Managing Ovarian tumors during pregnancy

Ovarian masses may complicate 2.3-4.1 % [ 1 ] of all pregnancies. Due to the extensive use of transvaginal ultrasound (US) in the fi rst trimester for the assessment of fetal viability, growth, and anomalies, the diagnosis of ovarian masses during pregnancy has increased in the last decades. Most of these are asymptomatic and undergo spontaneous resolution without treatment [ 2 ]. Pain related to mass torsion, enlargement, or rupture occurs in 3-28 % of cases. Most persistent ovarian masses diagnosed during pregnancy are benign tumors, with only 1-3 % [ 3 ] being malignant. After cervical cancer, ovarian cancer (OC) is the second most frequent gynecologic cancer complicating pregnancy, with an incidence rate of 1:12.000-47.000 pregnancies. Updated INCIP (International Network on Cancer, Infertility and Pregnancy) registration study described the frequency of cancer in pregnancy in European countries [ 4 ]: among more than 1000 cases of diagnosed cancer during pregnancy, ovarian cancer accounts for 5 % of all cases. Histological subtypes are similar to those reported for young nonpregnant women. Most common benign tumors are teratomas and serous cystadenomas, whereas most common malignant histology is epithelial invasive and borderline cancer. Eighty percent of malignancies are diagnosed at early stage. Germ cell tumors are less frequent, with few cases reported in several series [ 5 ]. Table 13.1 describes a summary of ovarian cancer cases reported in literature so far.