P16.16: The efficiency and the limits of the ultrasound examination in pregnancy associated with an ovarian tumor

The ultrasound is a very useful tool to assess a tumor considering the image characteristics. We can also use the Doppler ultrasound to appreciate the possible malignancy of the tumor if we have doubts about the etiology, the increased vascularisation being a sign for cell proliferation, neovascularisation and cancer. Usually, an ovarian cyst is a functional one and these are simple, serous cysts, with smooth and regular capsula, no vegetations inside or outside of the capsula, without septations, so the ultrasonic image is clear anechoic or hypoechoic. Sometimes, the ovarian mass is an inhomogeneous tumor, or an ovarian cyst with septation inside or vegetations, giving the suspicion of ovarian cancer. If in addition, in the same time with the ovarian tumor is diagnosed a pregnancy in evolution, the confusion may be greater. We present the cases of two pregnant patients from our hospital diagnosed with ovarian tumors associated to pregnancy in the first trimester. Both of them came with symptoms and signs of pregnancy and at ultrasound examination besides the first trimester pregnancy, were highlighted ovarian tumors with an increased volume, around 100 mm diameters and ultrasound images as inhomogeneous multilocular tumors. These two cases were alike at first sight, but very different as diagnosis and evolution. Even if the ultrasound image was almost similar and the presence of the pregnancies was an argument for benign tumors, in one case the diagnosis was bilateral ovarian metastasis from colon cancer and in the other case, the diagnosis was ovarian border-line tumor. The final diagnosis was sustained by histopathology exam conjunct with immunohistochemistry tests, which made the difference between ovarian cancer and ovarian metastasis from digestive tract. In these two situations, the ultrasound was important and represented just the first step for investigate the patients, but was not enough to finalize the diagnosis and make the difference between them.