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| COMMENTARY |
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| Year : 2017 | Volume
: 10
| Issue : 4 | Page : 388-389 |
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Ovarian pregnancy: A diagnostic dilemma
Subhashish Das
Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
| Date of Web Publication | 4-Sep-2017 |
Correspondence Address:
Subhashish Das
Department of Pathology, Sri Devaraj Urs Medical College, Kolar - 563 101, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/MJDRDYPU.MJDRDYPU_18_17
How to cite this article:
Das S. Ovarian pregnancy: A diagnostic dilemma. Med J DY Patil Univ 2017;10:388-9 |
Ovarian cancer is the third common gynecologic malignant tumor (25%). Frequent ovulation, family history, increasing age, and use of ovulatory drugs are known risk factors. Elevated serum levels of CA 125 have a very limited role in distinguishing ovarian malignancy from normal pregnancy.[1]
A high index of clinical suspension along with appropriate laboratory results and radiological investigations such as endovaginal color Doppler sonography may be helpful in making a correct preoperative diagnosis.[1]
Some of the characteristic radiological features of ovarian cancer include (a) size >4 cm, (b) solid or complex (solid and cystic), (c) necrosis, and (d) high flow pulsatility of the tumor vessels along with certain associated findings, namely (a) infiltration of pelvic sidewall, (b) ascites, (c) peritoneal implants, and (d) lymph node enlargement may help in the diagnosis of ovarian cancer.[1]
However, despite well-established imaging criteria for ovarian cancer, findings in benign and malignant ovarian lesions overlap and a variety of ovarian cancer mimics contribute to the diagnostic dilemmas and challenging the clinical scenarios.[2]
Some of the common mimics of the ovarian cancer include [2] (1) solid pelvic/adnexal lesions (mature solid teratoma, massive ovarian edema), (2) complex adnexal lesions (tubo-ovarian abscess, endometrioma), and (3) mimics of metastasizing ovarian cancer (gastrointestinal, breast cancer or melanoma metastasizing to the ovary and peritoneum, pseudomyxoma peritonei).
Of late, fine needle aspiration cytology has been used as a diagnostic tool a distinguish between ovarian pregnancy and ovarian carcinoma with limited success.[3] Peritoneal washing cytology may also help in the diagnosis of ovarian pregnancy.[4] Recent review of literature revealed a few cases where a correct diagnosis of ectopic pregnancies was done from Arias-Stella reaction in cervicovaginal smears.[5]
Although it is possible to retrieve trophoblastic cells by fine needle aspiration following rupture in ectopic pregnancies, interpretation of cytology smears should be done cautiously along with proper clinical and radiological correlation as it is difficult to differentiate on smears between trophoblastic and malignant cells.[6] This because trophoblastic cells are large cells with basophilic or eosinophil cytoplasm and multiple nuclei with irregular nuclei and a finely granular chromatin pattern.[7] Occasionally, papillary projection may be seen which probably reactive tubal epithelial cells.[8]
| References | |  |
| 1. | Tan PL, Ridley LJ. Incidental heterotopic pregnancy demonstrated on magnetic resonance imaging. Australas Radiol 2005;49:75-8.  [ PUBMED] |
| 2. | Park SB. Features of the hypointense solid lesions in the female pelvis on T2-weighted MRI. J Magn Reson Imaging 2014;39:493-503. [ PUBMED] |
| 3. | Chaudhuri S, Datta S, Paul PC, Mukherjee S, Mala S. Cytologically diagnosed ovarian carcinoma turned out to be a case of chronic ectopic pregnancy. J Interdiscip Histopathol 2014;2:116-20. |
| 4. | Su CC, Tzeng CC, Huang KF. Chronic ovarian pregnancy mimicking an ovarian tumor diagnosed by peritoneal washing cytology: A case report. Acta Cytol 2009;53:195-7. [ PUBMED] |
| 5. | Kobayashi TK, Okamoto H. Cytopathology of pregnancy-induced cell patterns in cervicovaginal smears. Am J Clin Pathol 2000;114 Suppl 1:S6-20. |
| 6. | Fiorella RM, Cheng J, Kragel PJ. Papanicolaou smears in pregnancy. Positivity of exfoliated cells for human chorionic gonadotropin and human placental lactogen. Acta Cytol 1993;37:451-6. [ PUBMED] |
| 7. | Frank TS, Bhat N, Noumoff JS, Yeh IT. Residual trophoblastic tissue as a source of highly atypical cells in the postpartum cervicovaginal smear. Acta Cytol 1991;35:105-8. |
| 8. | Gungor T, Altinkaya SO, Ozat M, Özgü E, Mollamahmutoglu L. A case of chronic ectopic pregnancy mimicking ovarian cancer. Int J Gynecol Cancer 2009;19 Suppl 2:382. |
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