July 19th, 2019

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Adnexal Masses 5 cm in Diameter or Greater Extirpated During Cesarean Operation
Authors:  Serenat Eris Yalcin, M.D., Yakup Yalcin, M.D., Mehmet Ozgur Akkurt, M.D., And Yavuz, M.D., and Mekin Sezik, M.D.
  OBJECTIVE: To describe our experience with adnexal masses ≥5 cm in diameter removed at cesarean delivery during a 10-year-period.

STUDY DESIGN: During 8,308 cesarean deliveries, there were 60 (0.7%) adnexal masses of ≥5 cm in diameter with a diagnosis after 28 weeks’ gestation. These were matched on 2:1 basis with 120 randomly selected cesarean deliveries that served as controls. Maternal age, parity, gestational age at delivery, operative findings, tumor histopathology, and perioperative data were retrieved from patient files and compared across cases and controls.

RESULTS: Baseline data such as maternal age, parity, and gestational age at cesarean delivery were similar (p>0.05 for all) across the groups. Composite obstetric morbidity (15% vs. 17%, p=0.67), mean drop in hematocrit (3.0±2.4 vs. 3.5±2.2, p=0.10), postoperative fever (3.3% vs. 4.1%, p=0.785), and postpartum hospitalization (2.4±0.6 days vs. 2.5±0.4 days, p=0.289) also did not differ. However, operative length was longer in the adnexal mass group (44.7±9.2 min vs. 40.2±6.4 min, p=0.0001). The most common pathologic diagnosis was mature cystic teratoma (33.3%). There were 2 (3.3%) borderline tumors and 1 malignancy (1.6%, mucinous cystadenocarcinoma).

CONCLUSION: Removal of an adnexal mass ≥5 cm in diameter during cesarean operation is not associated with increased morbidity except for longer operative length. Although malignancy is relatively rare, routine frozen section and availability of a gynecologic oncology team can be endorsed.
Keywords:  adnexal diseases; adnexal mass; adnexa uteri; cesarean delivery; cesarean section; cystic teratoma; ovarian tumor; teratoma; teratoma, cystic
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