Cytologic diagnosis of ovarian tumors: factors influencing accuracy in previously undiagnosed cases

Peripartum ovarian masses

The presentation and management of ovarian tumours complicating pregnancy may have altered with changes in obstetric practice and developments in diagnostic imaging and pathology. A retrospective review of the presentation, management, pathological findings and pregnancy outcome of all women whose pregnancies were complicated by an ovarian tumour was undertaken. We found 84 cases where ovarian masses complicated pregnancy. Thirteen presented in association with an ectopic pregnancy. Forty-seven cases were asymptomatic and 29 of these were discovered incidentally at caesarean section despite the routine use of ultrasound. Twenty-two cases were symptomatic, presenting with mass, pain or bleeding. Aspiration cytology was helpful in only 53% while histology allowed definitive diagnosis for all tumours. Benign cystic teratoma was the most common tumour found. There was one tumour of borderline malignancy in this series. Examination of the ovaries at the time of caesarean section should be a routine practice since the majority of asymptomatic ovarian masses were discovered incidentally and not antenatally, having been missed at the time of routine ultrasound. Although differentiation of functional from neoplastic lesions can be difficult, most lesions are benign and selective conservative management may be considered.