Large proportion of ovarian tumor in pregnancy belongs to benign. And thus malignant ovarian carcinoma in pregnancy remains a rare event. Recently, incidence of primary ovarian tumor complicated in pregnancy shows an increasing tendency in
various
literatures. Management of ovarian tumor in pregnancy has a crucial importance. The treatment depends on the multiple factors such as symptoms, complications, gestational weeks, possibility of dystocia and presence of malignancy, etc.
In this study, clinical and pathologic review of the ovarian tumor in pregnancy including one case report of ovarian malignancy was present. The records of 83 ovarian tumors complicated in pregnancy among 28,435 deliveries were reviewed at
Department of
Obstetrics and Gynecology, Yonsei University, Wonju College of Medicine from July, 1981, to July 1995.
@ES The results obtained were as follows:
@EN 1) The incidence of benign ovarian tumor in pregnancy was 1 in 343 deliveries. The incidence of malignant tumor and borderline malignancy was 2.4% and 4.8% of ovarian tumors complicated in pregnancy, respectively.
2) Mean age was 27.5 years, and the range was 19~39 years. 90.4% of this tumor was distributed among 21~34 years of age.
3) As to the initial chief complaints or the mode of presentation, low abdominal pain or discomfort were found in 33 cases(39.8%), no symptom including incidentally diagnosed-adnexal mass during the Cesarean section was 27 cases(32.5%) ;
palpable
mass
in 9 cases(10.8%), known mass in 6 cases(7.3%), vaginal bleeding in 5 cases(6.0%), genitourinary discomfort in case(1.2%), lumbargo in 1 case(1.2%), and fever in 1 case(1.2%).
4) 48cases(57.9%) were diagnosed in the first trimester, 10 cases(12.0%) in 2nd trimester, 23 cases(27.7%) in third timester and during Cesarean section and 2 cases in puerperium.
5) According to mode of diagnosis, 31 cases(37.4%) were discovered during routine pelvic examination with abdominal or transvaginal ultrasonogram. Only ultrasonogram was applied in 27 cases(32.5%), when the tumors were not able to be diagnosed
with
physical examination due to small size or impalpable mass. 19 cases(22.8%) were diagnosed incidentally at the time of cesarean section.
6) According to location of tumor, unilateral tumor was 73 cases(88.0%), and there was no statistical difference between left and right site(p>0.05). Bilaterality was shown in 10 cases(12.0%). In all cases of teratoma, bilaterality was 19.0%. In
all
cases of corpus luteal cyst, bilaterality was 26.3%.
7) Histopathologically, benign tumor was 78 cases(92.8%), borderline epithelial tumor was 4 cases(4.8%), and malignant ovarian neoplasm was 2 cases(2.4%). Most common tumor was benign teratoma(21 cases ; 25.0%). Cortus luteal cyst was 19
cases(22.6%).
Simple cyst was 11 cases(13.4%). Mucinous cystadenoma and serous cystadenoma were 8 cases(9.5%) and 8 cases(8.3%) respectively. Other benign ovarian tumors were one thecom a and one cystic adenofibroma.
8) According to size of tumor, group of tumors less than 5cm in mean diameter was 21 cases(25.0%), between 6~10cm being 39 cases(46.4%), between 11~20 cm being 17 cases(20.1%), and more than 20 cm being 6f cases(7.1%).
9) According to complication of tumor, torsion was 12 cases(14.5%), and rupture was 4 cases(4.8%).
10) Obstetrical complication rate after adnexal operation was 15.9%, which was composed of abortion(3 cases) and preterm labor(4 cases).
11) Mode of delivery was as follows: normal spontaneouc vaginal delivery in 20 cases (45.5%), Cesarean section at term in 17 cases(38.0%), preterm delivery in 4 cases(9.1%), and spontaneous or missed abortion in 3 cases(6.8%).
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