|Year : 2022 | Volume
| Issue : 2 | Page : 56-58
Huge mucinous cystadenoma in pregnancy: A case report from Ile-Ife, South West Nigeria, and review of challenges in management
MS Archibong, M Amuda, OJ Olayemi, OC Eze, OD Ojo, EO Ayegbusi
Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
|Date of Submission||13-Aug-2022|
|Date of Decision||13-Sep-2022|
|Date of Acceptance||02-Jan-2023|
|Date of Web Publication||21-Mar-2023|
Dr. M S Archibong
Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State
Source of Support: None, Conflict of Interest: None
Huge ovarian masses in pregnancy can have significant impact and effect on pregnancy outcome. Mucinous cystadenoma is a benign tumour of the ovary, which sometimes can undergo significant growth in pregnancy, thereby posing certain challenges in management. A case of a 26-year-old G4P1 +2 with huge mucinous cystadenoma is presented, who had an elective caesarean section at term and right salpingo-oophorectomy. Ovarian mass measured 40 cm × 30 cm. The challenges in management are highlighted and discussed.
Keywords: Ile-Ife, mucinous cystadenoma, pregnancy
|How to cite this article:|
Archibong M S, Amuda M, Olayemi O J, Eze O C, Ojo O D, Ayegbusi E O. Huge mucinous cystadenoma in pregnancy: A case report from Ile-Ife, South West Nigeria, and review of challenges in management. Niger J Health Sci 2022;22:56-8
|How to cite this URL:|
Archibong M S, Amuda M, Olayemi O J, Eze O C, Ojo O D, Ayegbusi E O. Huge mucinous cystadenoma in pregnancy: A case report from Ile-Ife, South West Nigeria, and review of challenges in management. Niger J Health Sci [serial online] 2022 [cited 2023 Jun 10];22:56-8. Available from: http://www.https://chs-journal.com//text.asp?2022/22/2/56/372260
| Introduction|| |
Ovarian masses are quite uncommon in pregnancy with a reported incidence of 1%–5%. The advent and routine use of high-resolution ultrasound have contributed to the rise in cases of ovarian masses coexisting with pregnancy. 1 A significant proportion of these masses are functional, asymptomatic and tends to resolve as pregnancy advances with no need for any intervention. Some of these masses are pathologic, and most of the pathologic masses are benign, while malignant masses account for only about 10% of ovarian masses in pregnancy.,
Various forms of benign ovarian masses may coexist with pregnancy, such as serous cystadenoma, mucinous cystadenoma and cystic corpus luteum. Mucinous cystadenomas have been shown to be one of the most frequently occurring benign adnexa masses in pregnancy with a propensity for attaining huge sizes, which may pose some challenges in management. 3
We present a case of a huge mucinous cystadenoma in pregnancy and also highlight the challenges in management.
| Case Report|| |
A 26-year-old G4P1 +2 (1A) woman presented for antenatal booking with no complaint at an estimated gestational age of 20 weeks. Routine obstetric ultrasound done revealed a complex left adnexal cyst measuring 14 × 20 cm with normal intrauterine gestation. Tumour markers were requested with results as follows: alpha fetoprotein – 43.6 ng/ml (1.1–8.5 ng/ml), beta human chorionic gonadotropin – 1066 μ/ml (0–2 mi μ/ml), lactate dehydrogenase – 1293 μ/l (120–240 μ/l) and Ca125–50.9 μ/ml (0–35 μ/ml). Pregnancy progressed with a varying degree of abdominal pain, for which she was admitted at 27 weeks for 6 days and managed with analgesics. Repeat abdominopelvic ultrasound done then revealed a huge multiseptated intra-abdominal mass arising from the pelvis with extension to the epigastrium. There was no flow on Doppler interrogation, no extraluminal fluid and no back pressure effect on the kidneys. Other intra-abdominal organs were normal. Pregnancy progressed satisfactorily, and the foetal growth was monitored with ultrasound. After a comprehensive discussion with the patient, she opted for an elective caesarean section and oophorectomy, which she had under spinal anaesthesia at 37 weeks and was delivered of a live female baby weighing 2.86 kg with Apgar scores of 9 at 1 min and 10 at 5 min. A huge cystic right ovarian mass measuring 40 cm × 30 cm and extending to the epigastrium with torsion of the stalk was found intraoperatively [Figure 1], [Figure 2], [Figure 3], and she had right salpingo-oophorectomy. The left ovary and Fallopian tube More Details were grossly healthy looking. The estimated blood loss was 400 mls. The post-partum period was uneventful, and she was discharged 4 days after the surgery.
Histology report revealed a mucinous cystadenoma; she was adequately counselled on the report at the post-natal clinic.
| Discussion|| |
The presence of ovarian masses in pregnancy may sometimes have a significant impact on pregnancy. There may be certain mass-related complications, such as torsion, rupture, infection, aortocaval compression, virilisation, preterm contractions/labour and breathing difficulties from diaphragmatic splinting, to mention a few. 4 These complications may necessitate more frequent hospital visits/antenatal admissions, medical or surgical interventions and increase in the overall cost of antenatal care. The case presented was admitted at 27 weeks on account of abdominal pain.
Management of adnexal masses in pregnancy depends on its size, nature, symptoms and gestational age amongst others factors. For small asymptomatic benign masses, a conservative approach is usually recommended. Management of a huge adnexal mass like the case presented may be fraught with some challenges; therefore, the role of multidisciplinary care cannot be overemphasised. Management should involve the radiologist for proper medical imaging and characterisation of the mass. Ultrasonography (as was done for the case presented) is usually the first line; however, in cases where there is a poor characterisation of the mass, then magnetic resonance imaging is preferred due to its non-ionising radiation properties and safety in pregnancy.
The gynaeoncologist also has a role to play in the initial evaluation and assessment to rule out malignancy. Even though alpha-fetoprotein, Ca125 and lactate dehydrogenase were elevated and may be associated with an adnexal mass, the role of tumour markers in the management of masses in pregnancy is limited due to a physiological elevation and uncertainty regarding pregnancy-specific normal values. This calls for caution when the results of tumour markers are interpreted in pregnancy.
During the antenatal period, the routine measurement of the symphysiofundal height in huge masses may not be accurate, and determination of the foetal presentation and lie may also be unconvincing. It is therefore imperative, for this category of patients to be monitored with serial growth ultrasound scan in the antenatal period as was done for the case presented.
Mode of delivery for huge masses requires individualisation of cases. It should however be noted, that caesarean section is not absolutely indicated in patients with huge masses coexisting with pregnancy as some patients may prefer to have a spontaneous vaginal delivery and subsequent elective exploratory laparotomy. For patients who may have to undergo vaginal delivery, monitoring of labour could be challenging with respect to palpating for contractions and auscultating the foetal heart. Furthermore, the risk of labour dystocia in the presence of a huge mass has also been shown to be increased. These risks and challenges should be discussed with the patient.
For huge masses like the case presented, surgery is ultimately necessary to relieve pressure effect and more importantly for histological confirmation of the nature of the mass. Surgery can be done in the antenatal period (if there are mass-related complications), peripartum alongside a planned or emergency caesarean section or as a planned procedure during or after the puerperium. The timing of surgery, if indicated in the antenatal period, has previously been a subject of controversy; however, evidence has shown that the second trimester appears to be the most ideal period for surgery, due to the increased risk of miscarriage if done in the first trimester and increased risk of preterm labour and delivery if done before term. Emergency surgical intervention should not be withheld once there is a valid indication irrespective of the gestational age. The case presented opted for, and had a planned caesarean section with salpingo-oophorectomy at term as there was no indication for surgery earlier in pregnancy.
Obstetricians should be aware of the litany of challenges that may be associated with the management of a huge mucinous cystadenoma in pregnancy to ensure a good maternal and perinatal outcome.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]