ovarian cancers in pregnancy. incidence effect on pregnancy histologic variations clinical variation...
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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