임신중 발생한 난소종양의 임상적 고찰

서정욱(Jeong Wook Seo),노정훈(Jeong Hoon Rho),오관영(Kwan Young Oh),박미혜(Mi Hye Park),김은경(Eun Kyung Kim),양윤석(Yun Seok Yang),황인택(In Taek Hwang),정지학(Ji Hak Jung),박준숙(Joon Sook Park) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

목적 : 임신 중 동반된 자궁부속기종양에 대한 임상양상 및 임신경과에 미치는 영향을 알아보고자 본 연구를 하였다.방법 및 재료 : 1995년 1월부터 1999년 12월까지 만 5년간 본원에서 경험한 임신 중 동반된 자궁부속기종양 69례를 분석하였다. 추적관찰 중 자연소멸되었거나 자궁외 임신과 동반된 경우는 제외되었다. 임상양상을 조사하였으며 임신 중 수술적 처치 및 보존적 치료가 임신경과에 미치는 영향을 분석하였다. 결과 :1. 발생빈도는 같은 기간의 총 분만수 10,550예에 69례로 1:153(0.65%)이었고 악성으로는 1예(1/10,550)의 점액성 경계성 종양이 발견되었다. 2. 연령은 25세∼29세군이 가장 많았으며(42.0%) 다산모보다 초산모에서 더 흔했다.(59.4%:40.6%)3. 난소종양으로 인한 합병증은 염전이 10예(14.6%)로 가장 많았으며 기타 출혈이나 파열의 예는 없었다.4. 진단시기는 임신 제 1삼분기가 53.6%, 제 2삼분기가 14.5%, 제 3삼분기가 31.9%였고 진단방법은 초음파와 내진에 의하였으며 제왕절개수술중 우연히 발견된 경우도 20예(29.0%)였다. 5. 수술시기는 제왕절개술중 우연히 발견된 20예를 제외하고 제 1삼분기에 67.6%, 제 2삼분기에 24.3%, 제 3삼분기에 8.1%순이었다.6. 총 69예중 제왕절개수술중 우연히 발견된 20예와 난소종양수술과 동시에 인공유산시킨 22예를 제외한 27예에서 이중 18예는 수술적 처치로 나머지 9예에서는 비수술적 요법으로 치료받으며 임신의 경과를 관찰했다.7. 임신경과는 수술적 처치를 받은 군(18예)에서 만삭질식분만이 12예(66.7%), 만삭 제왕절개수술이 5예(27.8%), 조산이 1예였으며 평균 분만주수는 38.8주였다. 비수술군(6예)에서는 만삭질식분만이 1예(16.7%), 만삭제왕절개수술이 4예(67.0%), 조산이 1예였다.8. 병리조직학적 소견으로는 양성 낭성기형종이 35.7%, 점액성 낭선종이 22.9%, 장액성 낭선종이 14.3%, 단순낭종이 14.3%였다.9. 제왕절개수술이 32예에서 행해졌는데 25례에서 산과적 이유로, 나머지 7예에서 난소종양을 주소로 수술하였다.결론 : 최근 산전진찰에 초음파의 이용으로 임신 중 자궁부속기종양의 발견율이 증가하는 추세이며 이의 처치에 있어서 임신에 미치는 영향을 고려할 때 방법의 선택에 있어 신중을 기해야 한다. 본 논문은 임신 중 자궁부속기종양의 임상양상을 조사하였으며 수술적, 비수술적 처치 및 수술시기가 임신의 경과에 미치는 영향을 비교, 분석하였다. Objective : Our purpose was to evaluate the clinical appearance and outcome of pregnancy associated with ovarian tumors. Methods : A review was performed of patients who were seen with an ovarian tumor in pregnancy from January 1995 to December 1999. We excluded ovarian tumors that resolved spontaneously and were found simultaneously with ectopic pregnancy. Results : 1. The incidence of ovarian tumors in pregnancy was 69 in 10,550 deliveries.(1:153) One case of mucinous borderline malignancy was found. 2. The ovarian tumors occuring in pregnancy were the most common at 25 to 29 years old-pregnant women(42.0%) and more common in nulliparous pregnant women(59.4%) than in multiparous women.(40.6%) 3. The most common complication of ovarian tumors in pregnancy was torsion which is 10 cases(14.6%) 4. Pre-operative diagnosis of ovarian tumors was made in the first trimester(53.6%), second trimester(14.5%), and third trimester(31.9%) 5. Excluding the 20 cases of cesarean section, operation was performed at first trimester in 25cases(67.6%), at second trimester in 9 cases (24.3%), at third trimester in 3 cases (8.1%). 6. The surgical management was performed from 18 women and the conservative therapy was done at 6 cases. 7. According to the outcome of pregnancy, among 18 cases in which the ovarian tumor was removed, vaginal delivery occurred at term in 12 cases (66.7%), cesarean section in 5 cases(27.8%) and premature delivery in 1 case. Among the other cases in which conservative management was performed, term vaginal deliveries were done in 1 case(16.7%), cesarean section in 4 cases(67.0%) and premature delivery in 1 case(16.7%). 8. The histologic features of the exised ovarian tumors were benign cystic teratoma 25 cases (35.7%), mucinous cystadenoma 16 cases(22.9%), serous cystadenoma 10 cases(14.3%) and simple cyst 10 case(14.3%) 9. The cesarean section was performed in 32 cases including emergency operation. In 25 cases, common cause was due to obstetrical problem( elective repeat cesarean section, fetal malpresentation, labor disorder) and in the rest 7 cases was due to adnexal masses. Conclusion : Although the incidence of ovarian cancer in pregnancy is low, the incidental finding of an adnexal mass in pregnancy is more common. Because complications of surgery are increased in pregnancy, operative management needs to be considered. Our data was consistent with what has been reported clinical study to determine optimal management of an ovarian tumor in pregnancy.

흰쥐의 번식과정에 있어서 Progesterone-tube 이식이 난소와 태반중량 및 임신기간에 미치는 영향

민관식,오석두,윤창현 한국동물번식학회 1990 Reproductive & developmental biology Vol.14 No.4

This study was conducted to find out the changes of ovarian, placental and fetal weights and periods of pregnancy in rats implanted with progesterone-tube during the reproductive stages. One hundred and thirty-four mature rats, 10~13 weeks old, were offered for this experiment. The animals, which were implanted with silicon tubes filled with progesterone on day 15 of pregnancy, were sacrified at 18, 20, 21 and 22 days of pregnancy. The changes of ovarian, placental and fetal weights and the number of fetuses during late pregnancy were recorded. The results obtained were summarized as follows : 1. After progesterone-tube implantation, ovarian weight reached to a peak value of 92.0$\pm$0.9mg at 20 days of pregnancy, there after decreased significantly to 79.5$\pm$7.6 and 68.26$\pm$4.2mg at 20 and 22 days of pregnancy(P<0.01). 2. The placental weight increased rapidly during 15~18 days of pregnancy in control and progesterone treated rats. A peak value of 447.78$\pm$20.9mg was shown at 20 days of pregnancy after progesterone-tube implantation, and in control rats the value decreased significantly to 419.42$\pm$11.6 and 404.1$\pm$29.3mg at 20 and 21 days of pregnancy(P<0.01). 3. The fetal weights was not shown any significant differences between control and progesterone-tube implanted rats. 4. The number of fetuses in control rats were 14.75$\pm$0.4 at 8~10 days of pregnancy and 13.5$\pm$0.3 and 13.25$\pm$0.4 at 12 and 20 days of pregnancy. 5. The significant difference in periods of pregnancy was appeared between progesterone-tube implanted(27.3$\pm$0.3 days) and control(22.1$\pm$0.3 days)rats(P<0.01).

난소 임신 10예의 분석

김용진,이충일,이해혁,남계현,이임순,이권해 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Ovarian pregnancy is an uncommon form of the ectopic pregnancies. The ovarian vascularity results in maternal hemorrhage early in the first trimester, which disrupts the pregnancy and usually ruptures the ovary with sufficient hemoperitoneum to require emergency operation. This report presents 10 cases of ovarian pregnancy by retrospective review between January 1986 and December 1995 at the Department of Obstetrics and Gynecology, Soonchunhyang University Hospital. There was 19,849 deliveries and 637 ectopic pregnancies during same period. It showed that the incidence of ovarian pregnancy was 3.21 % of all ectopic pregnancies. The clinical features of ovarian pregnancy revealed that abdominal pain was the major symptom, and history of amenorrhea was obscure. Because of life-threatening course, the early diagnosis and treatment of ovarian pregnancy is important. The clinical diagnosis of ovarian pregnancy was more difficult than that of tubal pregnancy.

Don’t Hesitate on Performing Laparoscopic Surgery for Ovarian Masses during Pregnancy: A Multidisciplinary Approach to Ovarian Masses Complicating Pregnancy

( Sujung Oh ),( Ji Hye Jo ),( Subeen Hong ),( Hyun Sun Ko ),( In Yang Park ),( Hyesung Hwang ) 대한주산의학회 2022 Perinatology Vol.33 No.2

Objective: This study demonstrates sonographic features of such ovarian masses and share treatment process for those that require surgery during pregnancy. Methods: This retrospective study includes females diagnosed with ovarian masses during pregnancy at The Catholic University of Korea, Seoul St. Mary’s Hospital from 2009 to 2020. The study population was categorized into 2 groups depending on the need for surgery based on gestational age at the time of detection of ovarian masses, sonographic findings, and delivery outcomes. From the group that had surgery, outcomes were analysed according to the gestational age at surgery and the surgical indications. Results: Of the 114 females with ovarian masses found during pregnancy, 49 (43.0%) underwent surgery during pregnancy, and 65 (57.0%) did not require surgery. Ovarian masses were found in the first trimester in 82 cases (71.9%). The risk factors for surgery were maternal age (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.72-0.98), gestational age at the time of detection (OR, 0.85; 95% CI, 0.76-0.94), the size of the mass (OR, 1.06; 95% CI, 1.03-1.09), and ascites (OR, 18.09; 95% CI, 1.83-178.78). In females undergoing surgery during pregnancy, 45 (91.8%) had laparoscopic surgery, and 20 (40.8%) were treated surgically after 1st trimester. The most common cause of surgery was mass torsion (n=22, 44.9%). Conclusion: The risk of ovarian surgery is higher during pregnancy when the mass is identified at an earlier gestational age, the masses are larger, or ascites is detected. Laparoscopic surgery is recommended even after the first trimester.

원조: 임상 : 임신 중 진단의 난소암: 17년간의 경험

위지선 ( Ji Sun We ),최세경 ( Sae Kyung Choi ),최정수 ( Jeong Soo Choi ),안현영 ( Hyun Young Ahn ),이영 ( Young Lee ),김사진 ( Sa Jin Kim ),신종철 ( Jong Chul Shin ) 대한주산의학회 2008 Perinatology Vol.19 No.2

목적: 임신 중 진단된 난소암 환자들의 임상 경과 및 임신의 결과를 알아보고자 한다. 방법: 1991년부터 2007년까지 가톨릭 중앙 의료원 산하 3개 병원에서 임신 중 조직학적으로 난소암 진단을 받은 환자들의 의무기록을 후향적으로 조사하였다. 결과: 임신 중 난소암 진단을 받은 10예 중 6예가 악성 난소암이었으며, 4예가 경계성 난소암이었다. 진단 당시의 임신주수는 제1삼분기가 6예, 제2삼분기가 1예, 그리고 제3삼분기가 3예였다. 10예 중 6예에서는 진단 전 특별한 증상을 보이지 않았고, 난소 낭종 염전으로 수술했던 1예 외에는 모두 초음파상 악성 종양을 시사하는 소견을 보였다. 조직학적 검사 결과에서 2예가 각각 IIIb기, Ia기의 투명세포암종이었으며, 다른 2예는 각각 Ic기, Ia의 장액성 선암종, 1예는 Ic기의 생식세포종, 다른 1예는 Ic기의 악성 기형종이었다. 상피성 난소암 I기를 보인 3예는 추가적인 항암치료를 시행하지 않았으며, 2예의 비상피성 난소암과 l예의 IIIb기 상피성 난소암의 경우는 항암 요법을 시행했다. 이 중 1예는 임신 중 항암 요법을 받았으나 합병증 없이 정상아를 분만하였다. 10예 중 4예는 추적 검사 도중 누락되었으나, IIIb기의 진행된 난소암을 진단받은 1예를 포함한 6예에서는 재발없이 생존하고 있다. 결론: 임신 중 진단된 난소암은 조기진단 및 치료가 이루어진 경우 좋은 예후를 보이므로 임신으로 인해 치료가 지연되지 않아야 하며, 임신 중의 항암화학 요법도 고려해 볼 수 있다. Objective: The aim of this study was to evaluate the clinical course and pregnancy outcome in patients who had ovarian cancer diagnosed during pregnancy. Methods: Review of medical records of 10 cases of patients who have ovarian cancer diagnosed during pregnancy at three affiliated hospitals in the Catholic Medical Center from January 1991 to December 2007 was done. Results: Among 10 cases diagnosed as ovarian cancer during pregnancy, six cases were in the first trimester, one case in the second trimester, and 3 cases in the third trimester. Six cases did not show any specific symptoms at diagnosis and seven cases showed malignant characteristics on ultra-sonography. Pathologic evaluation showed 2 clear cell tumors in stage IIlb and Ia, I germ cell tumor in Ic, I immature teratoma in Ic, and 2 serous adenocarcinoma in Ic and Ic, 2 borderline serous adenocarcinoma, and 2 borderline mucinous adenocarcinoma. Three cases with epithelial ovarian cancer in stage I did not receive chemotherapy. Two cases in non-epithelial ovarian malignancy and I stage IIlb epithelial ovarian cancer received chemotherapy. In one case, chemotherapy was performed during pregnancy and a healthy child was delivered. Five in 10 cases were lost in long term follow-up and 5 cases including stage IIlb case, remain without evidence of recurrent disease. Conclusion: If early diagnosis and treatment are performed, ovarian cancer diagnosed during pregnancy has favorable prognosis. So, delay the treatment of ovarian cancer due to pregnancy should not be permitted and proper chemotherapy during pregnancy should be considered if necessary.

난소임신에 관한 증례보고

황효순 ( Hyo Soon Hwang ),조금준 ( Geum Joon Cho ),진찬희 ( Chan Hee Jin ),오민정 ( Min Jeong Oh ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.2

Ovarian pregnancy is a rare form of ectopic pregnancy, and is most difficult to diagnosis before surgery. This study was conducted as a retrospective cohort series of women presenting to Korea University Medical Center between January 2000 and July 2011 in whom a diagnosis of ovarian pregnancy was made. We had total 7 cases of ovarian pregnancies between January 2000 and July 2011 at Korea University Medical Center. The mean age of the 7 ovarian pregnancy cases was 33.0 years (range, 22 to 42 years), mean parity was 1.0 (range, 0 to 3), mean gestational age at diagnosis was 8.0 (range, 5.6 to 12.4 weeks), and mean initial beta human chorionic gonadotropin (HCG) was 1,195.49 mIU/mL (range, 200.5 to 2,098.201 mIU/mL). The beta HCG level was lower remarkably in ovarian pregnancy group than in the tubal pregnancy group, and further study may be needed to find out the correlation between beta HCG level and ovarian pregnancy.

Ovarian pregnancy rupture in second trimester manifesting mental change in pregnancy: a case report

( Dong Won Hwang,),( Hae Won Choi ),( Yun Yeon Choi ),( Hee Sun Kim ),( Young Ah Kim ),( Kyoung-chul Chun ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.2

Ovarian pregnancies comprise approximately 3% of ectopic pregnancies. Moreover, ovarian pregnancies in the second trimester are extremely rare. We herein present a case of ruptured ovarian pregnancy in the second trimester. A 26-year-old Asian woman presented to our hospital complaining of an abrupt mental change. She was pregnant; however, she had not been receiving antenatal care. Her initial vital signs were unstable, and pelvic ultrasound revealed pelvic fluid collection. We analyzed the hemoperitoneum and performed exploratory laparotomy. When her abdomen was opened, we observed that her right ovary was ruptured. Placental cord insertion originated from the ovary, and a fetus was found in the pelvic cavity. The ovarian pregnancy was detected in a delayed state. Pregnant women require appropriate antenatal care, and pelvic ultrasound should be performed in the second trimester to ensure that the fetus is in the intrauterine cavity.

Ovarian Cancer during Pregnancy: Clinical and Pregnancy Outcome

권용순,목정은,임경택,이인호,김태진,이기헌,심재욱 대한의학회 2010 Journal of Korean medical science Vol.25 No.2

The aim of this study is to evaluate the clinical feature and pregnancy outcome in patients with ovarian cancer diagnosed during pregnancy. We retrospectively analyzed the medical records of 27 patients diagnosed with ovarian cancer during pregnancy at Cheil General Hospital & Women’s Healthcare Center from January 1996to December 2006. Mean age of the patients was 29.1 yr (range 23-40), and a mean follow-up period was 57 months (range 7-112 months). Of 27 patients, 15 (55.5%)had borderline malignancies, 7 (25.9%) had epithelial malignancies and 5 (18.6%)had germ cell tumors. A total of 26 patients received a conservative surgery preserving pregnancy. The mean time for surgical intervention during pregnancy was 20 weeks of gestational age. Of the 27 patients, 26 had full term delivery of a healthy baby without any congenital malformation. Only one patient with epithelial ovarian cancer had a relapse at 19 months after the first conservative operation with adjuvant chemotherapy. There were few data for managing patients with ovarian cancer diagnosed during pregnancy. This study results could help establish a guideline for management of ovarian malignancy complicating pregnancy.

Teenage pregnancy complicated by primary invasive ovarian cancer: association for oncologic outcome

Erin A. Blake,Madushka Y. De Zoysa,Elise B. Morocco,Samantha B. Kaiser,Michiko Kodama,Brendan H. Grubbs,Koji Matsuo 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.5

Objective: To examine survival of teenage women with pregnancies complicated by primary ovarian cancer. Methods: This is a secondary analysis of a previously organized systematic literature review of primary ovarian cancer diagnosed during pregnancy. Cases eligible for analysis were patients whose age at cancer diagnosis and survival outcome were known (n=201). Pregnancy and oncologic outcome were then examined based on patient age. Results: These were comprised of 95 (47.3%) epithelial ovarian cancers (EOCs), 82 (40.8%) malignant germ cell tumors (MGCTs), and 24 (11.9%) sex-cord stromal tumors (SCSTs). Teenage pregnancy was seen in 21 (10%) cases, and was highest among the SCST group compared to the other cancer types (EOC, 1.1%; MGCT, 14.6%; and SCST, 29.2%, p<0.001). Live birth rates, neonatal weight, full term delivery rates, and Cesarean section rates were similar between the teenage group and the non-teenage group (all, p>0.05); however, teenage pregnancy was significantly associated with an increased risk of serious maternal/neonatal adverse events (50% vs. 22.7%, p=0.013). On univariable analysis, teenage pregnancy was significantly associated with decreased ovarian cancer-specific survival (5-year rate: age ≥30, 79.6%; age 20–29, 87.2%; and age <20, 41.6%; p<0.001). On multivariable analysis controlling for calendar year, cancer type, cancer stage, and gestational age at ovarian cancer diagnosis, teenage pregnancy remained an independent prognostic factor for decreased ovarian cancer-specific survival compared to women aged ≥30 (adjusted-hazard ratio=4.71; 95% confidence interval=1.17–18.9; p=0.029). Conclusion: Teenage women with pregnancies complicated by primary ovarian cancer may be at increased risk of poor survival from ovarian cancer.

우측난소임신의 복강경적 치료 중 우연히 발견된 선천성 좌측 난소난관 형성부전 환자

장재연 ( Jae Yeon Jang ),김윤숙 ( Yun Sook Kim ),황인철 ( In Chul Hwang ),한효상 ( Hyo Sang Han ),선우재근 ( Jae Gun Sunwoo ),배동한 ( Dong Han Bae ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.11

Asymptomatic unilateral absence of a portion of a fallopian tube with or without adjacent ovarian agenesis is a very rare condition. The true incidence is unknown. Two etiologic causes are possible. Asymptomatic segmental torsion of the uterine tube and ovarian pedicle may occur for certain reasons during adulthood, in childhood, or even during the fetal stages. Consequently, torsion may give rise to necrosis and autoamputation. Alternatively, the absence of these organs may be congenital. Ovarian pregnancy is a rare form of ectopic pregnancy occurring in 0.5~1% of all ectopic pregnancies. Moreover, ovarian pregnancy in patient with congenital unilateral tubal and ovarian agenesis has not been reported. But, the presenting symptom is very similar and difficult to distinguish with other forms of ectopic pregnancy. Early detection is important role in preserving fertility to avoid the ablation of functional ovarian tissue. We report a case of congenital unilateral tubal and ovarian agenesis diagnosed during laparoscopic treatment of ovarian pregnancy.