<p>Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis</p>

Abstract

Purpose The aim of this study was to investigate the clinical characteristics and management of malignant ovarian tumors during pregnancy, as well as the feto-maternal outcomes and analyze the influential factors on the pregnancy outcomes. Patients and Methods Eighty-five patients with ovarian malignancies during pregnancy treated at 12 tertiary hospitals between 2009 and 2019 were analyzed in this study. The clinical features, histopathological characteristics, clinical management, and maternal and perinatal outcomes were retrospectively analyzed. The clinical features and managements were compared between abortion group and live birth group. Results The following diagnoses were made: 41 (48.24%) patients with borderline ovarian tumors, 18 (21.18%) patients with epithelial ovarian cancers, 17 (20.00%) patients with non-epithelial ovarian malignancies and 9 (10.59%) patients with metastatic ovarian tumors. Thirty-six (42.45%) patients underwent conservative surgical treatment. Thirty-four (40.00%) patients opted for fertility-sparing surgery, and fifteen (17.56%) patients received radical surgery. Chemotherapy was administered to 32.94% of the patients. The proportion of ovarian malignancies diagnosed in the first trimester in the abortion group was higher than that in the live birth group ( P <0.05). However, tumor diameter, reproductive history, stage and surgical indications showed no significant differences between groups. A total of 67 live babies were recorded in this study, including 19 premature babies and 1 full-term newborn who died of respiratory distress. All of the BOTs were diagnosed with stage I, among whom 38 (92.68%) patients exhibited disease-free survival. Twenty-eight ovarian cancers were in stage I–II and 26 of them had disease-free survival with the longest follow-up time of 10 years. Five of the sixteen patients in advanced stage (stage III–IV) died, four of whom had metastatic tumors. Conclusion Pregnant women with early-stage malignant ovarian tumors appear to have favorable outcomes. Conservative surgery is acceptable for early-stage borderline ovarian tumors during pregnancy. The gestational age of ovarian malignancy detection is key for pregnancy outcomes.

Huge Cystadenocarcinoma of the Ovary Disguising as Degenerating Uterine Fibroid in Pregnancy: Case Report and Literature Review

“…Being a 29 year old primipara, our index patient was in consonance with ndings that pregnant women with ovarian malignancy are more likely to be younger than those not pregnant who also tend to be of higher parity. 3,25,26 Except for these, there were no other risk factors in her. We managed our patient for symptomatic degenerating broid in pregnancy, conservatively initially, until worsening of her clinical state necessitated surgery at 26 weeks gestation.…”

“…In such instances, a restaging is planned postpartum. 6,25 Optimal treatment of ovarian and other malignancies in pregnancy are better achieved by collaboration of multidisciplinary teams. 4,6,7,22 Chemotherapy is associated with complications such as spontaneous abortions, congenital malformations and hypertrophy, which are observed more with multi-agents.…”

Cancer and Pregnancy: A Comprehensive Review

“…In case of ovarian masses, and when a malignancy is not highly suspected, intraabdominal surgery should be postponed until the second trimester, when the documented abortion rate was 8.7% after adnexal surgery [ 19 ]. Another multicenter retrospective analysis assessing patients with malignant ovarian masses during pregnancy described a live birth rate after surgery of 78.82% [ 20 ]. Fortunately and due to routine antenatal ultrasound, adnexal malignancies are usually detected at an early stage during pregnancy [ 21 ].…”

“…Chemotherapy should be performed during pregnancy, if indicated ( Table 1 ) [ 7 ]. In advanced stages of ovarian cancer with peritoneal spread, either termination of pregnancy or neoadjuvant chemotherapy should be considered before 22 weeks of gestation ( Table 1 ) [ 7 , 20 , 25 , 26 ]. After 22 weeks of gestation, chemotherapy should be offered with consecutive debulking surgery after delivery ( Table 1 ) [ 7 , 20 , 25 , 26 ].…”

“…Moreover, a retrospective study of 85 pregnant women diagnosed with malignant ovarian tumors during pregnancy, of whom 78.82% were in FIGO stage I, described a global survival rate of 83.53% [ 20 ]. Thus, pregnant patients with early-stage malignant ovarian tumors appeared to have favorable outcomes [ 20 ].…”