1. Ovarian Cancers In Pregnancy

2. Incidence Effect on Pregnancy Histologic Variations Clinical Variation Ovarian Cancers in Pregnancy

3. Ovarian Cysts in Pregnancy

4. Indications for Surgery Ovarian Cysts in Pregnancy - Diameter > 6cm - Persist at 18 weeks - Complications Rupture, Torsion, Hemorrhage

5. Diagnosis Ovarian Tumors in Pregnancy - Physical examination - Ultra sonogram - M.R.I.

6. Differential Diagnosis Ovarian Tumors in Pregnancy - Retroverted pregnant uterus - Pedunculated myoma - Carcinoma of rectosigmoid - Pelvic kidney

7. Indications for Surgery Ovarian Tumors in Pregnancy - Persist at 18 weeks - Complications occur - Suddenly in creased

8. Ovarian Tumors in Pregnancy Complications - Torsion - Rupture - Hemorrhage (shock like syndrome) - Obstruction

9. Signs and Symptoms Of Complications Abdominal pain (Acute) Nausea, Vomiting Tenderness of the abdomen Rebound tenderness Shocklike symptoms

10. Management of Ovarian mass

12. Adnectomy Preservation of the ut. Preservation of controlateral ovary Chemotherapy Delivery at 34 w.

13. Pregnancy Related Ovarian Tumors Pregnancy Luteoma Hyperreactio luteinalis Ovarian hyper stimulation syndrome

14. Luteoma of Pregnancy Vary in size Bilateral in of cases Multiple Nodules Plasma testosterone Virilization and hirsutism Infant virilization CA-125 Biopsy

15. Hyperreactio Luteinalis Theca-lutein cyst Unilateral, or Bilateral Typically after first trimester Theca interna luteinization high h.C.G Virilization only in mother

16. Ovarian Hyper Stimulation Syndrome - Rare event - Multiple follicular cysts - Most often caused by induction ovulation I.V.F - Increased Capillary Permeability

17. Ovarian Hyper Stimulation Syndrome Hypovolemia, Ascites Pleural, Pericardial effusion Kidney injury, ARDS, Thromboembolism

18. Borderline Tumors Effect of pregnancy on L.M.P. Epithelial Atypia Epithelial Proliferation Eosinophilic Cells Mucin Production Frequent Microinvation L.M.P.

19. Frankly Malignant Tumors - 2%-5% of ovarian tumors - Diagnosis is Fortuitously - Close observation lead to earlier diagnosis

20. Frankly Malignant Tumors Germ cell tumors Epithelial Ovarian Tumors Sex Cord Stromal Cell Tumors

21. Germ Cell Tumors Dysgerminoma Yolk Sac Tumor Immature Teratoma Embryonal Carcinoma Mixed Germ Cell Tumors

22. Germ Cell Tumors 1. Adnexectomy 2. Omentectomy 3. Peritoneal washing 4. Peritoneal biopsy unilateral 5. Lymph node sampling 6. Chemotherapy Surgical Staging

23. Germ Cell Tumors Advanced Stages Unilateral adnexectomy Remove all Seedings Chemotherapy

24. Sex-cord Stromal Cell Tumors Granulosa cell tumor Sertoli-leydig cell tumor Slow growth Adnexectomy No staging, No debulking No chemotherapy

25. Epithelial Ovarian Tumors - More aggressive - No surgical staging - No debulking - Removal of the tumor - Chemotherapy - After delivery

26. Sex Cord Stromal Cell Tumors Granulosa cell tumor Sertoli-leydig cell tumor Slew growth Resection of tumor completely No chemotherapy