A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives

Boussios, Stergios; Moschetta, Michele; Tatsi, Konstantina; Tsiouris, Alexandros K.; Pavlidis, Nicholas

doi:10.1016/j.jare.2018.02.006

Cited by 52 publications

(55 citation statements)

References 94 publications

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“… 4 In patients with advanced-stage epithelial ovarian cancer, termination of the pregnancy should be considered when the diagnosis is made in early pregnancy stages. 6 We found that the abortion rates were significantly higher with ovarian malignancy detection in the first trimester than that in later trimesters. Further analysis showed no significant relationships among tumor size, reproductive history, stage, surgical indications and type.…”

Section: Discussionmentioning

confidence: 64%

“…Another review has also stated that fertility-sparing surgery can be offered to patients with stage I epithelial ovarian tumors, germ cell ovarian or sex-cord stromal ovarian tumors. 6 In our study, 16 of 28 patients with ovarian cancers at stage I/II received fertility-sparing operations. Although eight patients with ovarian cancers (stage IA/IC) received conservative treatment, such treatment remains strictly limited because of frequent relapse rates.…”

Section: Discussionmentioning

confidence: 91%

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<p>Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis</p>

Wang

Huang

Sheng

et al. 2020

CMAR

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Purpose The aim of this study was to investigate the clinical characteristics and management of malignant ovarian tumors during pregnancy, as well as the feto-maternal outcomes and analyze the influential factors on the pregnancy outcomes. Patients and Methods Eighty-five patients with ovarian malignancies during pregnancy treated at 12 tertiary hospitals between 2009 and 2019 were analyzed in this study. The clinical features, histopathological characteristics, clinical management, and maternal and perinatal outcomes were retrospectively analyzed. The clinical features and managements were compared between abortion group and live birth group. Results The following diagnoses were made: 41 (48.24%) patients with borderline ovarian tumors, 18 (21.18%) patients with epithelial ovarian cancers, 17 (20.00%) patients with non-epithelial ovarian malignancies and 9 (10.59%) patients with metastatic ovarian tumors. Thirty-six (42.45%) patients underwent conservative surgical treatment. Thirty-four (40.00%) patients opted for fertility-sparing surgery, and fifteen (17.56%) patients received radical surgery. Chemotherapy was administered to 32.94% of the patients. The proportion of ovarian malignancies diagnosed in the first trimester in the abortion group was higher than that in the live birth group ( P <0.05). However, tumor diameter, reproductive history, stage and surgical indications showed no significant differences between groups. A total of 67 live babies were recorded in this study, including 19 premature babies and 1 full-term newborn who died of respiratory distress. All of the BOTs were diagnosed with stage I, among whom 38 (92.68%) patients exhibited disease-free survival. Twenty-eight ovarian cancers were in stage I–II and 26 of them had disease-free survival with the longest follow-up time of 10 years. Five of the sixteen patients in advanced stage (stage III–IV) died, four of whom had metastatic tumors. Conclusion Pregnant women with early-stage malignant ovarian tumors appear to have favorable outcomes. Conservative surgery is acceptable for early-stage borderline ovarian tumors during pregnancy. The gestational age of ovarian malignancy detection is key for pregnancy outcomes.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 91%

<p>Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis</p>

Wang

Huang

Sheng

et al. 2020

CMAR

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“…Currently, serum CA125 is the most commonly used serum marker for screening ovarian cancer, but its levels can also increase in metastatic ovarian tumours and the first trimester of pregnancy (19). Specifically, CA125 levels are low in maternal serum but high in amniotic fluid in the second and third trimesters (20). Therefore, limited by their low sensitivity and specificity and by the pregnancy itself, serum tumour markers could not be used in an effort to establish the diagnosis of primary malignancies.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features and maternal and foetal management of pregnancy‑complicating Krukenberg tumours

et al. 2020

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Krukenberg tumours are not uncommon, but pregnancy-complicating Krukenberg tumours are rare. To identify management strategies of pregnancies with Krukenberg tumours, the medical records of patients treated at Peking Union Medical College Hospital over the past 20 years were collected and analysed. Four patients were enrolled. The primary tumour sites were the stomach and colorectal region. Three patients presented with obvious and severe gastrointestinal symptoms at 11-18 weeks of gestation, and their symptoms gradually developed into physiological signs associated with malignancy. Three patients underwent termination of pregnancy via induced delivery and gestational hysterectomy. One patient underwent caesarean section at 31 weeks of gestation. Two patients underwent palliative surgery due to extensive lesions. The other two patients with metastatic lesions confined to the ovaries and liver, underwent satisfactory cytoreductive surgery and anti-tumour treatments postoperatively. Pregnant women who exhibit new gastrointestinal symptoms or aggravation of previous gastrointestinal symptoms after the end of the first trimester should be carefully examined for digestive system diseases. If ovarian metastasis is highly suspected, the pregnancy should be terminated as early as possible. Materials and methods From January 1, 1999 to January 1, 2019, four pregnant women of Chinese Han nationality with ovarian metastasis who were hospitalized and had complete clinical records at the Department of Obstetrics and Gynaecology, PUMCH, were enrolled into the present study. Data regarding the general condition, symptoms, preoperative examinations and diagnosis of each patient, as well as data regarding foetal treatment and outcome, surgery, postoperative pathology and prognosis were collected and analysed. SPSS Statistics (version 25.0) was used to calculate our descriptive statistics. The median age of the four patients was 31.5 years. The median gestational age on admission was 21 weeks and 5 days (Table I). Two patients had no routine physical examination or obstetrical care; the other two patients were routinely examined

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“…One of the most recently published review studies regarding the therapeutic perspectives for pregnant women diagnosed with ovarian malignancies was published by Boussios et al and was published in March 2018. [ 19 ] The study identified 193 cases of ovarian cancer diagnosed during pregnancy and published until that moment in the English literature and underlined the utility of an adequate comprehensive staging; in cases with presumed early-stage ovarian cancer, multiple biopsies should be taken to exclude any disseminated lesions. Once the negativity of microscopic disease is confirmed, pregnancy preservation can be taken in consideration.…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive surgery for advanced stage ovarian cancer in the second trimester of pregnancy—a case report and literature review

Bacalbaşa

Bălescu²,

Vîlcu

et al. 2020

Medicine

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Rationale: Advanced stage ovarian cancer is rarely encountered in pregnant women, due to the high number of ultrasound imagistic studies performed during this period. The clinical course of patients diagnosed with advanced stage ovarian cancer is similar in pregnant and nonpregnant women. Patient concerns: We present the case of a 27-year-old woman initially submitted to emergency surgery for ovarian cyst torsion in the ninth week of gestation, at that moment ovarian cystectomy being performed. Diagnoses: The histopathological studies demonstrated the presence of a moderately differentiated epithelial ovarian cancer. Interventions: Although the interdisciplinary team decided for staging surgery followed by platinum-based chemotherapy beginning from the second trimester of pregnancy, both the patient and her family refused this strategy and opined for total hysterectomy en bloc with bilateral adnexectomy. Surprisingly, intraoperatively both ovaries had a tumoral aspect, whereas peritoneal carcinomatosis nodules were found in the Douglas pouch. Therefore, the neoplastic process was staged as a IIIC epithelial ovarian cancer, a total hysterectomy with bilateral adnexectomy, Douglas pouch peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection being performed. Outcomes: The patient was discharged in the sixth postoperative day and was confined to the oncology service in order to be submitted to the standard taxanes and platinum based chemotherapy. Lessons: Although ovarian cancer has been rarely reported during pregnancy, this diagnostic should be taken in consideration whenever persistent adnexal masses are encountered.

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A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives

Abstract: Graphical abstract

Cited by 52 publications

References 94 publications

<p>Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis</p>

<p>Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis</p>

Clinicopathological features and maternal and foetal management of pregnancy‑complicating Krukenberg tumours

Cytoreductive surgery for advanced stage ovarian cancer in the second trimester of pregnancy—a case report and literature review

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