynecol Surv 2006;61:463-470.
Engelen M, Bongaerts A, Sluiter W, et al. Distinguishing benign and malignant pelvic masses: The value of different diagnostic methods in everyday clinical practice. Eur J Obstet Gynecol Reprod Biol 2008;136:94-101.
Schmeler KM, Mayo-Smith WW, Peipert JF, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005;105:1098-1103.
Morales F, Santillán A. Antígeno sérico CA 125 en cáncer epitelial de ovario. Cancerologia 2007;2:s21-s24.
Lee GS, Hur SY, Shin JC, et al. Elective vs conservative management of ovarian tumors in pregnancy. Int J Gynecol Obstet 2004;85:250-254.
Bunyavejchevin S, Phupong V. Cirugía laparoscópica para el tumor ovárico benigno presunto en embarazadas. La Biblioteca Cochrane Plus 2008.
Attanucci C, Ball H, Zweizig S, Chen A. Differences in symptoms between patients with benign and malignant ovarian neoplasms. Am J Obtet Gynecol 2004;190:1435-7.
14 Lernes J, Timor-Trisch I, Federman A. Transvaginal ultrasonography characterization of ovarian masses with an improved, weighted scoring system.Am J Obstet Gynecol 1994;170:81-85.
Guerriero S, Ajossa S, Garau N, et al. Ultrasonography and color Doppler-based triage for adnexal masses to provide the most appropriate surgical approach. Am J Obstet Gynecol 2005;192:4016.
Grab D, Flock F, Stöhr I, et al. Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol 2000;77:454-459.
Mironov S, Akin O, Pandit-Taskar N, Hann L. Ovarian cancer. Radiol Clin North Am 2007;45:149-166.
Whitecar M,Turner S, Higby M. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181:19-24.
Pereg D, Koren G, Lishner M. Cancer in pregnancy: Gaps, challenges and solutions. Can Treat Rev 2008;34:302-312.
Machado F, Vegas C, Leon J, et al. Ovarian cancer during pregnancy: Analysis of 15 cases. Gynecol Oncol 2007;105:446-450.
Chobanian N, Dietrich C. Ovarian Cancer. Surg Clin North Am 2008;88:285-299.
Gol M, Balaglu A, Yigit S. Accuracy of frozen section diagnosis in ovarían tumors: is there a change in the course of time? Int J Gynecol Cancer 2003;13:593-597.
Tapia M, Orellana R, Cisterna P, Gazitua R. Tumores anexiales y embarazo. Rev Chil Ginecol 2005;70:391-394.