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Complex Ovarian Mass

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Acute Abdomen During Pregnancy

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Abstract

Complex ovarian mass is a separate entity from adnexal torsion which is only one presentation due to ovarian mass and is described in detail in a separate chapter. Complex ovarian mass found in pregnancy is important for several reasons: (1) adnexal torsion, as a result, should be detorsed immediately to preserve ovarian function, (2) persistent pain, (3) ovarian mass rupture and bleeding, and (4) tumor with malignant potential. Persistent pain or compression of surrounding structures is important because it commonly does not subside without surgical intervention. The timing of the operation is critical because intervention during the second trimester carries the lowest risk of obstetric complications. Intra-abdominal bleeding is difficult to diagnose initially, especially if bleeding is small. Bleeding from ovarian mass is always the indication for immediate operation. The most difficult issue is asymptomatic and small ovarian mass. Small ovarian mass can commonly be treated conservatively if the malignancy is excluded. There are different imaging and non-imaging methods for confirmation of malignancy. Malignancy status determines the timing and the type of treatment intervention.

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References

  1. Yakasai IA, Bappa LA. Diagnosis and management of adnexal masses in pregnancy. J Surg Tech Case Rep. 2012;4:79–85.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yen CF, Lin SL, Murk W, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril. 2009;91:1895–902.

    Article  Google Scholar 

  3. Rosales AE. Giant ovarian cyst and pregnancy. Case report and literature review. Ginecol Obstet Mex. 2011;79:235–8.

    Google Scholar 

  4. Suprasert P, Khunamornpong S, Siriaunkgul S, et al. Ruptured mature cystic teratomas mimicking advanced stage ovarian cancer: a report of 2 cases study. J Med Assoc Thail. 2004;87:1522–5.

    Google Scholar 

  5. Whitecar MP, Turner S, Higby M. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol. 1999;181:19–24.

    Article  CAS  Google Scholar 

  6. Leiserowitz GS, Xing G, Cress R, et al. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol. 2006;101:315–21.

    Article  PubMed  Google Scholar 

  7. Hermans RHM, Fischer DC, van der Putten H, et al. Adnexal masses in pregnancy. Onkologie. 2003;26:167–72.

    CAS  PubMed  Google Scholar 

  8. Agarwal N, Parul KA, Bhatla N, et al. Management and outcome of pregnancies complicated with adnexal masses. Arch Gynecol Obstet. 2003;267:148–52.

    Article  PubMed  Google Scholar 

  9. Boulay R, Podczaski E. Ovarian cancer complicating pregnancy. Obstet Gynecol Clin North Am. 1998;25:385–99.

    Article  CAS  PubMed  Google Scholar 

  10. Harlozinska A, Bar JK, Rabczynski J, et al. Density distribution and antigenic characterization of cell subpopulations isolated from cystic fluids of ovarian serous neoplasms. Anticancer Res. 1989;9:161–6.

    CAS  PubMed  Google Scholar 

  11. Hill LM, Connors-Beatty DJ, Nowak A, et al. 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;179:703–7.

    Article  CAS  Google Scholar 

  12. Yazbek J, Salim R, Woelfer B, et al. The value of ultrasound visualization of the ovaries during the routine 11–14 weeks nuchal translucency scan. Eur J Obstet Gynecol Reprod Biol. 2007;132:154–8.

    Article  PubMed  Google Scholar 

  13. McKerron R, editor. Pregnancy, labour and child-bed with ovarian tumour. London: Rebman Limited; 1903.

    Google Scholar 

  14. Ovarian CA. Cysts complicating pregnancy. Am J Surg. 1943;61:387–93.

    Article  Google Scholar 

  15. Goffinet F. Ovarian cysts and pregnancy. J Gynecol Obstet Biol Reprod. 2001;30:S100–8.

    CAS  Google Scholar 

  16. Zanetta G, Mariani E, Lissoni A, et al. A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG. 2003;110:578–83.

    Article  Google Scholar 

  17. Borgfeldt C, Andolf E. Transvaginal sonographic ovarian findings in a random sample of women 25–40 years old. Ultrasound Obstet Gynecol. 1999;13:345–50.

    Article  CAS  PubMed  Google Scholar 

  18. Huang P-H, Tsai K-B, Tsai E-M, et al.. Hemorrhagic corpus luteum cyst torsion in term pregnancy: a case report. Kaohsiung J Med Sci. 2003;19:75–8.

    Article  PubMed  Google Scholar 

  19. Bider D, Mashiach S, Dulitzky M, et al. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet. 1991;173:363–6.

    CAS  Google Scholar 

  20. Hibbard L. Corpus luteum surgery. Am J Obstet Gynecol. 1979;135:666–70.

    Article  CAS  PubMed  Google Scholar 

  21. Hallatt JG, Steele CH, Snyder M. Ruptured corpus luteum with hemoperitoneum: a study of 173 surgical cases. Am J Obstet Gynecol. 1984;149:5–9.

    Article  CAS  PubMed  Google Scholar 

  22. Peterson WF, Prevost EC, Edmunds F, et al. Benign cystic teratomas of the ovary; a clinico-statistical study of 1,007 cases with a review of the literature. Am J Obstet Gynecol. 1955;70:368–82.

    Article  CAS  PubMed  Google Scholar 

  23. Comerci JT, Licciardi F, Bergh PA, et al. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol. 1994;84:22–8.

    Google Scholar 

  24. Jubb E. Primary carcinoma in pregnancy. Am J Obstet Gynecol. 1963;85:345–54.

    Article  CAS  Google Scholar 

  25. Palmer J, Vatish M, Tidy J. Epithelial ovarian cancer in pregnancy: a review of the literature. BJOG. 2009;116:480–91.

    Article  CAS  Google Scholar 

  26. Novak ER, Lambrou CD, Woodruff JD. Ovarian tumors in pregnancy. An ovarian tumor registry review. Obstet Gynecol. 1975;46:401–6.

    CAS  PubMed  Google Scholar 

  27. Beischer NA, Buttery BW, Fortune D. Growth and malignancy of ovarian tumours in pregnancy. Aust N Z J Obstet Gynaecol. 1971;11:208–20.

    Article  CAS  PubMed  Google Scholar 

  28. Dobashi M, Isonishi S, Morikawa A, et al. Ovarian cancer complicated by pregnancy: analysis of 10 cases. Oncol Lett. 2012;3:577–80.

    Article  Google Scholar 

  29. Creasman WT, Rutledge F, Smith J. Carcinoma of the ovary associated with pregnancy. Obstet Gynecol. 1971;38:111–6.

    CAS  PubMed  Google Scholar 

  30. Miyakoshi K, Tanaka M, Gabionza D, et al. Decidualized ovarian endometriosis mimicking malignancy. Am J Roentgenol. 1998;171:1625.

    Article  CAS  Google Scholar 

  31. Bromley B, Benacerraf B. Adnexal masses during pregnancy: accuracy of sonographic diagnosis and outcome. J Ultrasound Med. 1997;16:447–52.

    Article  CAS  PubMed  Google Scholar 

  32. DePriest PD, DeSimone C. Ultrasound screening for the early detection of ovarian cancer. J Clin Oncol. 2003;21:194s–9s.

    Article  PubMed  Google Scholar 

  33. Caverly C. Ovarian cyst complicating pregnancy. Am J Obstet Gynecol. 1931;21:566–74.

    Article  Google Scholar 

  34. Noreen H, Syed S, Chaudhri R, et al. A large unilocular mucinous cystadenoma in third trimester of pregnancy. J Coll Physicians Surg Pak. 2011;21:426–8.

    PubMed  Google Scholar 

  35. Hertzberg BS, Kliewer MA, Bowie J. Adnexal ring sign and hemoperitoneum caused by hemorrhagic ovarian cyst: pitfall in the sonographic diagnosis of ectopic pregnancy. Am J Radiol. 1999;173:1301–2.

    Article  CAS  PubMed  Google Scholar 

  36. Fiegler P, Katz M, Kaminski K, et al. Clinical value of a single serum CA-125 level in women with symptoms of imminent abortion during the first trimester of pregnancy. J Reprod Med. 2003;48:982–8.

    PubMed  Google Scholar 

  37. He S, Bremme K, Kallner A, et al. Increased concentrations of lactate dehydrogenase in pregnancy with preeclampsia: a predictor for the birth of small-for-gestational-age infants. Gynecol Obstet Invest. 1995;39:234–8.

    Article  CAS  PubMed  Google Scholar 

  38. Han SN, Lotgerink A, Gziri M, et al. Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review. BMC Med. 2012;10:86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Lerner JP, Timor-Tritsch IE, Federman A, Abramovich G. Transvaginal ultrasonographic characterization of ovarian masses with an improved, weighted scoring system. Am J Obstet Gynecol. 1994;170:81–5.

    Article  CAS  PubMed  Google Scholar 

  40. Sherard GB III, Hodson CA, Williams H, et al. Adnexal masses and pregnancy: a 12-year experience. Am J Obstet Gynecol. 2003;189:358–63.

    Article  Google Scholar 

  41. Wheeler TC, Fleischer A. Complex adnexal mass in pregnancy: predictive value of color Doppler sonography. J Ultrasound Med. 1997;16:425–8.

    Article  CAS  PubMed  Google Scholar 

  42. Yoffe N, Bronshtein M, Brandes J, et al. Hemorrhagic ovarian cyst detection by transvaginal sonography: the great imitator. Gynecol Endocrinol. 1991;5:123–9.

    Article  CAS  PubMed  Google Scholar 

  43. Baltarowich OH, Kurtz AB, Pasto ME, et al. The spectrum of sonographic findings in hemorrhagic ovarian cysts. Am J Roentgenol. 1987;148:901–5.

    Article  CAS  Google Scholar 

  44. Bree RL, Edwards M, Bohm-Velez M, et al. Transvaginal sonography in the evaluation of normal early pregnancy: correlation with HCG level. Am J Roentgenol. 1989;153:75–9.

    Article  CAS  Google Scholar 

  45. Jain KA. Sonographic spectrum of hemorrhagic ovarian cysts. J Ultrasound Med. 2002;:21, 879–886.

    Article  PubMed  Google Scholar 

  46. Barbieri M, Somigliana E, Oneda S, et al. Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity. Hum Reprod. 2009;24:1818–24.

    Article  PubMed  Google Scholar 

  47. Yuen PM, Chang A. Laparoscopic management of adnexal mass during pregnancy. Acta Obstet Gynecol Scand. 1997;76:173–6.

    Article  CAS  PubMed  Google Scholar 

  48. Hill LM, Johnson CE, Lee R. Ovarian surgery in pregnancy. Am J Obstet Gynecol. 1975;122:565–9.

    Article  CAS  PubMed  Google Scholar 

  49. Gustafson GW, Gardiner SH, Stout F. Ovarian tumors complicating pregnancy; a review of 45 surgically proved cases. Am J Obstet Gynecol. 1954;67:1210–23.

    Article  CAS  PubMed  Google Scholar 

  50. Platek DN, Henderson CE, Goldberg G. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol. 1996;173:1236–40.

    Article  Google Scholar 

  51. Hess LW, Peaceman A, O’Brien WF, et al. Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management. Am J Obstet Gynecol. 1988;158:1029–34.

    Article  CAS  Google Scholar 

  52. Cohen-Herriou K, Semal-Michel S, Lucot J, et al. Management of ovarian cysts during pregnancy: Lille’s experience and literature review. Gynecol Obstet Fertil. 2013;41:67–72.

    Article  CAS  PubMed  Google Scholar 

  53. Crispens MA. Borderline ovarian tumours: a review of the recent literature. Curr Opin Obstet Gynecol. 2003;15:39–43.

    Article  PubMed  Google Scholar 

  54. Timmerman D, Schwarzler P, Collins W, et al. Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obstet Gynecol. 1999;13:11–6.

    Article  CAS  PubMed  Google Scholar 

  55. Taylor LH, Madhuri TK, Walker W, et al. Decidualisation of ovarian endometriomas in pregnancy: a management dilemma. A case report and review of the literature. Arch Gynecol Obstet. 2015;291:961–8.

    Article  PubMed  Google Scholar 

  56. Caspi B, Ben-Arie A, Appelman Z, et al. Aspiration of simple pelvic cysts during pregnancy. Gynecol Obstet Investig. 2000;49:102–5.

    Article  CAS  Google Scholar 

  57. Caspi B, Zalel Y, Lurie S, et al. Ultrasound-guided aspiration for pain relief generated by simple ovarian cysts. Gynecol Obstet Invest. 1993;35:121–2.

    Article  CAS  PubMed  Google Scholar 

  58. Barrett C. Ovarian tumors complicating pregnancy, delivery, and the puerperium. Surg Gynecol Obstet. 1913;16:28.

    Google Scholar 

  59. Mandi D, Chandra Mondal R, Bhar D, et al. Successful vaginal delivery despite a huge ovarian mucinous cystadenoma complicating pregnancy: a case report. Iran J Med Sci. 2013;38:339–42.

    PubMed  PubMed Central  Google Scholar 

  60. Teng SW, Tseng JY, Chang C, et al. Comparison of laparoscopy and laparotomy in managing hemodynamically stable patients with ruptured corpus luteum with hemoperitoneum. J Am Assoc Gynecol Laparosc. 2003;10:474–7.

    Article  PubMed  Google Scholar 

  61. Yamada T, Okamoto Y, Kasamatsu H, et al. Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery. JSLS. 2003;7:97–100.

    Google Scholar 

  62. Phupong V, Sueblinvong T, Triratanachat S. Ovarian teratoma with diffused peritoneal reactions mimicking advanced ovarian malignancy. Arch Gynecol Obstet. 2004;270:189–91.

    Article  PubMed  Google Scholar 

  63. Kocak M, Dilbaz B, Ozturk N, et al. Laparoscopic management of ovarian dermoid cysts: a review of 47 cases. Ann Saudi Med. 2004;24:357–60.

    Article  PubMed  Google Scholar 

  64. Clément D, Barranger E, Benchimol Y, et al. Chemical peritonitis: a rare complication of an iatrogenic ovarian dermoid cyst rupture. Surg Endosc. 2003;17:658.

    Article  PubMed  Google Scholar 

  65. Shamshirsaz AA, Shamshirsaz AA, Vibhakar JL, et al. Laparoscopic management of chemical peritonitis caused by dermoid cyst spillage. JSLS. 2011;15:403–5.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Nagai H, Kondo Y, Yasuda T. An abdominal wall-lift method of laparoscopic cholecystectomy without peritoneal insufflation. Surg Laparosc Endosc. 1993;3:175–9.

    CAS  PubMed  Google Scholar 

  67. Smith RS, Fry WR, Tsoi E, et al. Gasless laparoscopy and conventional instruments: the next phase of minimally invasive surgery. Arch Surg. 1993;128:1102–7.

    Article  CAS  PubMed  Google Scholar 

  68. Akira S, Yamanaka A, Ishihara T, et al. Gasless laparoscopic ovarian cystectomy during pregnancy: comparison with laparotomy. Am J Obstet Gynecol. 1999;180:554–7.

    Article  CAS  PubMed  Google Scholar 

  69. Tanaka H, Futamura N, Takubo S, et al. Gasless laparoscopy under epidural anesthesia for adnexal cysts during pregnancy. J Reprod Med. 1999;44:929–32.

    CAS  PubMed  Google Scholar 

  70. Murakami T, Noda T, Okamura C, et al. Cul-de-sac packing with a metreurynter in gasless laparoscopic cystectomy during pregnancy. J Am Assoc Gynecol Laparosc. 2003;10:421.

    Article  PubMed  Google Scholar 

  71. Oguri H, Taniguchi K, Fukaya T. Gasless laparoscopic management of ovarian cysts during pregnancy. Int J Gynaecol Obstet. 2005;91:258–9.

    Article  CAS  PubMed  Google Scholar 

  72. Eichelberger KY, Cantrell LA, Balthazar U, et al. Robotic resection of adnexal masses during pregnancy. Am J Perinatol. 2013;30:371–5.

    PubMed  Google Scholar 

  73. Scheib SA, Jones HH, Boruta D, et al. Laparoendoscopic single-site surgery for management of adnexal masses in pregnancy: case series. J Minim Invasive Gynecol. 2013;20:701–7.

    Article  PubMed  Google Scholar 

  74. Dursun P, Gülümser C, Cağlar M, et al. Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy: preliminary experience. J Matern Fetal Neonatal Med. 2013;26:1282–96.

    Article  Google Scholar 

  75. Pearl J, Price R, Richardson W, et al. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2011;25:3479–92.

    Article  Google Scholar 

  76. Nezhat F, Nezhat C, Silfen SL, et al. Laparoscopic ovarian cystectomy during pregnancy. J Laparoendosc Surg. 1991;1:161–4.

    Article  CAS  PubMed  Google Scholar 

  77. Pittaway DE, Takacs P, Bauguess P. Laparoscopic adnexectomy: a comparison with laparotomy. Am J Obstet Gynecol. 1994;171:385–91.

    Article  CAS  PubMed  Google Scholar 

  78. Ramadoss R, Abhinaya P, Hameed J, et al. Dilemma in the management of ovarian cyst in pregnancy: a series of three different cases. IJSS Case Rep Rev. 2015;1:10–3.

    Google Scholar 

  79. Spencer CP, Robarts P. Management of adnexal masses in pregnancy. Obstet Gynaecol. 2006;8:14–9.

    Google Scholar 

  80. Mathew M, Mubarak SA, Jesrani S. Conservative management of twisted ischemic adnexa in early pregnancy. Ann Med Heal Sci Res. 2015;5:142–4.

    Article  CAS  Google Scholar 

  81. Lynch F. Fibroids and ovarian cysts complicating pregnancy. Calif West Med. 1931;35:415–20.

    CAS  Google Scholar 

  82. Usui R. A retrospective survey of clinical, pathological and prognostic features of adnexal masses operated during pregnancy. J Obstet Gynecol Res. 2008;26:89–93.

    Article  Google Scholar 

  83. Lenglet Y, Roman H, Robishong B, et al. Laparoscopic management of ovarian cyst in pregnancy. Gynecol Obstet Fertil. 2006;34:101–6.

    Article  CAS  PubMed  Google Scholar 

  84. Schemeler K, William W, Jeffrey P, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005;105:1098–103.

    Article  Google Scholar 

  85. Soriano D, Yuval Y, Saidman D, et al. Laparoscopy versus laparotomy in the management of adnexal masses in pregnancy. Fertil Steril. 1999;71:955–60.

    Article  CAS  Google Scholar 

  86. Mendilcioglu I, Zorlu CG, Trak B, et al. Laparoscopic management of adnexal masses. Safety and effectiveness. J Reprod Med. 2002;47:36–40.

    PubMed  Google Scholar 

  87. Rizzo AG. Laparoscopic surgery in pregnancy: long-term follow-up. J Laparoendosc Adv Surg Tech A. 2003;13:11–5.

    Article  Google Scholar 

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  1. School of Medicine University of Zagreb, Zagreb, Croatia

    Goran Augustin

  2. Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia

    Goran Augustin

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Augustin, G. (2018). Complex Ovarian Mass. In: Acute Abdomen During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-72995-4_14

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  • DOI: https://doi.org/10.1007/978-3-319-72995-4_14

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