Management of adnexal masses during the third trimester of pregnancy: a case report in twin-pregnancy and review of the literature

The occurrence of ovarian masses during pregnancyis uncommon, nevertheless the correct diagnosis and management, either surgical or obstetric, may represent an issue. The clinical management has to take into consideration aspects both related to the mass (symptoms of torsion, rupture or occlusion and malignant potential) and to the foetal risks. A 36-year-old woman with a twin pregnancy at 29 weeks of gestation was diagnosed with an ovarian cyst with suspicious ultrasonographic features (diameter of 15 cm and enhanced blood flow). An expectant management until a safer gestational age for the twins was established. At 32 weeks of gestation symptoms of bowel obstruction and abdominal pain required a caesarean section and the removal of the affected adnexum. The histological analysis revealed a mucinous borderline tumour with intraepithelial carcinoma. When an adnexal mass is diagnosed during third trimester of pregnancy the ultrasonographic evaluation has to be done to assess the potential of malignancy. The clinical management needs a multidisciplinary approach has to be balanced between the risk of malignancy or other issues related to the mass and the foetal health.