OvarianCancers

In Pregnancy

IncidenceEffect on PregnancyHistologic VariationsClinical Variation

Ovarian Cancers in Pregnancy

Ovarian Cysts inPregnancy

Indications for Surgery

Ovarian Cysts in Pregnancy

- Diameter > 6cm- Persist at 18 weeks- Complications Rupture, Torsion, Hemorrhage

Diagnosis

Ovarian Tumors in Pregnancy

- Physical examination- Ultra sonogram- M.R.I.

Differential Diagnosis

Ovarian Tumors in Pregnancy

- Retroverted pregnant uterus- Pedunculated myoma- Carcinoma of rectosigmoid- Pelvic kidney

Indications for Surgery

Ovarian Tumors in Pregnancy

- Persist at 18 weeks- Complications occur- Suddenly in creased

Ovarian Tumors in Pregnancy Complications

- Torsion- Rupture- Hemorrhage (shock like syndrome)- Obstruction

Signs and SymptomsOf Complications

Abdominal pain (Acute)Nausea, VomitingTenderness of the abdomenRebound tendernessShocklike symptoms

Management of Ovarian mass

Management of Ovarian mass

Management of Ovarian mass

AdnectomyPreservation of the ut.Preservation of controlateral ovaryChemotherapyDelivery at 34 w.

Pregnancy Related Ovarian Tumors

Pregnancy LuteomaHyperreactio luteinalisOvarian hyper stimulation syndrome

Luteoma of PregnancyVary in sizeBilateral in of casesMultiple NodulesPlasma testosteroneVirilization and hirsutismInfant virilizationCA-125Biopsy

Hyperreactio LuteinalisTheca-lutein cystUnilateral, or BilateralTypically after first trimesterTheca interna luteinizationhigh h.C.GVirilization 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, AscitesPleural, Pericardial effusionKidney injury, ARDS,Thromboembolism

Borderline Tumors

Effect of pregnancy on L.M.P.Epithelial AtypiaEpithelial ProliferationEosinophilic CellsMucin ProductionFrequent Microinvation

L.M.P.

Frankly Malignant Tumors

- 2%-5% of ovarian tumors- Diagnosis is Fortuitously- Close observation lead to earlier diagnosis

Frankly Malignant Tumors

Germ cell tumorsEpithelial Ovarian TumorsSex Cord Stromal Cell Tumors

Germ Cell TumorsDysgerminomaYolk Sac TumorImmature TeratomaEmbryonal CarcinomaMixed Germ Cell Tumors

Germ Cell Tumors

1. Adnexectomy2. Omentectomy3. Peritoneal washing4. Peritoneal biopsy unilateral5. Lymph node sampling6. Chemotherapy

Surgical Staging

Germ Cell TumorsAdvanced Stages

Unilateral adnexectomy

Remove all Seedings

Chemotherapy

Sex-cord Stromal Cell Tumors

Granulosa cell tumorSertoli-leydig cell tumorSlow growthAdnexectomyNo staging, No debulkingNo 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 tumorSertoli-leydig cell tumorSlew growthResection of tumor completely

No chemotherapy