CCoPE
Date: 2002-07-17

Question:
if there is a cystadenoma in the ovary with a 6 weeks pregnancy, what would you advice as a line of treatment? should the baby be aborted or cystadenoma have malignant potential. What are the risk factors in continuing with the pregnancy to the embryo and the mother?

Answer:
There are many issues to consider and all should be discussed with your doctor. Here's a summary of some key points --

(1). The actual diagnosis - Is it really cystadenoma or not? Early in pregnancy there could be other cysts (hemorrhagic, corpus luteum, etc). These may look like cystadenoma but may regress in a few weeks. Usually it is not that easy to be certain of this specific diagnosis.

(2). Who made the diagnosis? - Some radiologist/perinatologists have more experience with adnexal masses than others. OB referral centers have more experience. If the scan was done in a general ultrasound lab it may be wise to obtain a second opinion from a person with expertise in this area.

(3). Change in size - A repeat ultrasound needs to be done in a few weeks to see if the cyst regresses, got bigger or stayed unchanged. If it disappeared it is possible that nothing needs to be done. If it is growing it may not be cystadenoma and something may need to be done sooner than later. If it is unchanged in size it could be left for follow up every few weeks and later therapy.

(4). The factors affecting management are mainly the size and the appearance of the cyst, its growth pattern over a few weeks, symptoms, and other risk factors, such as age, famiy history, etc.

The risks include:
(a). A malignant tumor - This is most often not the case. The frequency of malignancy is probably less than 1% although some studies suggested up to 6%. Women who are either very young or older have slightly higher chances.

(b). Rupture - The risk of the cyst bursting is very low (<1%)
(c). Torsion - Twisting of the cyst - Once again usually believed to occur in less than 1% (although some studies had a frequency of up to 8%). If either rupture or twisting occur there will be major pain and a high probability that surgery will be needed.

The management, in a nut shell: If it is growing, complicated by rupture/torsion or looks malignant the cyst needs to come out (at times it cannot be separated from the ovary which may need to be removed). Usually it is observed for 14-20 weeks and then a decision is made to either remove it at this point when the surgery is very unlikely to effect the pregnancy or to leave it until after the pregnancy. Both options carry some risks but luckily these are low.