Pregnancy with ovarian tumor

Introduction to pregnancy with ovarian tumors Clinically, the pregnancy rate of patients with ovarian tumors is reduced, but generally there are ovarian tumors before they are pregnant. Malignant tumors are relatively rare when pregnancy and ovarian tumors coexist. Endocrine factors: the risk of ovarian cancer in pregnant women is 2 times higher than that in fertile women; the risk of women with less fertility is higher than that of prolific women; early pregnancy, early menopause and oral contraceptives have all been shown to reduce the incidence of ovarian cancer. Danger, the above situation indicates that reducing or inhibiting ovulation can reduce the damage caused by ovulation in the ovarian epithelium, which may reduce the risk of ovarian cancer. The chance of breast cancer or endometrial cancer with functional ovarian cancer is 2 times higher than that of the average woman. All are hormone-dependent tumors. basic knowledge Sickness ratio: 0.0001% Susceptible population: pregnant women Mode of infection: non-infectious Complications: abdominal pain

Pregnancy with ovarian tumor etiology

(1) Causes of the disease

1. Endocrine factors The risk of ovarian cancer is 2 times higher than that of pregnant women; the risk of women with less fertility is higher than that of prolific women; early pregnancy, early menopause and oral contraceptives have all been shown to reduce the incidence of ovarian cancer. Danger, the above situation indicates that reducing or inhibiting ovulation can reduce the damage caused by ovulation in the ovarian epithelium, which may reduce the risk of ovarian cancer. The chance of breast cancer or endometrial cancer with functional ovarian cancer is 2 times higher than that of the average woman. All are hormone-dependent tumors.

2. Genetic and family factors 20% to 25% of patients with ovarian malignancies have a family history, the so-called familial ovarian cancer refers to a family of several generations, mainly epithelial cancer, Peutz-Jeghers syndrome 5% to 14% of women develop ovarian tumors.

3. Environmental factors and other factors The incidence of ovarian cancer in industrialized countries is high, which may be related to dietary components (high cholesterol content); talc powder exposure, smoking, drinking, etc. have also been studied, but the relative risk increase is not significant.

(two) pathogenesis

Pelvic blood flow is abundant during pregnancy, but so far there is no evidence that pregnancy accelerates tumor growth and spread.

Pregnancy with ovarian tumor prevention

In order to ensure the healthy growth of the fetus, pre-pregnancy physical examination should be done to achieve early detection and treatment of ovarian tumors before pregnancy.

Pregnancy with ovarian tumor complications Complications, abdominal pain

Occasionally, the uterus may oppress the ovarian tumor and cause the latter to rupture and hemorrhage.

Pregnancy with ovarian tumor symptoms Common symptoms Weight loss abdominal mass Ovarian cysts Abortion edema Urinary frequency severe pain Cacao nausea Ascites

Benign ovarian tumor

Early tumors were small, asymptomatic, and slow to develop. Even in gynecological examinations, when the tumors were increased to moderately large, the abdominal distension or abdominal hernia and mass were clear, and the boundary was clear. The gynecological examination touched the spherical mass on one side or both sides of the uterus. Mostly cystic, smooth surface, activity and uterus no adhesion, if the tumor is large enough to occupy the basin, the abdominal cavity appears compression symptoms, such as frequent urination, constipation, shortness of breath, palpitations, etc., abdominal bulging, poor mass of the capsule, no percussion movement Voiced voice.

2. Ovarian malignant tumor

Early asymptomatic, can be found in gynecological examination, once the symptoms often appear as abdominal distension, abdominal mass and ascites, but it is already advanced tumor, the severity of the symptoms is determined by:

(1) The size, location, and extent of invasion of adjacent organs.

(2) The histological type of the tumor.

(3) Whether there are complications.

If the tumor infiltrates or compresses the nerve into the surrounding tissue, it can cause abdominal pain, low back pain or pain in the lower limbs; if the pelvic vein is pressed, lower extremity edema occurs; if it is a functional tumor, the corresponding symptoms of estrogen or androgen are produced, and in the late stage, it is thin. , severe anemia and other signs of cachexia, triad examination in the posterior vaginal sacral touch and hard nodules in the pelvis, the mass is mostly bilateral, solid or semi-solid, the surface is uneven, inactive, often accompanied by ascites, or in the groin The swollen lymph nodes can be touched on the collarbone.

Pregnancy with ovarian tumor examination

At present, there is no tumor marker that is unique to a unique tumor. Various types of ovarian tumors can have relatively special markers; they can be used for auxiliary diagnosis and disease monitoring.

1. CA125 80% of patients with ovarian epithelial cancer CA125 level is higher than normal; more than 90% of patients with CA125 level is consistent with the disease remission or deterioration, can be used for disease monitoring, high sensitivity, serum CA125 normal value is 35U/ml .

2. AFP has specific value for ovarian endodermal sinus tumor. For immature teratoma, mixed neutrophiloma with yolk sac component, it has the significance of diagnosis. The normal serum value is 20~25ng/ml.

3. HCG is specific for primary ovarian choriocarcinoma, malignant germ cell tumors are often mixed, and HCG is also elevated.

4. CEA primary mucinous ovarian cancer and gastrointestinal ovarian metastases can be elevated.

5. Sex hormone granulosa cell tumor, follicular cell tumor produces a higher level of estrogen, serous, mucinous or Brenner tumor can sometimes secrete a certain amount of estrogen.

Pelvic B-mode ultrasonography: pelvic B-ultrasound examination during pregnancy is the most reliable method for diagnosing ovarian tumors. It is often found that ovarian tumors missed during pelvic examination during pregnancy can compensate for the deficiencies of pelvic examination, but it should be noted that in the third trimester In the ultra-examination, it is not possible to focus solely on observing the fetus, placenta and amniotic fluid, and neglecting the examination of the uterus attachment, so as not to miss the attachment lumps. B-mode ultrasound can not only determine the location, size, shape and relationship between the uterus and the uterus. It can also be judged that the contents of the mass are cystic, solid or cystic, and there is no separation, and there is no effusion in the pelvic cavity. Where the cystic mass may be an ovarian functional cyst or benign tumor, the solid partition is generally All of them are ovarian tumors. After the ovarian mass is found, regular B-mode ultrasound follow-up during pregnancy is more helpful to further determine the nature of the mass. For example, if the pregnancy is more than 3 months, the mass of the mass remains unchanged and the change may be benign. Ovarian tumors, gradually shrinking are generally ovarian functional or physiological cysts rather than tumors, gradually increasing or nodular growth should consider ovarian malignant swelling , CT examination harmful to the fetus, pregnancy is disabled, although MRI examination can be employed in pregnancy, but because of its expensive price, in after B-ultrasound diagnosis, usually no need to re-MRI.

Diagnosis and differentiation of pregnancy with ovarian tumor

Diagnostics <br /> Now using the criteria developed by FIGO, staging according to surgery and pathology, to estimate the prognosis and comparative efficacy, FIGO (1986) revised clinical stage, ovarian tumor patients have no symptoms in the early stage, although they can feel after conception Due to physical changes caused by pregnancy, but not aware of potential ovarian tumors in the pelvic cavity, clinical ovarian tumors can be diagnosed by gynecological double-consultation, triple-check and B-ultrasound in early pregnancy.

1. Ovarian tumor pedicle torsion or rupture in pregnant women in early pregnancy or mid-pregnancy, the side of the lower abdomen severe pain, unbearable, accompanied by nausea, vomiting, should first consider the possibility of ovarian cyst torsion or rupture, not difficult after examination Definite diagnosis is more common in patients with mature teratoma.

2. When the dystocia is delivered, if the labor process is prolonged, the fetus can not be lowered first. The vaginal examination finds that there are incarcerated masses in the pelvic cavity, and most of them are obstructive dystocia caused by ovarian tumors. End the delivery, and then surgically treat the ovarian tumor as usual.

3. Occasionally found that ovarian tumors are occasionally discovered during early pregnancy or mid-pregnancy abortion, so it is necessary to pay attention to routine double-check and triple-check before artificial abortion, and some in cesarean section Occasionally found ovarian tumors, so in each cesarean section should be routinely examined before the closure of the bilateral attachments, so as to avoid missed diagnosis.

Differential diagnosis

1. Identification of benign ovarian tumors and malignant tumors

2. Differential diagnosis of benign ovarian tumors

(1) ovarian tumor like condition: ovarian physiologic enlargement at the childbearing age, follicular cyst and corpus luteum cyst are the most common, mostly unilateral, diameter <5cm, thin wall, temporary observation or oral contraceptives It can disappear in 3 months. If it persists or grows up, it should be considered as an ovarian tumor.

(2) Fallopian tube ovarian cyst: an inflammatory cyst, often with a history of infertility or pelvic infection, a history of acute or subacute pelvic inflammatory disease, cystic mass formed on one or both sides of the attachment, the boundary is clear or unclear, Restricted activity, can be reduced after anti-infective treatment, often difficult to identify patients with laparotomy or laparoscopic surgery.

(3) uterine fibroids: subserosal fibroids or fibroids cystic changes easily confused with ovarian solid tumors or cysts, fibroids are often multiple, connected to the uterus, with menstrual abnormalities such as menstruation and other symptoms, check When the tumor moves with the uterus and the cervix, the probe examines the size and direction of the uterus to effectively identify the relationship between the mass and the uterus.

(4) Pregnancy uterus: In the early or middle pregnancy, the uterus enlarges and becomes softer, and the isthmus is softer. When the triad is diagnosed, the uterus and the cervix are not connected, that is, the Hegars sign, which is easy to mistake the soft uterus for ovarian tumor, but Pregnant women have a history of menopause. If you can ask for a detailed history, you can identify them by HCG or ultrasound.

(5) Ascites: a large amount of ascites should be differentiated from large ovarian cysts, ascites often have liver disease, history of heart disease, when lying flat on both sides of the abdomen, such as frog belly, percussion in the middle of the abdomen drum sound, both sides of the voiced, mobile voiced positive; B type Ultrasound examination showed irregular liquid dark area, in which the intestinal koji group floated, the liquid level changed with the body position, no space-occupying lesions, the large cyst was flat in the middle of the abdomen, the percussive dullness, the drum sounds on both sides of the abdomen, mobility The voiced voice is negative; the boundary of the lower abdomen is clear, and the B-mode ultrasound is seen in the spherical dark area, the boundary is neat and smooth, and the liquid level does not move with the body position.

3. Differential diagnosis of ovarian malignant tumors

(1) Endometriosis: Adhesive mass formed by ectopic disease and rectal uterus depression and ovarian malignant tumor are difficult to distinguish. The former often have progressive dysmenorrhea, menorrhagia, irregular vaginal bleeding before menstruation Etc. Progesterone therapy can be used for identification, B-mode ultrasound, serum CA125, etc. can be used for diagnosis, and laparoscopy is the gold standard for diagnosis of endometriosis.

(2) pelvic connective tissue inflammation: a history of abortion or puerperal infection, manifested as fever, lower abdominal pain, gynecological examination of the attachment area tissue thickening, tenderness, flaky tumors reach the pelvic wall, antibiotics to relieve symptoms, tumor shrinkage If the symptoms and symptoms after treatment are not improved, the tumor will increase instead, and it should be considered as an ovarian malignant tumor. B-mode ultrasonography is helpful for identification.

(3) tuberculous peritonitis: often combined with ascites, pots, intra-abdominal adhesions of mass formation, mostly in young, infertile women, more than a history of tuberculosis, systemic symptoms are weight loss, fatigue, low fever, night sweats, loss of appetite, menstruation Rare or amenorrhea, gynecological examination of the mass position is high, irregular shape, unclear boundaries, fixed motion, drum sounds and voiced sounds are unclear at the time of percussion, B-mode ultrasound, X-ray gastrointestinal examination can assist diagnosis, if necessary A laparotomy was confirmed.

(4) Tumors other than the genital tract: it must be differentiated from retroperitoneal tumor, rectal cancer, sigmoid colon cancer, and the retroperitoneal tumor is fixed. The lower position causes the uterus or rectum to be displaced. The intestinal cancer has typical gastrointestinal symptoms. B Ultrasound examination, barium enema, intravenous pyelography, etc. are helpful for identification.

(5) metastatic ovarian tumors: difficult to distinguish from ovarian malignant tumors, if in the attachment area and bilateral, moderately large, kidney-shaped, active solid mass, should be suspected of metastatic ovarian tumor, if the patient has digestive tract Symptoms, digestive tract cancer, history of breast cancer, diagnosis can basically be established, but most cases have no history of primary tumors.

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