Management of ovarian cysts and cancer in pregnancy

J de Haan, M Verheecke, F Amant, J de Haan, M Verheecke, F Amant

Abstract

Adnexal masses during pregnancy are not uncommon. Ovarian cysts or masses during pregnancy should be accurately evaluated to identify the patients who need surgical interventions from those where a 'wait-and-see' strategy can be followed. Ultrasound and MRI are safe diagnostic tools to distinguish between benign and malignant lesions. Treatment options (surgical procedures) should be discussed for each patient individually. Both open surgery and laparoscopy can be performed considering the tumour diameter, gestational age and surgical expertise. A multidisciplinary approach is necessary in case of high suspicion of malignancy and preferably patients should be referred to centres with specialized experience.

Keywords: Adnexal mass; diagnosis; management; pregnancy.

Figures

Fig. 1. Flow-chart: Management of adnexal masses…
Fig. 1. Flow-chart: Management of adnexal masses in pregnancy.
Abbreviations: US = Ultrasound; GA = Gestational Age; MRI = Magnetic Resonance Imaging.

References

    1. Amant F, Brepoels L, Halaska MJ, et al. Gynaecologic cancer complicating pregnancy: an overview. Best Pract Res Clin Obstet Gynaecol. 2010;24:61–79.
    1. Amant F, Halaska MJ, Fumagalli M, et al. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer. 2014;24:394–403.
    1. Bernhard LM, Klebba PK, Gray DL, et al. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999;93:585–589.
    1. Chiang G, Levine D. Imaging of adnexal masses in pregnancy. J Ultrasound Med. 2004;23:805–819.
    1. Cohen-Herriou K, Semal-Michel S, Lucot JP. Management of ovarian cysts during pregnancy: Lille’s experience and literature review. Gynecol Obstet Fertil. 2013;41:67–72.
    1. Giuntoli RL, 2nd, Vang RS, Bristow RE. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol. 2006;49:492–505.
    1. Glanc P, Salem S, Farine D. Adnexal masses in the pregnant patient: a diagnostic and management challenge. Ultrasound Q. 2008;24:225–240.
    1. Han SN, Lotgerink A, Gziri MM, et al. Physiologic variations of serum tumor markers in gynaecological malignancies during pregnancy: a systematic review. BMC Med. 2012;10:86.
    1. Han SN, Verheecke M, Vandenbroucke T, et al. Management of gynaecological cancers during pregnancy. Curr Oncol Rep. 2014;16:415.
    1. Hoffman MS. Barbieir RL (Ed), UpToDate. 2015. Differential diagnosis of the adnexal mass.
    1. Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol. 2011;205:97–102.
    1. Jackson H, Granger S, Price R, et al. Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc. 2008;22:1917–1927.
    1. Kaijser J, Sayasneh A, Van Hoorde K. Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update. 2014;20:449–462.
    1. Ko ML, Lai TH, Chen SC. Laparoscopic management of complicated adnexal masses in the first trimester of pregnancy. Fertil Steril. 2009;92:283–287.
    1. Leiserowitz G. Managing ovarian masses during pregnancy. Obstet Gynecol Surv. 2006;61:463–470.
    1. Levine D. Barbieir RL (Ed), UpToDate. 2015. Sonographic differentiation of benign versus malignant adnexal masses.
    1. Mancari R, Tomasi-Cont N, Sarno MA, et al. Treatment options for pregnant women with ovarian tumors. Int J Gynecol Cancer. 2014;24:967–972.
    1. Mathevet P, Nessah K, Darget D, et al. Laparoscopic management of adnexal masses in pregnancy; a case series. Eur J Obstet Gynecol Reprod Biol. 2003;108:217–222.
    1. Morice P, Uzan C, Gouy S, et al. Gynaecological cancers in pregnancy. Lancet. 2012;379:558–569.
    1. Parsons AK. Imaging the human corpus luteum. J Ultrasound Med. 2001;20:811–819.
    1. Patel MD, Feldstein VA, Chen DC, et al. Endometriomas: diagnostic performance of US. Radiology. 1999;210:739–745.
    1. Patel MD, Feldstein VA, Filly RA. The likelihood ratio of sonographic findings for the diagnosis of hemorrhagic ovarian cysts. J Ultrasound Med. 2005;24:607–614.
    1. Patel MD, Feldstein VA, Lipson SD, et al. Cystic teratomas of the ovary: diagnostic value of sonography. Am J Roentgenol. 1998;171:1061–1065.
    1. Prat J FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet. 2014;124:1–5.
    1. Runowicz CD, Brewer M. Barbieir RL (Ed), UpToDate. 2015. Adnexal mass in pregnancy.
    1. Telischak NA, Yeh BM, Joe BN, et al. MRI of adnexal masses in pregnancy. AJR AM J Roentgenol. 2008;191:364–370.
    1. Timmerman D, Ameye L, Fischerova D, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;14:341.
    1. Usui R, Minakami H, Kosuge S, et al. A retrospective survey of clinical, pathologic, and prognostic features of adnexal masses operated on during pregnancy. J Obstet Gynaecol Res. 2000;26:89–93.
    1. Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol. 1999;181:19–24.

Source: PubMed

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