Paratubal and paroovarian cysts are either distended remnants of the paramesonephric ducts or are mesothelil inclusion cysts. Although most measure 53 cm, they occasionally attain worrisome dimensions. Their reported incidence is inluenced by size, but one autopsy series in nonpregnant women cited this to be 5 percent (Dorum, 2005). The most common parmesonephric cyst is the hydatid of Morgagni, which is pedunculated and typically dangles from one of the imbria. hese cysts infrequently cause complications and are most oten identiied at the time of cesarean delivery or puerperal sterilization. In these instances, they can simply be excised or drained by creating a large window in the cyst wll. Neoplastic paraovarian cysts are rare, sonographically and histologically resemble tumors of ovarian origin, and rarely are of borderline potential or frankly malignant (Korbin, 1998).
Preinvasive disease in young women-vulvar intraepithelial neoplasia (YIN) and vaginal intraepithelial neoplasia (VAIN)are seen more often than invasive disease and are commonly associated with HPV infection. As with cervical neoplasia, these premalignant conditions are treated after delivery.
Cancer of the vulva or vagina is generally a malignancy of older women, and thus, these are rarely associated with pregnancy. Even so, any suspicious lesions should be biopsied. Treatment is individualized according to the clinical stage and depth of invasion. In a review of 23 cases, investigators concluded that radical surgery for stage I disease was feasible during pregnancy-including in the last trimester (Heller, 2000).
We and others question the necessity of resection in late pregnany because deinitive therapy can oten be delayed due to these cancers' typically slow progression (Anderson, 2001). It appears that vaginal delivery is not contraindicated if vulvar and inguinal incisions are well healed. Vulvar sarcoma, vulvar melanoma, and vaginal malignancies are rare in pregnancy and are the subjects of case reports (lexander, 2004; Kuller, 1990; Matsuo, 2009).
Breast cancer rates rise most acutely between ages 40 and 80 years. However, because of its overall high frequency, breast cancer is relatively common even in younger women and is the most frequent cancer found in gravidas. From the Nationwide Inpatient Sample of 11.8 million births, the incidence approximated 1 in 15,000 (Maor, 2017). And, as more women choose to delay childbearing, the frequency of associated breast cancer is certain to grow. Postponed childbearing was considered partially responsible for the increase in pregnancy-associated breast cancer in Sweden and Denmark (Andersson, 2015; Eibye, 2013).
Some studies suggest that women with a family history of breast cancer-especially those with BRCAl and BRC2 breast cancer gene mutations-are more likely to develop breast malignancy during pregnancy (Wohlfahrt, 2002). However, it may be that it is parity that modiies this risk. Namely, parous women older than 40 years with these mutations have a signiicantly lower cancer risk than nulliparas with these mutated genes (Andrieu, 2006; Antoniou, 2006). Women with BRAl and BRC2 gene mutations who undergo induced abortion or those who breastfeed do not have an increased breast cancer risk (Friedman, 2006). Moreover, Jernstrom and associates (2004) found that breastfeeding conveyed a protective efect against this cancer in those with BRCAl gene mutation, but not in those with BRCA2 mutations. Of other congenital factors, it is controversial whether DES exposure raises breast cancer risks (Hoover, 2011; Titus-Ernstof, 2006).