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Rialon KL, Akinkuotu A, Fahy AS, Shelmerdine S, Traubici J, Chiu P. Management of ovarian lesions diagnosed during infancy. J Pediatr Surg 2019; 54:955-958. [PMID: 30795909 DOI: 10.1016/j.jpedsurg.2019.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively. METHODS A retrospective study was performed of ovarian lesions in children <1 year-old from 2000 to 2014. RESULTS Forty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid-fluid or fluid-debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution. CONCLUSIONS The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kristy L Rialon
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adesola Akinkuotu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Traubici
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Priscilla Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Tyraskis A, Bakalis S, David AL, Eaton S, De Coppi P. A systematic review and meta-analysis on fetal ovarian cysts: impact of size, appearance and prenatal aspiration. Prenat Diagn 2017; 37:951-958. [DOI: 10.1002/pd.5143] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Athanasios Tyraskis
- Stem Cells and Regenerative Medicine; UCL Institute of Child Health and Great Ormond Street Hospital; London UK
| | - Spyros Bakalis
- Institute for Women's Health; University College London; London UK
| | - Anna L. David
- Institute for Women's Health; University College London; London UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine; UCL Institute of Child Health and Great Ormond Street Hospital; London UK
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine; UCL Institute of Child Health and Great Ormond Street Hospital; London UK
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3
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A Wandering Abdominal Mass in a Neonate: An Enteric Duplication Cyst Mimicking an Ovarian Cyst. Case Rep Pediatr 2017; 2017:9209126. [PMID: 28348910 PMCID: PMC5352883 DOI: 10.1155/2017/9209126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 11/17/2022] Open
Abstract
Enteric duplication cysts are rare congenital anomalies that are prenatally diagnosed through antenatal ultrasonography (US). In female patients, however, attention must be paid since these formations might be confused with ovarian cysts. Herein, we present a case of a low birth weight female infant with an enteric duplication cyst. A cystic lesion was detected in the right abdomen of the fetus on antenatal US and magnetic resonance imaging (MRI). Serial US and MRI examinations performed after birth showed a single cyst that wandered from side to side in the abdomen; the initial diagnosis was thought to be an ovarian cyst. During laparotomy, however, it was found to be an enteric duplication cyst with volvulus. To our knowledge, there has been no report of an enteric duplication cyst presenting as a wandering abdominal mass. Our experience indicates that early intervention is necessary for patients who have a wandering abdominal mass to avoid complications and urgent surgery, whether it is an ovarian cyst or an enteric duplication cyst.
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Kim HS, Yoo SY, Cha MJ, Kim JH, Jeon TY, Kim WK. Diagnosis of neonatal ovarian torsion: Emphasis on prenatal and postnatal sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:290-297. [PMID: 27154434 DOI: 10.1002/jcu.22327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/28/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Our aim was to retrospectively review the imaging findings of patients with neonatal ovarian torsion, emphasizing prenatal and postnatal sonographic findings. METHODS Eleven patients who had had neonatal ovarian torsion diagnosed surgically (n = 9) or clinicoradiologically (n = 2) were enrolled. Prenatal and postnatal sonographic features, including sequential postnatal change, were reviewed. Clinical and pathologic features were also investigated. RESULTS All patients except one had a fetal ovarian cyst (mean, 5.3 cm) detected on third-trimester sonography, either simple (n = 6) or complex (n = 4). In all 11 patients, initial postnatal sonography had revealed a complex cyst (mean, 4.7 cm) with intracystic clot or debris, the double-wall sign, a fluid-fluid level, and multiple septation. None of the patients had had symptoms or signs related to the ovarian torsion. Follow-up sonography in seven patients had revealed increased echogenicity of the cyst wall with frequent calcification and a decrease in size of the cyst. In two patients, the interval of the change in cyst position was noted, and autoamputation of the torsed ovary had been surgically confirmed. Serous cystadenoma had been identified in one patient. CONCLUSIONS Neonatal ovarian torsion most commonly manifests as an asymptomatic complex cyst on sonography due to torsion of a fetal ovarian cyst. Serial monitoring of a fetal ovarian cyst for its resolution or changes in its appearance is mandatory for making an early diagnosis of torsion. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:290-297, 2016.
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Affiliation(s)
- Hyun Su Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Min Jae Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Wee Kyoung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
- Department of Radiology, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-712, Korea
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Imaging Findings of Fetal-Neonatal Ovarian Cysts Complicated With Ovarian Torsion and Autoamputation. AJR Am J Roentgenol 2015; 205:185-9. [PMID: 26102397 DOI: 10.2214/ajr.14.13426] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Large nonresolving neonatal ovarian cysts may be a risk factor for complications such as torsion, mass effect, rupture, intracystic hemorrhage, and autoamputation. Torsed cysts and autoamputated cysts can cause a diagnostic dilemma. The objective of our study was to correlate the imaging findings of intrauterine ovarian torsion and autoamputated ovaries with their pathologic findings. MATERIALS AND METHODS We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation notes, and pathologic reports of 15 patients with ovarian torsion. All patients had complex cysts noted on postnatal sonographic examination. A complex heterogeneous ovarian cyst was defined by the presence of a fluid-debris level indicating hemorrhage within the cyst, a retracting clot, septations with or without internal echoes, calcification, and a solid component. RESULTS On ultrasound examination, four cysts had solid components, and 11 were heterogeneous and had a fluid-debris level. Calcifications were seen in two patients. The mean patient age at the time of surgery was 3.9 months. Exploratory laparotomy was performed on all patients. Torsed ovaries were identified in five patients. Ten patients had ovaries that were floating free in the peritoneal cavity at the time of surgery. Histopathologic evaluation revealed that 11 of the cysts consisted of extensive hemorrhagic, necrotic autolytic tissue with dystrophic calcification. None of the cysts contained any ovarian tissue. CONCLUSION A complex heterogeneous ovarian cyst with a fluid-debris level indicating hemorrhage is a significant sonographic hallmark for the diagnosis of ovarian torsion. A calcified abdominal mass, with or without wandering, can be an autoamputated ovary.
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Zampieri N, Mantovani A, Scirè G, Camoglio FS. Neonatal surgery for giant floating abdominal cysts in females: clinical and surgical management. J Pediatr Adolesc Gynecol 2014; 27:271-3. [PMID: 24841518 DOI: 10.1016/j.jpag.2013.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Abdominal cystic formations in neonates are rare entities and often diagnostic suspicion arises before birth as a result of routine ultrasonographic scans carried out during pregnancy. The aim of this study is to report the authors' experience with giant floating abdominal cysts in females. STUDY DESIGN The cases of antenatal abdominal cysts in females detected on ultrasound at the Department of Antenatal Diagnosis (Azienda Ospedaliera Universitaria Integrata, Verona, Italy) of the authors' institution between May 2005 and May 2013 were recorded together with their clinical and surgical findings. RESULTS 16 patients underwent surgery for a giant floating abdominal cyst 2 to 6 days after birth. Postnatal ultrasound and laparoscopic exploration were useful to identify an antenatal torsion of the ovarian-tube complex. All patients were treated with a laparoscopic approach using 3-mm ports after video-assisted percutaneous aspiration of the cyst. CONCLUSIONS Giant abdominal cysts in female neonates should be treated immediately in order to avoid respiratory distress and complications. The laparoscopic approach is useful to confirm the diagnosis and to choose the most suitable treatment; giant floating abdominal cysts are closely correlated with torsion or autoamputation of the ovarian-tube complex.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona; Policlinico G. B. Rossi, Verona, Italy.
| | - Alberto Mantovani
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona; Policlinico G. B. Rossi, Verona, Italy
| | - Gabriella Scirè
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona; Policlinico G. B. Rossi, Verona, Italy
| | - Francesco Saverio Camoglio
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona; Policlinico G. B. Rossi, Verona, Italy
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7
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The auto-amputated adnexa: a review of findings in a pediatric population. J Pediatr Adolesc Gynecol 2013; 26:305-13. [PMID: 23287601 DOI: 10.1016/j.jpag.2012.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/01/2012] [Accepted: 08/21/2012] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To quantify our experience and that of the literature with diagnosis and management of the auto-amputated adnexa in a pediatric population. DESIGN Case series and literature review. SETTING Tertiary care medical center. PARTICIPANTS Case series of pediatric patients (<18 years of age) with surgically documented adnexal auto-amputation collected from our medical center and the literature. INTERVENTIONS None. MAIN OUTCOME MEASURE Auto-amputated adnexa. RESULTS In addition to the 3 cases discussed from our institution, 91 cases of auto-amputated adnexa were identified in the literature dating back to 1943, for a total of 94 cases. Forty-nine percent (46/94) of the cases involved girls in a pediatric population (<18 years of age). Of these, the majority (n = 26) were identified in a subgroup of girls who were diagnosed with an adnexal cyst by antenatal ultrasound. Most of these neonates were asymptomatic at birth or had a palpable abdominal mass (n = 6) and at the time of surgical exploration were found to have an auto-amputated adnexa. 34 out of 46 cases were analyzed in detail. The right adnexa were involved in 56% of the cases. The most common presenting complaint verbalized by the older girls was pain; however, 8 cases were identified in asymptomatic girls undergoing unrelated diagnostic testing. CONCLUSION The auto-amputated adnexa is a rare finding in the pediatric population, but it must be considered as a possible explanation for the incidental finding of absence of the fallopian tube or ovary in the subgroup of patients who undergo surgery for any reason. Patients with an antecedent history of pelvic pain either chronic or intermittent in nature may be diagnosed with torsion or less frequently auto-amputation of the adnexa. A fetal "pelvic mass" or "ovarian cyst" may predispose the adnexa to torsion and subsequent auto-amputation either in-utero or post-delivery. Many of these antenatally diagnosed cysts and even subsequent auto-amputations are completely asymptomatic, however, and do not compromise fertility assuming the contralateral adnexa are normal. Thus expectant management is appropriate for small (less than 4 cm), asymptomatic simple cysts and even suspected auto-amputated adnexa in an asymptomatic patient.
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8
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Uygun I, Aydogdu B, Okur MH, Otcu S. The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child. Case Rep Surg 2012; 2012:615734. [PMID: 23119216 PMCID: PMC3478731 DOI: 10.1155/2012/615734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.
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Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey
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Zampieri N, Scirè G, Zambon C, Ottolenghi A, Camoglio FS. Unusual presentation of antenatal ovarian torsion: free-floating abdominal cysts. Our experience and surgical management. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S149-52. [PMID: 18973466 DOI: 10.1089/lap.2008.0128.supp] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Abdominal cystic formations in newborns are relatively common and often diagnostic suspicion arises before birth as a result of ultrasound scans carried out during pregnancy. Prenatal ovarian torsion is a rare condition very difficult to manage in the first days of life. We report and discuss the management of prenatal ovarian torsion with a free-floating abdominal cyst detected on prenatal ultrasound. MATERIALS AND METHODS We recorded the cases of antenatal abdominal cysts detected on ultrasound at the Department of Antenatal Diagnosis between January 2003 and January 2007. Only patients with a free-floating cyst were included in the study. Clinical and surgical findings were then recorded. RESULTS Two out of 57 patients underwent surgery for a free-floating abdominal cyst during the second day of life. Postnatal ultrasound, Doppler ultrasound, and laparoscopic exploration were useful to identify an unusual presentation of antenatal ovarian torsion with a complete atresia of the Fallopian tube. CONCLUSIONS The cases reported in this study suggest that a good clinical approach to all cases of abdominal cysts detected on prenatal ultrasound scans require postnatal Doppler and abdominal ultrasound with a laparoscopic exploration. Free-floating abdominal cysts are rare but, at the same time, strictly correlated with autoamputation of the ovary/Fallopian tube complex.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Policlinico, Verona, Italy.
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10
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Koike Y, Inoue M, Uchida K, Kawamoto A, Yasuda H, Okugawa Y, Otake K, Kusunoki M. Ovarian autoamputation in a neonate: a case report with literature review. Pediatr Surg Int 2009; 25:655-8. [PMID: 19513725 DOI: 10.1007/s00383-009-2396-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
Abstract
A case of ovarian autoamputation in an asymptomatic neonate is presented. An abdominal cyst was detected in a 30-week-gestation fetus on an antenatal ultrasound scan (USS). Postnatal USS confirmed the presence of a cyst in the right pelvis and revealed it to be 3.2 cm in diameter. CT and MRI revealed cyst wall calcification and intracystic hemorrhage. To confirm the diagnosis and treatment, the cyst was surgically removed. During the operation, a free autoamputated right ovarian cyst was found and removed from the abdomen. Ovarian cyst autoamputation is an extremely rare complication. In this article, we review the infantile ovarian autoamputation cases reported in the literature and assess their diagnosis and therapeutic management.
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Affiliation(s)
- Yuhki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507, Japan.
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11
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Zampieri N, Scirè G, Zambon C, Ottolenghi A, Camoglio FS. Unusual presentation of antenatal ovarian torsion: free-floating abdominal cysts. Our experience and surgical management. J Laparoendosc Adv Surg Tech A 2008. [PMID: 18973466 DOI: 10.1089/lap.2008.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Abdominal cystic formations in newborns are relatively common and often diagnostic suspicion arises before birth as a result of ultrasound scans carried out during pregnancy. Prenatal ovarian torsion is a rare condition very difficult to manage in the first days of life. We report and discuss the management of prenatal ovarian torsion with a free-floating abdominal cyst detected on prenatal ultrasound. MATERIALS AND METHODS We recorded the cases of antenatal abdominal cysts detected on ultrasound at the Department of Antenatal Diagnosis between January 2003 and January 2007. Only patients with a free-floating cyst were included in the study. Clinical and surgical findings were then recorded. RESULTS Two out of 57 patients underwent surgery for a free-floating abdominal cyst during the second day of life. Postnatal ultrasound, Doppler ultrasound, and laparoscopic exploration were useful to identify an unusual presentation of antenatal ovarian torsion with a complete atresia of the Fallopian tube. CONCLUSIONS The cases reported in this study suggest that a good clinical approach to all cases of abdominal cysts detected on prenatal ultrasound scans require postnatal Doppler and abdominal ultrasound with a laparoscopic exploration. Free-floating abdominal cysts are rare but, at the same time, strictly correlated with autoamputation of the ovary/Fallopian tube complex.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Policlinico, Verona, Italy.
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12
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Abstract
Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. Clinical presentation is nonspecific, and diagnosis is based on a high index of suspicion. Ultrasound scan remains the most useful investigation, but blood flow on Doppler examination does not exclude ovarian torsion. Current recommendations of treatment strongly support ovary conservation, and macroscopic appearance of the ovary is not a reliable indicator of the degree of necrosis and potential for ovary recovery. For children with ovarian torsion, laparoscopic detorsion should be performed with strong consideration of oophoropexy. An underlying ovary lesion such as mature teratoma or functional cyst is found in most cases; however, the risk of cancer in these patients is extremely low. If there is concern of a mass or underlying pathology, then follow-up ultrasound, resolution of edema and interval laparoscopic treatment may be required.
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Affiliation(s)
- Darrell L Cass
- Michael E. DeBakey Deparment of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
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13
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Abstract
This article reviews salient features of pediatric gynecologic ultrasound. It reviews technologic factors, technique, and normal anatomy used to evaluate the pediatric gynecologic tract for abnormality. It reviews and illustrates clinical imaging information necessary to know in the ultrasonic analysis of several clinical problems in the pediatric gynecologic tract. This includes ovarian torsion, ambiguous genitalia, pelvic mass, and precocious puberty, as well as acute pelvic pain occurring from newborn life through puberty.
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Affiliation(s)
- Rita S Ratani
- Division of Body Imaging, SUNY at Stony Brook School of Medicine, NY, USA
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14
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Avni FE, Garel L, Hall M, Rypens F. Perinatal Approach to Anomalies of the Urinary Tract, Adrenals and Genital System. ACTA ACUST UNITED AC 2002. [DOI: 10.1007/978-3-642-56402-4_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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15
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Bagolan P, Giorlandino C, Nahom A, Bilancioni E, Trucchi A, Gatti C, Aleandri V, Spina V. The management of fetal ovarian cysts. J Pediatr Surg 2002; 37:25-30. [PMID: 11781981 DOI: 10.1053/jpsu.2002.29421] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Ovarian torsion causing the loss of an ovary represents the most common complication of fetal ovarian cysts and occurs more frequently before than after birth. Thus, treatment of fetal simple ovarian cysts should be performed antenatally; however, criteria for prenatal decompression still need to be evaluated. Previous experience of the authors showed that large simple cysts have a poor outcome, whereas preliminary attempts of their "in utero" aspiration were all successful and uneventful. The authors evaluated the outcome of fetal simple ovarian cysts after prenatal aspiration and considered criteria for this procedure. The outcome of cysts showing a prenatal ultrasound pattern of torsion also was studied. METHODS This prospective study includes 73 ovarian cysts (48 simple, 25 showing torsion) diagnosed in 72 fetuses from June 1992 to June 1999, and followed up until spontaneous resolution or surgery. Prenatal aspiration was performed in the case of simple cysts >/=5 cm in diameter. The outcome of these cysts was compared with that of similar cysts not aspirated in the authors previous study (X(2). Cysts with an US pattern of torsion persisting at birth were operated on. The outcome of simple cysts less than 5 cm and cysts with a prenatal ultrasound appearance of torsion also was evaluated. RESULTS Prenatal decompression was performed without any complications in 14 cases: 12 (86%; 95% CI: 0.68 to 1.00) regressed subsequently; 2 (14%; 95% CI: 0.00 to 0.32) showed torsion postnatally. This outcome is significantly better than that of similar cysts not aspirated in the authors' previous study(10) (P =.0002). Among the 34 simple cysts less than 5 cm, 26 (76%; 95% CI: 0.62 to 0.90) resolved spontaneously; 8 (24%; 95% CI: 0.10 to 0.38) had complications, 7 of which showing torsion (diameter at evidence of torsion, 4.4 cm [median]; range, 3.3 to 5.2 cm). Among the 34 cysts showing torsion (25 with initial US pattern of torsion + 9 subsequently complicated simple cysts), 24 (71%; 95% CI: 0.56 to 0.86) required oophorectomy; 9 (26%; 95% CI: 0.11 to 0.41) spontaneously disappeared at ultrasound, one of which required surgery for intestinal obstruction secondary to adhesion of a necrotic ovary; one patient (3%; 95% CI: 0.00 to 0.09) was lost to follow-up. CONCLUSIONS Prenatal aspiration of ovarian cysts appears effective and safe: a "cutoff" of 4 cm should be investigated. Cysts with ultrasound pattern of torsion persisting postnatally require surgery; options for their management, when sonographically disappearing and asymptomatic, need to be investigated.
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Affiliation(s)
- Pietro Bagolan
- Department of Neonatal Surgery, "Bambino Gesù" Pediatric Hospital, Rome, Italy
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16
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Abstract
Prenatal sonography uncovers many fetal ovarian masses that previously would have gone unrecognized. This challenges clinicians to learn the natural history of these asymptomatic lesions so as to provide the best care postnatally. Spontaneous resolution of simple ovarian cysts is expected by about 6 months of age, which is attributed to predicted changes in the postnatal hormonal milieu. After birth, levels of human chorionic gonadotropin (HCG) and estrogen plummet. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) rise until about 3 months of age and then fall as the "gonadostat" matures. Although symptomatic cysts demand intervention, simple asymptomatic cysts less than 5 cm in diameter should be left alone but reassessed sonographically. If simple cysts are larger than 5 cm in diameter the risk of torsion may be significant, and intervention often is advocated. However, the risk of torsion versus the likelihood of resolution is not well established. The therapeutic goal for a clinician managing a newborn with a simple ovarian cyst is to maximize ovarian salvage. Aspiration alone may be a reasonable option. The laparascopic approach to the neonatal ovarian cyst provides a view of both ovaries and allows aspiration, unroofing, cystectomy, or ovariectomy. The sonographically complex cyst usually represents adnexal torsion but could be a neoplasm and warrants intervention because the morbidity from untreated neonatal adnexal torsion can be significant beyond loss of the ovary (eg, hemorrhage, peritonitis, intestinal obstruction, or a wandering tumor).
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Affiliation(s)
- S E Dolgin
- Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA
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17
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Mizuno M, Kato T, Hebiguchi T, Yoshino H. Surgical indications for neonatal ovarian cysts. TOHOKU J EXP MED 1998; 186:27-32. [PMID: 9915104 DOI: 10.1620/tjem.186.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ante- or neonatal ovarian cysts can be often diagnosed by routine ultrasonography. Small simple ovarian cysts, which can be followed with serial ultrasonography, usually resolve spontaneously. Large simple cysts and complicated cysts should undergo surgical treatment to reduce the potential for serious complications. Seventeen ovarian cysts were experienced between 1983 and 1997. Sixteen cases underwent surgical treatment at less than 1 month of age according to our protocols. In this report, we reviewed these cases for clinical presentation, ultrasound data, management, intraoperative findings, complications, and outcome. At operation, nine of them showed torsion, and seven of them showed necrotic changes. Only five of them was considered to fall into torsion by preoperative ultrasonography. In five cases whose blood flow could not improve after reduction of torsion, salpingo-oophorectomy was performed. We consider that small simple ovarian cysts under 4 cm in diameter can be observed carefully with serial ultrasonography. But, not only complicated ovarian cysts and simple cysts over 5 cm in diameter, but smaller cysts showing no decrease in size should be considered for surgical indication to rescue the ovarian tissue.
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Affiliation(s)
- M Mizuno
- Department of Pediatric Surgery, Akita University School of Medicine, Japan.
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18
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Cohen HL, Bober SE, Bow SN. Imaging the pediatric pelvis: the normal and abnormal genital tract and simulators of its diseases. UROLOGIC RADIOLOGY 1992; 14:273-83. [PMID: 1471321 DOI: 10.1007/bf02926944] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Imaging of the pediatric pelvis has proven of great use in defining the normal and abnormal genital tracts. Sonography is the key screening tool and often the only tool necessary for the diagnosis of problems related to ambiguous genitalia, ovarian and uterine masses, amenorrhea, and abdominal and pelvic pain. Computed tomography (CT) and magnetic resonance imaging (MRI) have key roles in the global assessment of the pelvis particularly with regard to the assessment of tumor spread.
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Affiliation(s)
- H L Cohen
- Division of Ultrasound/CT/MRI, North Shore University Hospital-Cornell University Medical College, Manhasset, New York
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19
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Croitoru DP, Aaron LE, Laberge JM, Neilson IR, Guttman FM. Management of complex ovarian cysts presenting in the first year of life. J Pediatr Surg 1991; 26:1366-8. [PMID: 1765908 DOI: 10.1016/0022-3468(91)91034-v] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With more frequent antenatal and postnatal diagnosis, the management of ovarian cysts has become somewhat controversial. Management protocols for simple ovarian cysts have been proposed. The purpose of this study was to establish a management protocol for complex ovarian cysts presenting antenatally and in the first year of life. We reviewed the records of nine infants who underwent surgical treatment for ovarian cysts over a 10-year period (1980 through 1989). Antenatal ultrasound performed between 24 and 34 weeks of gestation showed ovarian cysts in six infants. All six infants had complex cysts ranging in size from 3 to 10 cm on postnatal ultrasound. Exploration with oophorectomy or salpingooophorectomy was carried out at 2 days to 3 months of age for ovarian torsion. Ovarian cysts measuring up to 7 cm were diagnosed postnatally in three infants from 1 day to 7 months of age with ultrasound confirmation of complex, cystic intraabdominal masses. All patients underwent salpingooophorectomy, two for tuboovarian torsion and the third patient for a juvenile granulosa cell tumor. We recommend that all complex ovarian cysts, regardless of size, be surgically removed because they represent torsion, neoplasm, or alternate diagnoses, and removal can prevent possible complications.
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Affiliation(s)
- D P Croitoru
- Department of Surgery, Montreal Children's Hospital, Quebec, Canada
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20
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Fetal ovarian cysts: prenatal ultrasonographic detection and postnatal evaluation and treatment. Am J Obstet Gynecol 1991; 164:874-8. [PMID: 2003554 DOI: 10.1016/0002-9378(91)90532-v] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ovarian cysts were diagnosed by antenatal ultrasonographic examination in 15 fetuses between 19 and 37 weeks' gestation. In six cases there was ultrasonographic evidence of torsion. Intracystic flocculation, which typically was deposited on the sloping part of the cyst, gave a characteristic liquid interface that was regarded as ultrasonographic evidence of torsion. All cases with evidence of torsion were managed surgically post partum, and in all patients this complication was confirmed. The remaining nine cases were followed up by repeated ultrasonograms, and in all patients disappearance of the cyst was documented within the first 6 months of life. The mean size of cysts with evidence of torsion was 5.41 +/- 0.25 cm, and the mean size of those without torsion was 4.33 +/- 0.3 cm (p less than 0.01). Histologic examination of the surgical specimen in the cases with evidence of torsion revealed follicular cysts in three cases and necrotic ovarian cysts with no specific epithelial findings in the remaining three. We recommend continuous ultrasonographic assessment of antenatally diagnosed cysts and believe that the choice of treatment depends on the appearance of the cyst and its evolution throughout pregnancy.
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21
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Brandt ML, Luks FI, Filiatrault D, Garel L, Desjardins JG, Youssef S. Surgical indications in antenatally diagnosed ovarian cysts. J Pediatr Surg 1991; 26:276-81; discussion 281-2. [PMID: 1827651 DOI: 10.1016/0022-3468(91)90502-k] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The antenatal diagnosis of ovarian cysts poses a therapeutic dilemma because the natural history of these lesions is not well known. A retrospective review from 1980 to 1989 showed 29 ovarian cysts in 27 patients diagnosed by prenatal ultrasonography performed between 28 and 36 weeks of gestation. Nineteen cysts were initially observed. Eleven cysts resolved (diameter less than 2 cm), three are decreasing, three were lost to follow-up, and two underwent resection. Eight patients underwent surgical exploration immediately following birth. The diagnosis of benign ovarian cyst was confirmed histologically in all cases. A review of the literature showed an additional 230 cases of antenatally diagnosed ovarian cysts. Simple cysts of the ovary tend to resolve spontaneously and, therefore, may be treated conservatively. Serial ultrasonography allows accurate diagnosis and long-term assessment of ovarian cysts in the neonate and may prevent unnecessary oophorectomy. Patients with cysts larger than 4 cm may be candidates for percutaneous aspiration, or should undergo removal of the cyst because of a significant risk of torsion. Complex cystic masses, symptomatic ovarian cysts, and cysts that do not resolve should be removed.
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Affiliation(s)
- M L Brandt
- Department of Surgery, Hôpital Ste-Justine, Montreal, Quebec, Canada
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22
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Garel L, Filiatrault D, Brandt M, Grignon A, Boisvert J, Perreault G, Patriquin H. Antenatal diagnosis of ovarian cysts: natural history and therapeutic implications. Pediatr Radiol 1991; 21:182-4. [PMID: 2047154 DOI: 10.1007/bf02011042] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A retrospective study from 1980 to 1990 shows 29 ovarian cysts in 27 patients diagnosed by prenatal ultrasound performed between 28 and 38 weeks of gestation. Ten patients underwent surgery, 17 patients were observed with serial ultrasound. Delayed good quality sonograms after spontaneous resolution of the cyst in a selected group of 7 patients showed restoration of a normal ovarian anatomy. The size of the cyst and/or its sonographic characteristics are the 2 main factors for deciding a conservative or a surgical management.
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Affiliation(s)
- L Garel
- Department of Radiology, Hôpital Ste-Justine, Montreal, Quebec, Canada
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23
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Giorlandino C, Rivosecchi M, Bilancioni E, Bagolan P, Zaccara A, Taramanni C, Vizzone A. Successful intrauterine therapy of a large fetal ovarian cyst. Prenat Diagn 1990; 10:473-5. [PMID: 2235907 DOI: 10.1002/pd.1970100710] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fetal ovarian cysts can be managed in different ways, depending upon their size and clinical course: conservatively, by open surgery or by postnatal transabdominal puncture. However, in cases of large cysts detected antenatally and affecting the ongoing pregnancy, in utero transabdominal puncture can be undertaken, without increase of risk. A case of such a puncture at 30 weeks gestation is reported.
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Affiliation(s)
- C Giorlandino
- Department of Ultrasound and Perinatal Medicine, Artemisia Medical Centre, Rome, Italy
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24
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D'Addario V, Volpe G, Kurjak A, Lituania M, Zmijanac J. Ultrasonic diagnosis and perinatal management of complicated and uncomplicated fetal ovarian cysts: a collaborative study. J Perinat Med 1990; 18:375-81. [PMID: 2292759 DOI: 10.1515/jpme.1990.18.5.375] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ovarian cysts can be demonstrated in the ovaries of fetuses and full term infants at birth. Small cysts involute spontaneously during fetal life or within the first few months of life. Large cysts may cause mechanical complications or respiratory distress. Sonographic detection of fetal ovarian cysts has been reported, as well as intrauterine surgical treatment. The sonographic findings and the outcome of the smaller and the complicated cysts were studied in 25 pregnant women. Uncomplicated fetal ovarian cysts should be monitored by weekly examination until delivery. Huge ovarian cysts may be an indication for cesarean section; or, intrauterine aspiration may be the alternative. Complicated fetal ovarian cysts represent an indication for neonatal surgery.
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Affiliation(s)
- V D'Addario
- 1st Department of Obstetrics and Gynecology, University of Bari, Italy
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25
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Berenson AB, Pokorny SF, Dutton RV. The autoamputated ovary: A rare cause of abdominal calcification. ACTA ACUST UNITED AC 1989. [DOI: 10.1016/s0932-8610(89)80049-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Abstract
Seven cases of neonatal ovarian cysts that presented over the past seven years were studied. Complications included torsion and rupture and usually occurred in cysts more than 5 cm in diameter. Surgical removal, either oophorectomy or cystectomy, was the treatment of choice. Because even cystectomy results in loss of normal ovarian tissue, and because spontaneous regression of cysts less than 5 cm in diameter can occur, a more conservative approach is now proposed. Regular ultrasonography alone is recommended if the cysts are less than 5 cm in diameter, and aspiration of the cysts followed by regular ultrasonographs if the cysts are more than 5 cm in diameter. Operation should be reserved for recurrent cysts or for those with complications. Cysts diagnosed antenatally may be aspirated in utero if there are signs of thoracic compression.
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Affiliation(s)
- D J Widdowson
- Department of Radiology, Royal Liverpool Children's Hospital
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27
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Alrabeeah A, Galliani CA, Giacomantonio M, Heifetz SA, Lau H. Neonatal ovarian torsion: report of three cases and review of the literature. PEDIATRIC PATHOLOGY 1988; 8:143-9. [PMID: 3045782 DOI: 10.3109/15513818809022291] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ovarian cysts are common incidental findings in term infants and, if unusually large, may result in dystocia, torsion, or rupture. Torsion and infarction of a normal ovary tend to occur in older childhood. During a 4-month period, 3 cases of neonatal ovarian torsion were observed after antenatal ultrasonography had detected fetal pelvico-abdominal cystic lesions. The three infants were explored between 4 and 16 days of age. Ovarian torsion was right-sided in all 3, and 1 ovary had been autoamputated. The resected specimens were nontense, thin-walled cysts, filled with hemorrhagic fluid, that measured between 4.5 and 8 cm in diameter. Microscopically, focal calcification and widespread necrosis precluded recognition of underlying histologic landmarks. Neonatal ovarian cysts or cystic ovaries greater than 4 cm in diameter should be excised, even if asymptomatic, because they are prone to, or have undergone, torsion.
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Affiliation(s)
- A Alrabeeah
- Department of Surgery, IWK Hospital for Children, Halifax, Nova Scotia
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28
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Berdon WE, Stolar CJ. Explanation of confusion in recent article. Postnatal resolution of large ovarian cysts detected in utero. Pediatr Radiol 1988; 18:178. [PMID: 3353154 DOI: 10.1007/bf02387570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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29
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Amodio J, Abramson S, Berdon W, Bell J, Winchester P, Stolar C, Liebert P. Postnatal resolution of large ovarian cysts detected in utero. Report of two cases. Pediatr Radiol 1987; 17:467-9. [PMID: 3317248 DOI: 10.1007/bf02388280] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two cases of spontaneous resolution of large ovarian cysts in newborns are presented. In both cases the cysts were detected prenatally with ultrasound. In one case the cyst disappeared before birth; in the other, the cyst resolved several weeks postnatally. Both infants also displayed labial, uterine and vaginal enlargement, signs of maternal estrogen stimulation. These large ovarian cysts are also most likely under some hormonal stimulation and may undergo spontaneous resolution and therefore obviate the need for surgery.
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Affiliation(s)
- J Amodio
- Department of Radiology, Babies Hospital, Columbia-Presbyterian Medical, New York, New York
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30
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Suita S, Ikeda K, Koyanagi T, Nakano H. Neonatal ovarian cyst diagnosed antenatally: report of two patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 1984; 12:517-519. [PMID: 6436335 DOI: 10.1002/jcu.1870120814] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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