EP23.03: Adnexal masses in pregnancy

We present a 27-year-old female patient who was admitted to our department for operative completion of childbirth in the 41st week of pregnancy. The cyst of the left ovary was visualised by ultrasonography at 12 weeks of gestation. The patient gave birth to a live, full-term child by Caesarean section. Intraoperatively, both ovaries were cystically altered in size about 8cm x 8cm with clear contents inside the cysts. The cyst capsule was smooth, without irregularities and adhesions. Both cystic changes were punctured, as well as a biopsy of the cyst wall, which was sent for histopathological examination. The postoperative period went well. Histopathological findings corresponded to mucinous cystadenoma with stromal hyperplasia of granulosa cells. Six weeks after the Caesarean section and complete preoperative preparation, a left-sided adnexectomy and a right-sided cystectomy were performed. Most such tumours are accidentally diagnosed by ultrasound. They contain liquid of different densities, so different degrees of echogenicity are observed on the ultrasound image, often with multiple septations. Due to very similar morphological characteristics, serous and mucinous cystadenoma cannot be distinguished by ultrasound. Mucinous cystadenoma rarely changes malignantly. In conclusion, most ovarian tumours in pregnancy are asymptomatic and are usually diagnosed incidentally during routine antenatal examinations. Therapy of adnexal masses is strictly personalised. Surgical treatment has multiple goals: remove the tumour mass, establish the histological type of the tumour, and perform the correct staging of the ovarian tumour if it is malignant.