Ovarian
Cancers
In Pregnancy
Ovarian Cancers in
Pregnancy
Incidence
Effect on Pregnancy
Histologic Variations
Clinical Variation
Ovarian Cysts in
Pregnancy
Ovarian Cysts in
Pregnancy
Indications for Surgery
- Diameter > 6cm
- Persist at 18 weeks
- Complications
Rupture, Torsion, Hemorrhage
Ovarian Tumors in
Pregnancy
Diagnosis
- Physical examination
- Ultra sonogram
- M.R.I.
Ovarian Tumors in
Pregnancy
Differential Diagnosis
- Retroverted pregnant uterus
- Pedunculated myoma
- Carcinoma of rectosigmoid
- Pelvic kidney
Ovarian Tumors in
Pregnancy
Indications for Surgery
- Persist at 18 weeks
- Complications occur
- Suddenly in creased
Ovarian Tumors in
Pregnancy Complications
- Torsion
- Rupture
- Hemorrhage
(shock like syndrome)
- Obstruction
Signs and Symptoms
Of Complications
Abdominal pain (Acute)
Nausea, Vomiting
Tenderness of the abdomen
Rebound tenderness
Shocklike symptoms
Management of
Ovarian mass
Management of
Ovarian mass
Management of Ovarian mass
Adnectomy
Preservation of the ut.
Preservation of controlateral ovary
Chemotherapy
Delivery at 34 w.
Pregnancy Related
Ovarian Tumors
Pregnancy Luteoma
Hyperreactio luteinalis
Ovarian hyper stimulation
syndrome
Luteoma of Pregnancy
Vary in size
Bilateral in of cases
Multiple Nodules
Plasma testosterone
Virilization and hirsutism
Infant virilization
CA-125
Biopsy
Hyperreactio Luteinalis
Theca-lutein cyst
Unilateral, or Bilateral
Typically after first trimester
Theca interna luteinization
high h.C.G
Virilization only in mother
Ovarian Hyper
Stimulation Syndrome
- Rare event
- Multiple follicular cysts
- Most often caused by
induction ovulation
I.V.F
- Increased Capillary Permeability
Ovarian Hyper Stimulation Syndrome
Hypovolemia, Ascites
Pleural, Pericardial effusion
Kidney injury, ARDS,
Thromboembolism
Borderline Tumors
L.M.P.
Effect of pregnancy on L.M.P.
Epithelial Atypia
Epithelial Proliferation
Eosinophilic Cells
Mucin Production
Frequent Microinvation
Frankly Malignant
Tumors
- 2%-5% of ovarian tumors
- Diagnosis is Fortuitously
- Close observation lead to
earlier diagnosis
Frankly Malignant
Tumors
Germ cell tumors
Epithelial Ovarian Tumors
Sex Cord Stromal Cell Tumors
Germ Cell Tumors
Dysgerminoma
Yolk Sac Tumor
Immature Teratoma
Embryonal Carcinoma
Mixed Germ Cell Tumors
Germ Cell Tumors
Surgical Staging
1. Adnexectomy
2. Omentectomy
3. Peritoneal washing
4. Peritoneal biopsy unilateral
5. Lymph node sampling
6. Chemotherapy
Germ Cell Tumors
Advanced Stages
Unilateral adnexectomy
Remove all Seedings
Chemotherapy
Sex-cord Stromal Cell
Tumors
Granulosa cell tumor
Sertoli-leydig cell tumor
Slow growth
Adnexectomy
No staging, No debulking
No chemotherapy
Epithelial Ovarian Tumors
- More aggressive
- No surgical staging
- No debulking
- Removal of the tumor
- Chemotherapy
- After delivery
Sex Cord Stromal Cell
Tumors
Granulosa cell tumor
Sertoli-leydig cell tumor
Slew growth
Resection of tumor completely
No chemotherapy