How are granulosa cell tumors (GCTs) of the ovaries treated during pregnancy?

Updated: Aug 30, 2018
  • Author: David C Starks, MD, MPH; Chief Editor: Warner K Huh, MD  more...
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Answer

Special concerns

Ovarian tumors occur or can be found during pregnancy. Because only 2% of masses in pregnant women are malignant, these masses can be followed expectantly if diagnosed in the first trimester because most masses resolve spontaneously. Tumors that persist into the second trimester, especially if complex or larger than 6 cm, should be managed surgically.

Approximately 10% of GCTs occur in pregnant patients. These masses do not resolve with expectant management, and surgical therapy should be carried out as follows:

  • The optimal time for abdominal exploration is approximately 16-18 weeks of gestation. The incidence of fetal loss, preterm labor, and maternal morbidity appears to be lower at this gestational age. A high vertical incision should be employed because the adnexa are out of the pelvis at this point in pregnancy. Because most tumors are stage Ia (see Staging), a unilateral salpingo-oophorectomy is sufficient treatment for most patients. In cases in which spread outside of the ovary already has occurred, treatment recommendations become unclear. Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of the fetus and placenta in toto, is another option to be considered. Some patients have been treated with unilateral salpingo-oophorectomy, resection of all visible tumor, and adjuvant chemotherapy.

  • The decision to begin chemotherapy during pregnancy rests with the patient and physician because all chemotherapy agents are potential teratogens. Reports of chemotherapeutic agent use in the second and third trimester for other ovarian tumors exist, but caution should be taken because little is known about the long-term effects on the developing fetus. Delaying adjunct therapy until after delivery is not well studied but could be considered because many of these tumors exhibit indolent growth.

A higher propensity for torsion exists in pregnant patients because the adnexa become abdominal structures early in the second trimester. In pregnant patients presenting with acute abdominal pain and a palpable mass, sonographic evaluation of the adnexa can help confirm the presence of an adnexal mass.


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