Clinical Analysis Of 13 Cases Of Pregnancy Complicated With Borderline Ovarian Tumors

Objective The clinical and pathological data of 13 cases of borderline ovarian tumors in pregnancy were retrospectively analyzed,to investigate the clinical manifestation,pathological features,diagnosis and treatment of borderline ovarian tumor in pregnancy and its effect on pregnancy outcome.Methods The clinical and pathological data of 13 pregnant women with ovarian borderline tumors admitted to Dalian Obstetrics And Gynecology Hospital,Affiliated Hospital Of Dalan Medical University(Dalian Maternal and Child Health Hospital)from May 2004 to May 2018 were retrospectively analyzed and followed up.Analysis of the age,history of pregnancy,clinical symptoms,assistant examination,gestational age,surgical gestation,termination of pregnancy,operation mode,tumor pathological type and stage,birth weight of newborn and neonatal apgar score were analyzed.Telephone interviews with patients and the prognosis of offspring and other data.Results From May 2004 to May 2018,the total rate of delivery was 181669 cases,of which 2007 cases were pregnant with ovarian tumors,the incidence was1.1%,pregnancy with borderline ovarian tumors accounted for 0.64%of pregnancy complicated with ovarian tumors.The mean age of 13 patients was(30.70±4.71)years.Among them,1 case(7.7%)was transpartum,12 cases(92.3%)were primipara.The time from finding ovarian tumor to surgical treatment in 13 patients varied from intraoperative to 4 years.Through ultrasound ovarian neoplasms were detected in 2cases before pregnancy,4 cases in early pregnancy,4 cases in late pregnancy and 3cases were found in cesarean section.The detection rate of ovarian tumor was 76.9%(10/13)before operation and 23.1%(3/13)during operation.There were no obvious clinical symptoms in 10 cases,abdominal pain in 2 cases,nausea and vomiting in 1case.The 3 cases with clinical symptoms were ovarian tumor pedicle torsion(1 case)and ovarian tumor rupture(2 cases).The missed diagnosis rate was 23.08 in 3 cases of cesarean section.The ovarian masses were revealed by ultrasound in 10 patients with diameter of 4-23cm.Ultrasound showed that in the adnexal fluid dark area,the boundary was clear or not clear,1 case had good sound permeability,6 cases with light film and light band,4 cases with strong light mass.Color Doppler flow imaging(color doppler flow imaging,CDFI)showed the internal blood flow signal in 3 cases,and the resistance index(resistive index,RI)in 2 cases was 0.52 and 0.44 respectively.One case showed a star-spot flow signal in a hypoechoic light mass.CA125 was normal in 5cases,CEA was detected in 3 cases,blood value was normal in 2 cases,2 cases had normal blood value and 1 case had elevated to 29.45ng/ml(normal value 0-4.7 ng/ml).The results of AFP were higher than normal(normal value 0-5.8 IU/ml),which were208.5IU/ml,240.7IU/ml,136IU/ml,240.7IU/ml.Frozen pathological examination was performed in 8 of the 13 patients,all of whom showed borderline ovarian tumors,including serous ovarian borderline tumors in 4 cases and mucinous ovarian borderline tumors in 4 cases.Postoperative paraffin sections revealed borderline ovarian tumors.serous ovarian borderline tumors were found in 8 cases(61.5%),mucinous ovarian borderline tumorswere found in 5 cases(38.5%).Ovarian tumors occur in unilateral ovaries.Of the 13 patients,3 cases underwent emergency surgery,one of whom underwent cesarean section and adnexectomy at the 34~+44 week of gestation due to the torsion of the pedicle of the ovarian cyst,1 case underwent cesarean section and associated appendectomy due to rupture of ovarian cyst at 36~+33 weeks of pregnancy,The rupture of ovarian cyst was performed by abdominal appendectomy,and then preserved to 36~+11 weeks of gestation and delivered naturally through vagina.The remaining 10 cases were treated by elective operation,during cesarean section,7 cases were treated by ovarian cyst nucleus and 3 cases were treated by adnexal resection of the affected side.Among the 13 cases,8 cases underwent intraoperative freezing,all of which indicated borderline,among them,3 cases underwent nuclear operation of ovarian cyst and 5 cases underwent adnexal resection of the affected side.No extraovarian lesions were found in all the 13 patients,but none of them underwent stage operation during the operation.No stage operation was performed at the later stage.13 cases were followed up and 3 cases were lost to follow-up.The follow-up 11 cases were alive,no recurrence,and 11 cases of the newborn were healthy and alive.The follow-up time was 13 months to 14 years.Conclusions The incidence of ovarian borderline tumors in pregnancy is gradually increasing with the popularization and deepening of standard antenatal examination and the continuous progress of ultrasonic diagnosis technology.Pregnancy with ovarian borderline tumors generally without clinical symptoms,some of the patients were found accidentally during gynecological examination.The preoperative diagnosis rate is not high,the imaging examination has certain limitation after the second trimester of pregnancy,the tumor marker CA125,CA199,CEA has certain value in differentiating benign ovarian tumor from ovarian malignant tumor.Diagnosis depends on intraoperative freezing and postoperative pathological examination.BOTs is easy to occur in young women,the survival rate is high and the recurrence interval is long after operation.,it has a good prognosis.However,according to the age of pregnant women,At present,there is no unified treatment standard,whether to have fertility requirements,whether to retain the fetus in this pregnancy,pregnancy stage,tumor stage,case type and other appropriate treatment options should be selected.