Ovarian masses and pregnancy: About 2 cases and literature review (experience of Gyneco-obstetrics service 2 Fez)

Abstract

Management of adnexal masses during pregnancy can be challenging for the patient and clinician. The specter of a possible malignant tumor may influence the decision to intervene rather than the expected management. The etiologies of ovarian masses vary depending on the age of the parturient, and therefore, benign entities such as functional ovarian cysts, benign cystic teratomas, and serous cystadenomas predominate. In cases of malignancy, these are generally germ cell tumors and borderline, low-grade ovarian tumors. Ultrasound is the primary modality used to detect ovarian masses and assess the risk of malignancy. Morphological criteria identify benign cysts more precisely than malignant tumors. Tumor markers are mainly used to monitor disease status after treatment rather than to establish the diagnosis of ovarian tumor due to lack of specificity, as several markers can be elevated by pregnancy itself (e.g. , CA-125, β-hCG). We report the cases of 2 patients who consulted the emergency room in a context of pelvic pain during pregnancy whose clinical examination aimed first to eliminate an emergency, notably a torsion of the adnexa, then to explore using ultrasound the etiology and characterize the objectified ovarian mass. The care is specific during pregnancy. Expectant management is recommended for most pregnant patients with asymptomatic, unsuspicious cystic ovarian masses. Surgical intervention during pregnancy is indicated for large and/or symptomatic tumors and those that appear highly suspicious for malignancy on imaging tests. The extent of surgery depends on the intraoperative diagnosis of a benign or malignant tumor. Conservative surgery is most often performed. More aggressive surgery is indicated for ovarian malignancies, including surgical staging. Although rarely necessary, chemotherapy has been used during pregnancy with minimal fetal toxicity in patients with advanced ovarian cancer, in which the risk of maternal mortality outweighs fetal consequences.