Original Article

Pregnant Women With Malignant Ovarian Tumors: A Case Series

Abstract

Ovarian cancer management during pregnancy is a topic of limited research due to low occurrence rates of malignant adnexal tumors. To shed further light on this issue, we present a case series of 22 pregnant ovarian cancer patients referred to an academic hospital's gynecology oncology department over six years. Data on each patient's demographic and clinical background were collected using a registry software recording surgical tumor staging, disease-free survival (DFS), and overall survival (OS). According to the data analysis reports, subtype epithelial tumor and germ cell pathology were equally 45.4%. However, sex-cord tumors were observed in a smaller percentage of cases (9.1%). Serous adenocarcinoma was the most common subtype among those with epithelial tumors (60%). Meanwhile, 72.7% of these pregnant women had a palpable mass in physical examination. In addition, adnexal mass was detected in 95.4% of ultrasonography. Due to the young age of the patients, fertility-preserving surgery was performed on 63.6% of patients, and chemotherapy was prescripted on 59% of patients. Over a six-year follow-up period, there was a recurrence rate of 22.7%, while DFS and OS were reported as 56% and 82%, respectively. In conclusion, treatment of ovarian malignancies during pregnancy requires an experienced multidisciplinary approach. However, more extensive studies with larger samples are needed to gain more insight into the treatment of ovarian cancer during pregnancy.  

1. Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011;155:119-24.
2. Yazbek J, Salim R, Woelfer B, Aslam N, Lee CT, Jurkovic D. The value of ultrasound visualization of the ovaries during the routine 11–14 weeks nuchal translucency scan. Eur J Obstet Gynecol Reprod Biol 2007;132:154-8.
3. Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011;205:97-102.
4. Oehler MK, Wain GV, Brand A. Gynaecological malignancies in pregnancy: a review. Aust N Z J Obstet Gynaecol 2003;43:414-20.
5. Gasim T, Al Dakhiel SA, Al Ghamdi AA, Al Ali M, Al Jama F, Rahman J, et al. Ovarian tumors associated with pregnancy: a 20-year experience in a teaching hospital. Arch Gynecol Obstet 2010;282:529-33.
6. Amant F, Halaska MJ, Fumagalli M, Steffensen KD, Lok C, Van Calsteren K, et al. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer 2014;24:394-403.
7. Mukhopadhyay A, Shinde A, Naik R. Ovarian cysts and cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016;33:58-72.
8. Tamauchi S, Kajiyama H, Yoshihara M, Ikeda Y, Yoshikawa N, Nishino K, et al. Reproductive outcomes of 105 malignant ovarian germ cell tumor survivors: a multicenter study. Am J Obstet Gynecol 2018;219:385.e1-385.e7.
9. Kwon YS, Mok JE, Lim KT, Lee IH, Kim TJ, Lee KH, et al. Ovarian cancer during pregnancy: clinical and pregnancy outcome. J Korean Med Sci 2010;25:230-4.
10. Machado F, Vegas C, Leon J, Perez A, Sanchez R, Parrilla JJ, et al. Ovarian cancer during pregnancy: analysis of 15 cases. Gynecol Oncol 2007;105:446-50.
11. Fruscio R, de Haan J, Van Calsteren K, Verheecke M, Mhallem M, Amant F. Ovarian cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2017;41:108-17.
12. Gynecology CCotIFo, Obstetrics. Staging Announcement: FIGO Cancer Committee. Gynecol Oncol 1986;25:383-5.
13. Valentin L, Hagen B, Tingulstad S, Eik‐Nes S. Comparison of 'pattern recognition' and logistic regression models for discrimination between benign and malignant pelvic masses: a prospective cross validation. Ultrasound Obstet Gynecol 2001;18:357-65.
14. Sekine M, Kobayashi Y, Tabata T, Sudo T, Nishimura R, Matsuo K, et al. Malignancy during pregnancy in Japan: an exceptional opportunity for early diagnosis. BMC Pregnancy Childbirth 2018;18:50.
15. Marret H, Lhommé C, Lecuru F, Canis M, Lévèque J, Golfier F, et al. Guidelines for the management of ovarian cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 2010;149:18-21.
16. Saghafi N, Roodsary ZY, Kadkhodaeian S, Mofrad MH, Farahabadi EH, Hoseinyfarahabady M. Comparison of adnexal mass in women undergoing mass excision during the antepartum period and cesarean section. Oman Med J 2016;31:217-22.
17. Mir O, Berveiller P, Ropert S, Goffinet F, Goldwasser F. Use of platinum derivatives during pregnancy. Cancer: 2008;113:3069-74.
18. Méndez LE, Mueller A, Salom E, González-Quintero VH. Paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer. Obstet Gynecol 2003;102:1200-2.
19. Zagouri F, Sergentanis TN, Chrysikos D, Dimitrakakis C, Tsigginou A, Zografos CG, et al. Taxanes for breast cancer during pregnancy: a systematic review. Clin Breast Cancer 2013;13:16-23.
20. Boussios S, Moschetta M, Tatsi K, Tsiouris AK, Pavlidis N. A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives. J Adv Res 2018;12:1-9.
21. Peccatori FA, Azim Jr H, Orecchia R, Hoekstra H, Pavlidis N, Kesic V, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24:vi160-vi70.
Files
IssueVol 61 No 3 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/acta.v61i3.12741
Keywords
Ovarian tumor Pregnancy Chemotherapy Fertility-preserving surgery Medical registery
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Azimi H, Sajjadi SR, Saeed S, Nakhaee M, Jafarian AH, Davachi B, Naderi Moghaddam A, Dehghani T, Yousefi Z. Pregnant Women With Malignant Ovarian Tumors: A Case Series. Acta Med Iran. 2023;61(3):181-186.