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Frauenheilkunde up2date 2021; 15(04): 359-373
DOI: 10.1055/a-1372-7828
Gynäkologische Onkologie

Operatives Management von Adnextumoren

Susanne Schüler-Toprak
,
Olaf Ortmann
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Raumforderungen im Bereich der Adnexe stellen häufige Gründe für eine Konsultation eines Gynäkologen dar. Oftmals fällt die Einordnung der Befunde und somit die Festlegung des weiteren Vorgehens schwer. Im Folgenden werden verschiedene Tumoren im Bereich der Adnexe vorgestellt. Die entsprechenden diagnostischen und therapeutischen Strategien werden dargestellt und bieten einen Handlungsalgorithmus für den klinischen Alltag.
Kernaussagen

  • Eine adäquate präoperative Einordnung von Adnexbefunden bezüglich ihrer Dignität ist elementar für die Wahl des operativen Vorgehens.

  • Für unerfahrenere Gynäkologen bieten validierte Scores, die zum Teil sonografische und klinische bzw. auch laborchemische Kriterien vereinen, eine Möglichkeit, die Unterscheidung zwischen benigne und maligne zu erleichtern.

  • Der Tumormarker CA 125 ist vor allem in der Prämenopause häufig unspezifisch erhöht.

  • Bei funktionellen Zysten sollte zunächst ein abwartendes Vorgehen favorisiert werden.

  • Bei Anhalt für Malignität sollte nicht laparoskopisch vorgegangen werden.

Schlüsselwörter

Adnextumor - Funktionelle Zyste - Dermoidzyste - Laparoskopie


Publication History

Article published online:
24 August 2021

© 2021. Thieme. All rights reserved.

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  • Literatur

  • 1 Huang C, Hong M-K, Ding D-C. A review of ovary torsion. Tzu Chi Med J 2017; 29: 143-147
    CrossrefPubMedSearch in Google Scholar
  • 2 Prömpeler HJ. Abklärung eines Adnexbefundes. Gynäkologe 2007; 40: 813-832
    CrossrefSearch in Google Scholar
  • 3 Carcangiu ML, Kurman RJ, Carcangiu ML, Herrington CS. WHO Classification of Tumours of female reproductive Organs. 4. Aufl.. Lyon: International Agency for Research on Cancer; 2014
    Search in Google Scholar
  • 4 Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF. S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, 2020; Langversion 4.0, 2020, AWMF-Registernummer: 032/035OL. Im Internet (Stand: 19.02.2021): https://www.awmf.org/uploads/tx_szleitlinien/032-035OLl_S3_Ovarialkarzinom_2020-04.pdf
  • 5 Kaufmann M, Costa SD, Scharl A. Die Gynäkologie. 3. Aufl.. Berlin, Heidelberg: Springer; 2013
    CrossrefSearch in Google Scholar
  • 6 Pinotti JA, Franzin C de Marussi EF. et al. Evolution of cystic and adnexal tumors identified by echography. Int J Gynaecol Obstet 1988; 26: 109-114
    CrossrefPubMedSearch in Google Scholar
  • 7 Herrmann UJ. Sonographic patterns of ovarian tumors. Clin Obstet Gynecol 1993; 36: 375-383
    CrossrefPubMedSearch in Google Scholar
  • 8 Dodge JE, Covens AL, Lacchetti C. et al. Preoperative identification of a suspicious adnexal mass: a systematic review and meta-analysis. Gynecol Oncol 2012; 126: 157-166
    CrossrefPubMedSearch in Google Scholar
  • 9 Spencer JA, Ghattamaneni S. MR imaging of the sonographically indeterminate adnexal mass. Radiology 2010; 256: 677-694
    CrossrefPubMedSearch in Google Scholar
  • 10 Häusler S, Wöckel A, Rehn M. Diagnostik und Management von Adnexraumforderungen. Gynäkologe 2016; 49: 607-622
    CrossrefSearch in Google Scholar
  • 11 Gadducci A, Ferdeghini M, Prontera C. et al. The concomitant determination of different tumor markers in patients with epithelial ovarian cancer and benign ovarian masses: Relevance for differential diagnosis. Gynecol Oncol 1992; 44: 147-154
    CrossrefPubMedSearch in Google Scholar
  • 12 Myers ER, Bastian LA, Havrilesky LJ. et al. Management of adnexal mass. Evid Rep Technol Assess (Full Rep) 2006; 130: 1-145
    Search in Google Scholar
  • 13 Holcomb K, Vucetic Z, Miller MC. et al. Human epididymis protein 4 offers superior specificity in the differentiation of benign and malignant adnexal masses in premenopausal women. Am J Obstet Gynecol 2011; 205: 358.e1-358.e6
    CrossrefPubMedSearch in Google Scholar
  • 14 Kim B, Park Y, Kim B. et al. Diagnostic performance of CA 125, HE4, and risk of Ovarian Malignancy Algorithm for ovarian cancer. J Clin Lab Anal 2019; 33: e22624
    CrossrefPubMedSearch in Google Scholar
  • 15 Aslan K, Onan MA, Yilmaz C. et al. Comparison of HE 4, CA 125, ROMA score and ultrasound score in the differential diagnosis of ovarian masses. J Gynecol Obstet Hum Reprod 2020; 49: 101713
    CrossrefPubMedSearch in Google Scholar
  • 16 Kumar V, Rajan S, Gupta S. et al. Diagnostic Value of Risk of Malignancy Algorithm (ROMA) in Adnexal Masses. J Obstet Gynaecol India 2020; 70: 214-219
    CrossrefPubMedSearch in Google Scholar
  • 17 Timmerman D, Valentin L, Bourne TH. et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000; 16: 500-505
    CrossrefPubMedSearch in Google Scholar
  • 18 Timmerman D, Ameye L, Fischerova D. et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ 2010; 341: c6839
    CrossrefPubMedSearch in Google Scholar
  • 19 van Calster B, van Hoorde K, Valentin L. et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ 2014; 349: g5920
    CrossrefPubMedSearch in Google Scholar
  • 20 Nohuz E, De Simone L, Chêne G. Reliability of IOTA score and ADNEX model in the screening of ovarian malignancy in postmenopausal women. J Gynecol Obstet Hum Reprod 2019; 48: 103-107
    CrossrefPubMedSearch in Google Scholar
  • 21 Szubert S, Wojtowicz A, Moszynski R. et al. External validation of the IOTA ADNEX model performed by two independent gynecologic centers. Gynecol Oncol 2016; 142: 490-495
    CrossrefPubMedSearch in Google Scholar
  • 22 Valentin L, Hagen B, Tingulstad S, Eik-Nes S. Comparison of ‘pattern recognition’ and logistic regression models for discrimination between benign and malignant pelvic masses: a prospective cross validation. Ultrasound Obstet Gynecol 2001; 18: 357-365
    CrossrefPubMedSearch in Google Scholar
  • 23 Gramellini D, Fieni S, Sanapo L. et al. Diagnostic accuracy of IOTA ultrasound morphology in the hands of less experienced sonographers. Austr N Z J Obstet Gynaecol 2008; 48: 195-201
    CrossrefPubMedSearch in Google Scholar
  • 24 Sebajuri JMV, Magriples U, Small M. et al. Obstetrics and Gynecology Residents Can Accurately Classify Benign Ovarian Tumors Using the International Ovarian Tumor Analysis Rules. J Ultrasound Med 2020; 39: 1389-1393
    CrossrefPubMedSearch in Google Scholar
  • 25 Grimes DA, Jones LB, Lopez LM. et al. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev 2009; (02) CD006134
    CrossrefPubMedSearch in Google Scholar
  • 26 Osmers RG, Osmers M. et al. Maydell B von et al. Preoperative evaluation of ovarian tumors in the premenopause by transvaginosonography. Am J Obstet Gynecol 1996; 175: 428-434
    CrossrefPubMedSearch in Google Scholar
  • 27 Grimes DA, Jones LB, Lopez LM. et al. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev 2014; (04) CD006134
    CrossrefPubMedSearch in Google Scholar
  • 28 Kroon E, Andolf E. Diagnosis and follow-up of simple ovarian cysts detected by ultrasound in postmenopausal women. Obstet Gynecol 1995; 85: 211-214
    CrossrefPubMedSearch in Google Scholar
  • 29 Bailey CL, Ueland FR, Land GL. et al. The malignant potential of small cystic ovarian tumors in women over 50 years of age. Gynecol Oncol 1998; 69: 3-7
    CrossrefPubMedSearch in Google Scholar
  • 30 Kindermann G, Maassen V, Kuhn W. Laparoskopisches „Anoperieren“ von ovariellen Malignomen. Erfahrungen aus 127 deutschen Frauenkliniken. Geburtshilfe Frauenheilkd 1995; 55: 687-694
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Marana R, Muzii L, Catalano GF. et al. Laparoscopic Excision of Adnexal Masses. J Am Assoc Gynecol Laparosc 2004; 11: 162-166
    CrossrefPubMedSearch in Google Scholar
  • 32 Du Bois A, Ewald-Riegler N. et al. Gregorio N de et al. Borderline tumours of the ovary: A cohort study of the Arbeitsgmeinschaft Gynäkologische Onkologie (AGO) Study Group. Eur J Cancer 2013; 49: 1905-1914
    CrossrefPubMedSearch in Google Scholar
  • 33 Du Bois A, Ewald-Riegler N, Du Bois O. et al. Borderline-Tumoren des Ovars – eine systematische Übersicht. Geburtshilfe Frauenheilkd 2009; 69: 807-833
    Thieme ConnectSearch in Google Scholar
  • 34 Menczer J, Chetrit A, Sadetzki S. The effect of hysterectomy on survival of patients with borderline ovarian tumors. Gynecol Oncol 2012; 125: 372-375
    CrossrefPubMedSearch in Google Scholar
  • 35 Trillsch F, Mahner S, Woelber L. et al. Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study. Ann Oncol 2014; 25: 1320-1327
    CrossrefPubMedSearch in Google Scholar
  • 36 van de Vrie R, Rutten MJ, Asseler JD. et al. Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer. Cochrane Database Syst Rev 2019; (03) CD009786
    CrossrefPubMedSearch in Google Scholar
  • 37 Leitao MM, Boyd J, Hummer A. et al. Clinicopathologic analysis of early-stage sporadic ovarian carcinoma. Am J Surg Pathol 2004; 28: 147-159
    CrossrefPubMedSearch in Google Scholar
  • 38 Sevelda P, Dittrich C, Salzer H. Prognostic value of the rupture of the capsule in stage I epithelial ovarian carcinoma. Gynecol Oncol 1989; 35: 321-322
    CrossrefPubMedSearch in Google Scholar
  • 39 Dembo AJ, Davy M, Stenwig AE. et al. Prognostic factors in patients with stage I epithelial ovarian cancer. Obstet Gynecol 1990; 75: 263-273
    PubMedSearch in Google Scholar
  • 40 Lim S, Lee KB, Chon SJ. et al. Is tumor size the limiting factor in a laparoscopic management for large ovarian cysts?. Arch Gynecol Obstet 2012; 286: 1227-1232
    CrossrefPubMedSearch in Google Scholar
  • 41 Matsuo K, Machida H, Yamagami W. et al. Intraoperative capsule rupture, postoperative chemotherapy, and survival of women with stage I epithelial ovarian cancer. Obstet Gynecol 2019; 134: 1017-1026
    CrossrefPubMedSearch in Google Scholar
  • 42 Kajiyama H, Suzuki S, Yoshikawa N. et al. Survival impact of capsule status in stage I ovarian mucinous carcinoma-A mulicentric retrospective study. Eur J Obstet Gynecol Reprod Biol 2019; 234: 131-136
    CrossrefPubMedSearch in Google Scholar
  • 43 Trimbos JB, Vergote I, Bolis G. et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial. J Natl Cancer Inst 2003; 95: 113-125
    CrossrefPubMedSearch in Google Scholar
  • 44 Magrina JF. Laparoscopic surgery for gynecologic cancers. Clin Obstet Gynecol 2000; 43: 619-640
    CrossrefPubMedSearch in Google Scholar
  • 45 Kruitwagen RF, Swinkels BM, Keyser KG. et al. Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer. Gynecol Oncol 1996; 60: 233-237
    CrossrefPubMedSearch in Google Scholar
  • 46 Ataseven B, Grimm C, Harter P. et al. Prognostic impact of port-site metastasis after diagnostic laparoscopy for epithelial ovarian cancer. Ann Surg Oncol 2016; 23: 834-840
    CrossrefPubMedSearch in Google Scholar