Coincidental adnexal neoplasms at cesarean section

Yıl 2004, Cilt: 35 Sayı: 2, 61 - 66, 01.03.2004

İlknur Aköz Kiliççi Çetin Kutlu Tayfun Pekin Oya Eren Sadiye

Öz

Objective: To examine adnexial masses which were found accidentally during cesarean section ( CIS) and evaluate these findings with literatere review. Material and Methods: This study was performed on Zeynep Kamil Hospital between January and December 2002. In this period, the patients who wewe delivered by sectio cesarean (CIS) evaluated retrospectively according to hospital records. All patients had CIS because of obstetrical indications and their adnexial masses were not diagnosed before CIS . They found accidentally. The patients' number was 42. Result: In this study, mean age was 24.4 (17-41), mean pregnancy number was 3.2 (1-8). Twelve of the patients 28.5 % were nulliparous, thirty (71.5%) patients were multiparous.Indications of CIS were previous CIS, fetal distress and fetal malpresentation their numbers were 11,19,12 respectivelyAdnexial masses were not found before CIS for all these patients.Histopathologically paratubal cyst was found with highest number of presentation corpus luteum cyst (9 patients,21.4%), mucinous cystadenom 6 patients (14.3 %) benign teratom ;5patients( 11.9%), serous cystadenom 3 patients( 7.1%), endometrioma 1 patient and fibrotechoma 1 patient were diagnosed histopathologically. Malignancy was not present for that group. Adnexial masses were found bilaterally for two patients. Mass sizes changed between 1.5 xl.O cm. (the smallest one), 22x18 cm .(the largest one). Nineteen patients had adnexial masses bigger than 6 cm in volume. Conclusion: Pregnancy complicated adnexal masses if mass size become 6cm than bigger, asymptomatic no malign screening test characterstics .exploratory laparotomy desicion will be agressive because of perinatal morbidity. We recommend observation in asymptomatic pregnants until labor if It become emergency situation.

Anahtar Kelimeler

Adnexal Diseases, Cesarean Section, Ovarian Neoplasms, Retrospective Studies

Sezaryen sırasında tesadüfen saptanmış adneksiyal kitleler

Öz

Amaç: Sezaryen sırasında tesadüfi olarak saptanmış adneksiyal kitlesi olan vakaların incelenmesi ve literatür bilgileri ışığında değerlendirilmesi yapılmıştır. Materyal ve Metod: Bu çalışma, Zeynep Kamil Kadın Hastalıkları ve Doğum Hastanesinde Ocak 1995 -Aralık 2002 yılları arasında sezaryen ile doğum yapmış hastaların, dosya kayıtlarının retrospektif olarak incelenmesiyle yapıldı. Tamamen obstetrik endikasyonlarla sezaryene alınan ve tesadüfi olarak adneksiyal kitle saptanan olgular seçildi, sezaryen öncesinde adneksiyal kitlesi olduğu bilinen hastalar çalışmaya alınmadı. Toplam 42 olgu vardı. Bulgular: Olguların ortalama yaşı 24.4 (17- 41),ortalama gebelik sayısı 3.2 ( l-8)di.Hastaların 12 (%28.5)si nullipar , 30 (%71.5)u multipardı. Sezaryen endikasyonlan; 11 (%26.1) olguda eski sezaryen, 19 (%45.2) unda fetal distress, 12 (%28.5) sinde fetal malprezantasyon olup hiçbirisinde operasyon öncesinde adneksiyal kitleden şüphelenilmemişti. Histopatolojik tanılarına göre; en çok tesbit edilen 17 vaka (% 40.4)ile paratubal kist olup bunu sırasıyla ; 9 olguda (%21.4) corpus luteum kisti, 6 (%14.3) sında müsinöz kistadenom, 5 (%11.9)inde benign teratom, 3 (%7.1) ünde seröz kistadenom ve birer vaka ile endometrioma ve fibrotekoma izlemektedir. Hiçbir olguda maligniteye rastlanmadı. İki vakada adneksiyal kitle bilateraldi.Kitle büyüklüğü, en küçük 1.5x 1.0 cm, en büyük 22 x 18 cm. arasında değişmekteydi. Vakalann 19'unda adneksiyal kitle çapı 6 cm den büyüktü. Sonuç: Adneksiyel kitle ile komplike olmuş gebeliklerde, kitle 6 cm den büyük ve ikinci trimesterde de sebat ediyor ama asemptomatik ve görüntüleme yöntemleri ile değerlendirildiğinde malignite kriterleri taşımıyorsa; laparotomi kararı perinatal morbiditeyi artıracak agressif bir karar olabilir. Hasta yakın takiple miadına kadar izlenebilir ve akut bir komplikasyon çıkmadıkça laparotomi gebelik sonrasına ertelenebilir.

Anahtar Kelimeler

Adneksa hastalıkları, Sezaryen, Yumurtalık neoplazmları, Geriyedönük çalışma

Kaynakça

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