Evaluation and management of adnexal mass in pregnancy

Hoover, Kim; Jenkins, Todd R.

doi:10.1016/j.ajog.2011.01.050

Cited by 124 publications

(125 citation statements)

References 37 publications

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“…Maternal death from ovarian torsion has not been yet reported in the literature [1]. Generally, laparotomy is the choice of surgery for adnexal masses in pregnancy [4].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

Fatema¹,

Badi²,

Moon³

2016

MOJCR

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Ovarian masses ≥5cm in diameter have been found in only 0.04-0.05% of pregnant women. Most of the adnexal masses encountered during pregnancy are simple cysts <5cm in diameter and about 70% would resolve by the early second trimester. The persistent cysts with gradual increase in size required surgical management. Adnexal masses requiring surgical intervention in pregnancy have been reported for around 1% to 2.3% of all gestations. In the series we reviewed 6 cases at different trimesters of pregnancy with ovarian masses measuring ≥5cm that were managed surgically in a regional hospital in Oman. We observed the maternal perinatal outcome after removal of cysts either by Laparotomy or during cesarean delivery. Ovarian masses with acute complications warranted immediate surgical intervention irrespective of gestational age and incidental findings of ovarian masses during cesarean section required removal to avoid delayed diagnosis of malignancy and repeat surgery. spontaneously with no history of ovarian stimulation treatments. On general examination she was vitally stable. However abdominal examination revealed that a palpable mass at the middle of the lower abdomen corresponding to 20 weeks in size was tender on palpation. Baselines of all investigations were within normal limit. Eventually a radiology ultrasound revealed that the gravid uterus with intra uterine alive fetus corresponding to 8 weeks of gestation and a huge anechoic well defined cystic lesion in the middle of lower abdomen measuring 13.8x8.8cm with no doppler signal around it. Both ovaries were masked by the mass. Minimal amount of free fluid was seen in the pouch of Douglas. An urgent laparotomy was undertaken, during which a large unilocular thick walled right-sided ovarian cyst was detected measuring around 14x8.5cm in size (Figure 1). The cyst was twisted twice with clear fluid inside it. A right ovarian cystectomy was then carried out, and around 1700 ml clear fluid aspirated from the cyst. The remaining ovarian tissue and fallopian tube were preserved. Postoperatively she was placed on oral progesterone (Tab Dydrogesterone 10 mg BID) support upon hospital discharge. Histopathology report confirmed serous cyst adenoma in the ovary with signs of torsion. Tumor markers were within the normal limit. She was on regular ANC follow up which was uneventful. At 40 weeks and 1 day of gestation she delivered by a spontaneous vaginal delivery of a live baby of weighting 3 kg with Apgar score 9/1 minute and 10/5 minute. Keywords Case 2A 31 year old female G2P1 at 24 weeks of gestation arrived at our ANC clinic with complaints of a sudden onset of lower abdominal pain since the past 4 hours .She was registered at 9 weeks of gestation at the local health center and was put on regular ANC follow up afterwards. Upon physical examination, her vital signs were within normal limits but she appeared to be in distress due to continuous pain. Upon abdominal examination the lower right quadrant was revealed to be tender on palpation, with voluntary guardin...

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“…Maternal death from ovarian torsion has not been yet reported in the literature [1]. Generally, laparotomy is the choice of surgery for adnexal masses in pregnancy [4].…”

Section: Discussionmentioning

confidence: 99%

“…Malignancy is not the only concern associated with an adnexal mass in pregnancy. Masses that persist into the second trimester are at risk for torsion, rupture, or labor obstruction [3,4]. The fifth most common surgical emergencies are ovarian torsions.…”

Section: Introductionmentioning

confidence: 99%

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

Fatema¹,

Badi²,

Moon³

2016

MOJCR

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“…The overall incidence of malignancy including low-malignant potential tumors in an adnexal mass noted in pregnancy is 1%-8% [6][7][8]. There are only a few case reports of PNET arising from the ovary diagnosed during pregnancy [5,9].…”

Section: Discussionmentioning

confidence: 99%

A case of primitive neuroectodermal tumor of the ovary

Kuk

Yoon

Kim

et al. 2012

Korean J Obstet Gynecol

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Peripheral primitive neuroectodermal tumor (PNET) is a small round tumor belonging to the PNET/Ewing's sarcoma family classified based on location in the body. There have been a small number of case reports of PNET arising in the ovary. We present extremely rare case of PNET of the ovary occurring in a 32-year-old pregnant woman, which was detected during her second Cesarean section. She had a past history of oophorectomy due to a huge mature solid teratoma in left ovary during her first Cesarean section. She got the operation of right salpingoophorectomy during the second Cesarean section at local gynecologic clinic and referred to our institute. Magnetic resonance imaging and positron emission tomography revealed the PNET was metastased to the peritoneum and the lymph nodes. We had persecuted vincristine, doxorubicin, cyclophosphamide, and etoposide/ifosfamide 8 cycles. There has been no evidence of local tumor recurrence and metastasis after the chemotherapy until now.

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“…Some authors, in fact advocate not to take management decisions based on single tumor marker values in cases of asymptomatic non complex masses during pregnancy. 21 The primary role of tumor markers is in following the levels as a marker of tumor control. In our case, serum CA 125 and LDH values were mildly elevated while alfa fetoprotein levels were normal.…”

Section: IIImentioning

confidence: 99%

Pregnancy with Ovarian Dysgerminoma : An Unusual Diagnosis

Jain¹

2013

IOSR-JDMS

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Evaluation and management of adnexal mass in pregnancy

Cited by 124 publications

References 37 publications

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

Management and Outcomes of Ovarian Masses Measuring ≥5cm in Pregnancy - a Series of Six Cases

A case of primitive neuroectodermal tumor of the ovary

Pregnancy with Ovarian Dysgerminoma : An Unusual Diagnosis

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