P08Case report: transvaginal ultrasonographic aspiration in the management of an ovarian cyst detected at the seventh gestational week

Objective To discuss a different approach, other than cystectomy, to an ovarian cyst detected at early gestation due to the risk of torsion. Case report During ultrasonographic control of a pregnant at seven weeks of gestation, 30-year-old with two gravidity, one parity and one living child, a cyst with regular contour, measuring 150 × 130 mm with a wall thickness smaller than two mm was detected. By Doppler evaluation, vascular pattern could not be detected on the cyst wall. Ca 125, AFP, CEA levels were measured as 41.4 U/ml, 2.4 IU/ml, 1.2 ng/ml, respectively. The cyst was aspirated by a 17 g needle through posterior fornix with the assistance of tranvaginal ultrasonography. In cytological evaluation of the cyst fluid, no malignant cells were found. The case was called for control at 12th week of gestation which was known as the week of the completion of luteoplacental shift. Conclusion Since ca125 levels could be increased by pregnancy and there was no malignant feature except the dimensions of the cyst, the cyst was supposed to be benign and a conservative approach was planned. Corpus luteum is necessary for the continuation of pregnancy at these weeks of gestation so the anxiety about cystectomy was the termination of pregnancy due to corpus luteum deficiency. On the other hand, however, expectant management could not also be chosen, because the risk of torsion was high due to the texture, dimensions and mobile characteristic of the cyst. For this case who was at a younger age for ovarian malignancy the shrinkage of the cyst by aspirating it with the assistance of transvaginal ultrasonography without dysfunctioning corpus luteum, was decided. The management could be changed according to the cytological evaluation. In conclusion, at the early weeks of gestation, transvaginal cyst aspiration could be a way of management by decreasing the torsion risk without being a handicap for the continuation of pregnancy.