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Objective: To determine the clinical outcomes and risk factors for persistence of ovarian cysts in pregnant women. With the increased use of ultrasound in pregnancy, the identification of incidental ovarian masses is becoming more common., Study Design: An observational study of women with ovarian masses identified before 24 weeks of pregnancy was performed. Only women who underwent follow-up imaging or surgery were included. Factors associated with persistence and outcomes of women who underwent surgery were analyzed., Results: Of the 803 women with available follow-up, the cysts resolved in 707 (88.1%) patients. Fifty (6.2%) women underwent surgical intervention. Women with persistent cysts were younger, more often Hispanic, detected at a later gestational age, had larger cysts, and more often had complex or solid components (p < 0.05 for all). Overall, 1 (0.1%) malignancy was diagnosed (a patient with a B-cell lymphoma), while 3 (0.4%) women had borderline epithelial ovarian tumors., Conclusion: Ovarian masses identified during pregnancy have a low risk of malignancy. The majority of women can be serially monitored without intervention.

Background: Incarceration of the gravid uterus is a rare but serious complication of pregnancy. The often required cesarean section is technically complicated, and preoperative planning is critical. An important initial surgical step is to lift the fundus out of the pelvis prior to creating the hysterotomy in order to facilitate adequate visualization of the pelvic anatomy., Case: A 38-year-old primigravida with uterine incarceration from a large anterior leiomyoma underwent cesarean delivery at 29 weeks' gestation. In this case, a failure of the fundal height to increase was not appreciated as the anterior leiomyoma was palpated to represent the fundus. Intraoperatively the uterus was unable to be repositioned because of the leiomyoma. However, the surgery did proceed smoothly primarily due to the highly detailed images obtained on pelvic magnetic resonance imaging., Conclusion: Although uterine incarceration is rare, knowledge of this condition is important. Magnetic resonance imaging is a useful tool in that it enables the detailed evaluation of the pelvic anatomy in cases with suspected uterine incarceration.

Objective: To describe the effects of pregnancy on the growth of leiomyomas using sonographic measurements of leiomyomas taken longitudinally during pregnancy., Study Design: The study population included asymptomatic gravidas with singleton pregnancies in whom we identified uterine leiomyomas. We included all women whose leiomyomas were measured at least twice during the pregnancy. In a subgroup of women we also compared the size of leiomyomas before and after the index pregnancy. Using real-time sonography, we measured each leiomyoma in 3 axes and averaged the measurements. During subsequent studies we calculated the percent change in the size of each tumor. We assessed complications related to the presence of these tumors., Results: We evaluated 137 leiomyomas in 72 women (average, 2.3 +/- 1.8 per woman). Each underwent an average of 3.7 +/- 2.1 scans. The average gestational age at the time of first assessment was 14.4 +/- 5.4 weeks. The average diameter of the leiomyomas at the first study was 34.2 +/- 23 mm. On average, there was no significant change in the size of leiomyomas during pregnancy. We found that the size, location and our ability to visualize leiomyomas varied significantly during pregnancy. Four of the 72 women had obstetric complications related to the presence of leiomyomas., Conclusion: The findings of our longitudinal sonographic assessment of 137 uterine leiomyomas suggest that despite the commonly held belief that they tend to enlarge during the course of pregnancy, this phenomenon is in fact quite rare.

Background: Multiple pregnancy complicated by the presence of a complete hydatidiform mole (CHM) is a rare clinical entity. However, there are enough accumulated data to assist the clinician in the management of such a patient., Cases: Case 1 presented in the first trimester with a twin pregnancy associated with a CHM. In the absence of other complications, the pregnancy was monitored with serial beta-human chorionic gonadotropin (beta-hCG) and ultrasound measurements. A reduction in molar volume suggested regression of the CHM. The pregnancy was successfully carried to term with no progress of the CHM. Beta-hCG levels regressed after delivery. Case 2 had a triplet pregnancy resulting from in vitro fertilization with a CHM detected in the first trimester. Similar measurements were applied. The pregnancy was complicated by episodes of antepartum hemorrhage (APH). Further, the molar volume continued to increase. Because of recurrent APH, delivery was by cesarean section. After delivery, after an initial decline, the beta-hCG level rose, and pulmonary metastases were detected. The patient was treated with single-agent chemotherapy, with complete resolution., Conclusion: The combination of serial ultrasound molar volume measurements with serial beta-hCG estimation may assist the clinician in predicting which of these rare complicated pregnancies will result in the development of trophoblastic neoplasia.

Background: Primary appendicular adenocarcinoma is a rare type of appendicular carcinoma. We report mucinous appendicular adenocarcinoma during pregnancy. To our knowledge, this is the third reported case., Case: A 35-year-old woman at 21 weeks of gestation presented with acute abdominal symptoms for the previous 10 days and underwent appendectomy. Histopathologically, examination of the appendectomy material was reported as "mucinous appendicular cystadenocarcinoma." The pregnancy was terminated by misoprostol induction. A right hemicolectomy and staging procedure were performed on the third postpartum day with relaparotomy., Conclusion: Although it rarely coexists with pregnancy, primary appendicular adenocarcinoma should be considered in pregnant women with atypical acute abdominal symptoms of long duration. Primary adenocarcinoma of the appendix should be treated with right hemicolectomy even if it is a secondary procedure. Termination of pregnancy is not essential to the surgical procedure, and the decision on the outcome of the pregnancy should be made with the patient.

Background: Papillary adenocarcinomas are rare tumors of the gastrointestinal tract. There are few reports of this neoplasm diagnosed during pregnancy., Case: A case of adenocarcinoma of the papilla of Vater was diagnosed by sonographically guided biopsy during pregnancy. The patient underwent radical resection of the tumor at 25 weeks' gestation; pregnancy termination was not indicated. At 39 weeks' gestation, a cesarean-section was performed. The postoperative period entailed total parenteral nutrition until intestinal motility stabilized. This ensured the mother and fetus' well-being until delivery., Conclusion: Papillary adenocarcinoma is associated with good prognosis since it is totally removed by radical resection, and pancreaticoduodenectomy can be performed successfully during pregnancy, but the patient must receive special prenatal care.

Background: Chorioangioma is the leading diagnosis for circumscribed placental lesion noted on ultrasound. Other rare intraplacental tumors may have a significant clinical impact on the mother and fetus., Case: An intraplacental, hypoechoic area consistent with chorioangioma was noted on ultrasound examination at 17 weeks' gestation. The lesion remained stable in size throughout gestation, with no evidence of fetal hydrops or polyhydramnios. At term, a live-born male infant was delivered vaginally, followed by spontaneous expulsion of the placenta. Histologic examination of the placenta revealed an intraplacental, potentially malignant smooth muscle tumor. Six weeks postpartum, total abdominal hysterectomy and pelvic node sampling were performed. No residual disease was found on the final histologic examination., Conclusion: Although ultrasound differentiation is difficult, rare nontrophoblastic tumors should be considered in the differential diagnosis of placental masses. To our knowledge, this is the first report of such a lesion in the placenta.

Objective: To determine the applicability and reliability of color Doppler ultrasonography (US) for distinguishing a uterine myoma from a focal myometrial contraction., Study Design: Images from 36 patients with uterine thickenings were classified as myomas when color Doppler US demonstrated no centralized flow with a circumscribed vessel pattern at the border. Thickenings were classified as focal myometrial contractions when there was demonstrable vascular flow throughout the thickening., Results: Using these diagnostic criteria, images from 36 patients were reliably characterized as representing myomas or contractions. The diagnosis was made more reliable by using the lowest velocity settings and exclusion of power Doppler US in nonretroplacental lesions., Conclusion: Color Doppler US is a sensitive and reliable tool for distinguishing uterine myomas from focal myometrial contractions.

Background: Malignant hemangioendothelioma is a neoplasm of vascular origin characterized by irregular vascular channels lined with atypical endothelial cells., Case: A gravida at 32 weeks' gestation presented with diffuse back and lower leg pain and was diagnosed with multifocal malignant hemangioendothelioma of bone. Computed tomography of the chest also demonstrated a small right atrial density. Three weeks later the patient became septic, and cesarean section was performed. After several cycles of chemotherapy, clinical improvement was noted. However, disease progression was noted thereafter, and the patient died one and a half years after the diagnosis., Conclusion: Our case was a primary multifocal malignant hemangioendothelioma of bone arising during pregnancy. Considering the absence of pulmonary involvement, it is unlikely that the skeletal lesions represented metastatic deposits from a cardiac primary. With such extensive skeletal disease, the right atrial density probably was a metastatic deposit.

Both heterotopic pregnancies and primary neoplasms of the fallopian tube are rare occurrences. A patient presented with early pregnancy, abdominal pain and ultrasound findings of an intrauterine gestation and a fallopian tube mass. Laparotomy revealed a primary leiomyoma of the fallopian tube.

With new techniques in transvaginal ultrasound, higher resolution allows the earlier diagnosis of fetal developmental anomalies. We describe a case of first-trimester antenatal diagnosis of alobar holoprosencephaly using transvaginal and perineal ultrasound that was obscured from transabdominal sonography by a large uterine leiomyoma.

Three rare conditions--amniotic band disruption sequence, placental chorioangioma and congenital nephrosis--were diagnosed in midtrimester because of elevated maternal serum alpha-fetoprotein. The diagnosis is important for genetic counseling and obstetric follow-up.

The diagnosis of advanced extrauterine pregnancy is made most often sonographically by identification of a uterus separate from the fetus. Leiomyomas or other pelvic masses can make the sonographic diagnosis more difficult. In a woman with an advanced ectopic pregnancy and uterine leiomyoma, the sonographic diagnosis was made by passing a sterile probe through the endocervix with simultaneous, real-time ultrasound observation.

Fibrolamellar carcinoma of the liver is a rare tumor that has not been previously reported to occur during pregnancy. A 22-year-old, pregnant Arab woman with documented fibrolamellar carcinoma of the liver was followed at our high-risk pregnancy unit. Despite the severity of the disease, the pregnancy and delivery were uneventful.

A Merkel cell tumor occurred in a young, pregnant woman. The patient delivered prematurely, and the infant died of prematurity. The patient died within two years of the diagnosis.

Two patients had elevated beta-human chorionic gonadotropin levels and normal abdominal ultrasound examinations. In both instances transvaginal ultrasonography demonstrated a persistent nodule of trophoblastic disease confirmed at the time of hysterectomy. This new imaging modality can assist in the diagnosis of persistent trophoblastic disease in the uterus.

Seven women with prolactin-secreting pituitary microadenomas and three with persistent hyperprolactinemia after surgical adenomectomies were evaluated with computed tomography to assess the effect of pregnancy on the volume of pituitary prolactinomas and hyperfunctioning pituitary tissue. In one patient a microadenoma enlarged to become a macroadenoma. Tumor enlargement occurred in the remaining six patients with microadenomas. None of the patients with previously resected adenomas exhibited hypertrophy of residual pituitary tissue or tumor recurrence after pregnancy.