DOI: https://doi.org/10.18370/2309-4117.2020.56.38-42

Diagnostic peculiarities of benign ovarian tumors during pregnancy

O. H. Boichuk, D. Y. Hulii

Abstract


Objective of the study: improvement of diagnostic methods for pregnant women with tumor-like formations and ovarian tumors.

Materials and methods. 60 pregnant women were examined and divided into 3 groups: group I – 28 pregnant women with ovarian tumors who underwent surgical treatment during pregnancy; group II – 21 women with ovarian tumors who underwent surgical treatment at various times after spontaneous delivery; group III (control) – 11 women with a normal course of pregnancy without ovarian tumors.

Doppler ultrasound was performed on a mandatory basis at the screening time, and as well as needed. MRI was performed in 8 diagnostically difficult cases. In the II trimester of pregnancy at 12–24 weeks in 49 women with ovarian tumors tumor markers were determined: CA-125, HE-4, β2-microglobulin, transthyretin, transferrin and apolipoprotein A-I, and combined ROMA and RMI indices.

Results. The analysis showed the characteristic echographic signs of most ovarian tumors in pregnant women. The overall accuracy of ultrasound in determining the ovarian tumor structure at the outpatient level was extremely low and amounted to 21.8%, in a specialized medical institution it was 79.2%. In the diagnosis of mature teratomas were found MRI sensitivity and specificity of 100%, less diagnostic value (sensitivity 91.7%, specificity 96.9%) was typical for endometrioid ovarian cysts. MRI efficiency in detecting malignant potential (borderline and malignant tumors) was quite high (sensitivity 80.0%, specificity 97.4%).

The presence of any ovarian tumor, except for mature teratomas, was accompanied by a significant increase in CA-125 level. The strongest correlation was found for RMI index and CA-125 and HE-4 tumor markers.

Conclusions. Doppler ultrasound and MRI are complementary highly informative methods for diagnosing ovarian tumors in pregnant women. Tumor markers used for the differential diagnosis of benign and malignant tumors outside pregnancy (CA-125, HE-4, apolipoprotein A-I, transferrin, transthyretin, β2-microglobulin) do not have a high enough diagnostic value in ovarian tumors in pregnant women, therefore their tests should be supportive.


Keywords


ovarian tumors; pregnancy; tumor markers; MRI; ultrasonography

References


Bakhidze, E.V. “Ovarian tumors in pregnant women.” Journal of Obstetrics and Women's Diseases LX.3 (2011): 190–6.

Khachkuruzov, S.G. Ultrasound in Gynecology. Symptoms, diagnostic difficulties and mistakes. St. Petersburg. ELBISPb (2012): 672 p.

Brewer, M., Kueck, A., Runowicz, C.D. “Chemotherapy in pregnancy.” Clin Obstet Gynecol 54.4 (2011): 602–18. 4.

Fauvet, R., Brzakowski, M., Morice, P., et al. “Borderline ovarian tumors diagnosed during pregnancy exhibit a high incidence of aggressive features: results of a French multicenter study.” Ann Oncol 14 (2011).

Gezginc, K., Karatayli, R., Yazici, F., et al. “Ovarian cancer during pregnancy.” Int J Gynaecol Obstet 115.2 (2011): 140–3.

Koo, Y.J., Kim, H.J., Lim, K.T., et al. “Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy.” Aust N Z J Obstet Gynaecol 17 (2011): 213–9.

Balthazar, U., Steiner, A.Z., Boggess, J.F., Gehrig, P.A. “Management of a persistent adnexal mass in pregnancy: what is the ideal surgical approach?” J Minim Invasive Gynecol 18.6 (2011): 720–5.

Dubossarskaya, Z.M., Lutsenko, N.S., Grishchenko, O.V. “Tivortin: on guard of the health of mother and child.” Health of Ukraine. Thematic issue. Obstetrics. Gynecology. Reproductology 3 (2011): 55.

Horowitz, N.S. “Management of adnexal masses in pregnancy.” Clin Obstet Gynecol 54.4 (2011): 519–27.

Shaik, A.P., Sultana, A., Bammidi, V.K., et al. “A meta-analysis of eNOS and ACE gene polymorphisms and risk of pre- eclampsia in women.” J Obstet Gynaecol 31.7 (2011): 603–7.

Bharathan, R., Ramsawak, L., Kelly, A. “Ovarian torsion: opportunities to improve clinical management.” J Obstet Gynaecol 32.7 (2012): 683–6.

Savelyeva, G.M., Breusenko, V.G. Acute abdomen in gynecology. 4th ed., revised and enlarged. Moscow. GEOTAR-Media (2012): 339 p.

Sanchez, A.M., Vanni, V.S., Bartiromo, L. “Is the oocyte quality affected by endometriosis?” J Ovarian Res 10.43 (2017).

Ramachandran, K.N. “Osteosarcoma arising in a mature cystic teratoma of the ovary: A case report.” Indian Journal of Radiology Imaging 9.2 (2017): 65–7.

Wada, R., Kato, Y., Yamashiro, C. “Adenosquamous carcinoma arising in benign cystic teratoma of ovary.” Nippon Sanka Fujinka Gakkai Zasshi 43.9 (2014): 1259–62.

Iwaoki, Y., Katsube, Y., Toyota, N. “Adenosquamous carcinoma arising in a mature cystic teratoma of the ovary: a case report and review of the literature. Asia Oceania.” J Obstet Gynaecol 20.3 (2016): 237–43.

Beuzeboc, P., Dorval, T., Mathieu, G. “Malignant epidermoid degeneration of dermoid cysts of the ovary. Apropos of 2 cases.” Ann Chir 47.7 (2017): 641–4.

Guinet, C., Ghossain, M.A., Buy, J.N. “Mature cystic teratomas of the ovary: CT and MR findings.” Eur J Radiol 20 (2016): 137–43.

Ayhan, A., Aksu, T., Develioglu, O. “Complications and bilaterality of mature ovarian teratomas (clinicopathological evaluation of 286 cases).” Aust N Z J Obstet Gynaecol 31.1 (2015): 83–5.

Kurtx, J.E. “Combined modality treatment for malignant transformation of a benign ovarian teratoma.” Gynecology Oncology 73.2 (2017): 319–21.

Climie, A.R., Heath, L.P. “Malignant degeneration of benign cystic teratoma.s of the ovary.” Cancer 22 (2016): 824–32.

Poremba, C., Dockhorn-Dworniczak, B. “Immature teratomas of different origin carried by a pregnant mother and her fetus.” Diagn Mol Pathol 2.2 (2015): 131–6 .

Ushakov, F.B., Meirow, D., Prus, D. “Parasitic ovarian dermoid tumor of the omentum – A review of the literature and report of two new cases.” Eur J Obstet Gynecol Reprod Biol 81.1 (2016): 77–82.

Besser, M.J., Posey, D.M. “Cystic teratoma in a supernumerary ovary of the greater 168 omentum. A case report.” J Reprod Med 37.2 (2015): 189–93.

Onon, T.S., Allen, C.A. “Primary ovarian pregnancy associated with mature cystic teratoma.” J Obstet Gynaecol 7.5 (2016): 99–500.


GOST Style Citations


1.         Бахидзе, Е.В. Опухоли яичника у беременных / Е.В. Бахидзе // Журнал акушерства и женских болезней. – 2011. – № 3, Т. LX. – С. 190–196.

2.         Хачкурузов, С.Г. УЗИ в гинекологии. Симптоматика, диагностические трудности и ошибки / С.Г. Хачкурузов. – СПб.: ЭЛБИСПб. – 2012. – 672 с.

3.         Brewer, M., Kueck, A., Runowicz, C.D. “Chemotherapy in pregnancy.” Clin Obstet Gynecol 54.4 (2011): 602–18. 4.

4.         Fauvet, R., Brzakowski, M., Morice, P., et al. “Borderline ovarian tumors diagnosed during pregnancy exhibit a high incidence of aggressive features: results of a French multicenter study.” Ann Oncol 14 (2011).

5.         Gezginc, K., Karatayli, R., Yazici, F., et al. “Ovarian cancer during pregnancy.” Int J Gynaecol Obstet 115.2 (2011): 140–3.

6.         Koo, Y.J., Kim, H.J., Lim, K.T., et al. “Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy.” Aust N Z J Obstet Gynaecol 17 (2011): 213–9.

7.            Balthazar, U., Steiner, A.Z., Boggess, J.F., Gehrig, P.A. “Management of a persistent adnexal mass in pregnancy: what is the ideal surgical approach?” J Minim Invasive Gynecol 18.6 (2011): 720–5.

8.            Дубоссарская, З.М. Тивортин: на страже здоровья матери и ребенка / З.М. Дубоссарская, Н.С. Луценко, О.В. Грищенко // Здоров'я України. Тематичний випуск. Акушерство. Гінекологія. Репродуктологія. – 2011. – № 3. – С. 55.

9.            Horowitz, N.S. “Management of adnexal masses in pregnancy.” Clin Obstet Gynecol 54.4 (2011): 519–27.

10.          Shaik, A.P., Sultana, A., Bammidi, V.K., et al. “A meta-analysis of eNOS and ACE gene polymorphisms and risk of pre- eclampsia in women.” J Obstet Gynaecol 31.7 (2011): 603–7.

11.          Bharathan, R., Ramsawak, L., Kelly, A. “Ovarian torsion: opportunities to improve clinical management.” J Obstet Gynaecol 32.7 (2012): 683–6.

12.          Савельева, Г.М. Острый живот в гинекологии / Г.М. Савельева, В.Г. Бреусенко. – 4-е изд., перераб. и доп. – М.: ГЭОТАР-Медиа, 2012. – 339 с.

13.          Sanchez, A.M., Vanni, V.S., Bartiromo, L. “Is the oocyte quality affected by endometriosis?” J Ovarian Res 10.43 (2017).

14.          Ramachandran, K.N. “Osteosarcoma arising in a mature cystic teratoma of the ovary: A case report.” Indian Journal of Radiology Imaging 9.2 (2017): 65–7.

15.          Wada, R., Kato, Y., Yamashiro, C. “Adenosquamous carcinoma arising in benign cystic teratoma of ovary.” Nippon Sanka Fujinka Gakkai Zasshi 43.9 (2014): 1259–62.

16.          Iwaoki, Y., Katsube, Y., Toyota, N. “Adenosquamous carcinoma arising in a mature cystic teratoma of the ovary: a case report and review of the literature. Asia Oceania.” J Obstet Gynaecol 20.3 (2016): 237–43.

17.          Beuzeboc, P., Dorval, T., Mathieu, G. “Malignant epidermoid degeneration of dermoid cysts of the ovary. Apropos of 2 cases.” Ann Chir 47.7 (2017): 641–4.

18.          Guinet, C., Ghossain, M.A., Buy, J.N. “Mature cystic teratomas of the ovary: CT and MR findings.” Eur J Radiol 20 (2016): 137–43.

19.          Ayhan, A., Aksu, T., Develioglu, O. “Complications and bilaterality of mature ovarian teratomas (clinicopathological evaluation of 286 cases).” Aust N Z J Obstet Gynaecol 31.1 (2015): 83–5.

20.          Kurtx, J.E. “Combined modality treatment for malignant transformation of a benign ovarian teratoma.” Gynecology Oncology 73.2 (2017): 319–21.

21.          Climie, A.R., Heath, L.P. “Malignant degeneration of benign cystic teratoma.s of the ovary.” Cancer 22 (2016): 824–32.

22.          Poremba, C., Dockhorn-Dworniczak, B. “Immature teratomas of different origin carried by a pregnant mother and her fetus.” Diagn Mol Pathol 2.2 (2015): 131–6 .

23.          Ushakov, F.B., Meirow, D., Prus, D. “Parasitic ovarian dermoid tumor of the omentum – A review of the literature and report of two new cases.” Eur J Obstet Gynecol Reprod Biol 81.1 (2016): 77–82.

24.          Besser, M.J., Posey, D.M. “Cystic teratoma in a supernumerary ovary of the greater 168 omentum. A case report.” J Reprod Med 37.2 (2015): 189–93.

25.          Onon, T.S., Allen, C.A. “Primary ovarian pregnancy associated with mature cystic teratoma.” J Obstet Gynaecol 7.5 (2016): 99–500.





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)