1
|
Saxena AK, Mutanen A, Gorter R, Conforti A, Bagolan P, De Coppi P, Soyer T. European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts. Eur J Pediatr Surg 2024; 34:215-221. [PMID: 37557903 DOI: 10.1055/s-0043-1771211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). METHODS The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. RESULTS There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. CONCLUSION A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.
Collapse
Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Annika Mutanen
- Department of Pediatric Surgery, University of Helsinki Children's Hospital, Helsinki, Finland
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Children's Hospital UMC, Amsterdam, the Netherlands
| | - Andrea Conforti
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Paolo De Coppi
- Department of Paediatric Surgery, UCL Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
- Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| |
Collapse
|
2
|
Cheng Y, Cheng Y. Ovarian cysts. Am J Obstet Gynecol 2021; 225:B23-B25. [PMID: 34507793 DOI: 10.1016/j.ajog.2021.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
3
|
Chiarenza SF, Conighi ML, Conforti A, Bleve C, Esposito C, Escolino M, Beretta F, Cheli M, Di Benedetto V, Scuderi MG, Casadio G, Marzaro M, Gambino M, Pini Prato A, Molinaro F, Gerocarni Nappo S, Caione P. Guidelines of the Italian Society of Videosurgery in Infancy (SIVI) for the minimally invasive treatment of fetal and neonatal ovarian cysts. LA PEDIATRIA MEDICA E CHIRURGICA 2020; 42. [PMID: 33140631 DOI: 10.4081/pmc.2020.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
In the last three decades, fetal ovarian cysts were diagnosed more frequently, due to technological improvement and the increasing use of prenatal screening ultrasound. Nonetheless, treatment uncertainties are still present, either prenatally or postnatally. Recently, significant innovations on diagnosis and treatment have been proposed and a more conservative, minimally invasive approach may be offered to the Pediatrician or the Surgeon who face with this condition during prenatal or neonatal age. (...).
Collapse
Affiliation(s)
- Salvatore Fabio Chiarenza
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Maria Luisa Conighi
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Andrea Conforti
- Congenital Esophageal Disorders Unit, Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital, Rome.
| | - Cosimo Bleve
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University, Naples.
| | | | | | - Maurizio Cheli
- Pediatric Surgery Department Papa Giovanni XXIII Hospital, Bergamo.
| | | | | | | | - Maurizio Marzaro
- Pediatric Surgery Unit, Local Health Unit 2, Treviso Hospital, Treviso.
| | - Marco Gambino
- Pediatric Surgery Unit, Annunziata Civil Hospital, Cosenza.
| | - Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - Francesco Molinaro
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena.
| | | | - Paolo Caione
- Pediatric Surgery and Urologic Unit, Pediatric Hospital Bambino Gesù, Rome.
| |
Collapse
|
4
|
Chen L, Hu Y, Hu C, Wen H. Prenatal evaluation and postnatal outcomes of fetal ovarian cysts. Prenat Diagn 2020; 40:1258-1264. [PMID: 32441348 DOI: 10.1002/pd.5754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/07/2022]
Abstract
To evaluate the natural history and outcome of cases of fetal ovarian cyst under conservative prenatal treatment. A retrospective cohort study included patients diagnosed with fetal ovarian cysts was conducted between January 2008 to December 2016. Data including clinical data, sonographic feature and postnatal outcomes were obtained. One hundred and two cases were included for statistical analysis. The rate of spontaneous resolution was significantly higher among cases with simple than complex cysts (70/92 or 76.1% vs 2/10 or 20%, P < .01) and for cysts <4 cm than cysts ≥4 cm (50/56 or 89.3% vs 22/46 or 47.8%, P < .01). Ovarian torsion was confirmed in 5/102 (4.9%) cases; neither prenatal characteristics of cysts (complex: 2/10 or 20% vs simple: 3/92 or 3.3%, P = .07), nor their size (≥40 mm: 4/46 or 8.7% vs < 40 mm: 1/56 or 1.8%, P = .17) was predictive for ovarian torsion. 25/102 (24.5%) of cysts change in size or sonographic characteristics prenatally. Half of the complex cysts at the last prenatal scan are not ovarian in origin. 98/102 neonates (96.1%) were able to preserve both ovaries. Spontaneous resolution of ovarian cysts is predicted by cyst size and characteristics, whereas likelihood of torsion cannot be predicted.
Collapse
Affiliation(s)
- Lu Chen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Hu
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chanchan Hu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Wen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
5
|
Raźnikiewicz A, Korlacki W, Grabowski A. Evaluation of the usefulness of laparoscopy in the diagnosis and treatment of adnexal pathologies in the pediatric population. Wideochir Inne Tech Maloinwazyjne 2020; 15:366-376. [PMID: 32489499 PMCID: PMC7233164 DOI: 10.5114/wiitm.2020.93998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The current trend in adnexal surgery in children is to minimize the invasiveness of diagnostic and therapeutic procedures, reduce the number of complications and reduce the risk of infertility. AIM Evaluation of the usefulness and effectiveness of laparoscopy in diagnostics and treatment of pathological lesions of adnexa in the pediatric population and evaluation of the correlation of imaging with the intraoperative diagnosis during laparoscopy. MATERIAL AND METHODS The study included 89 patients aged 0-18 years (mean: 12.62) who underwent an emergency or elective laparoscopic procedure due to the suspicion of adnexa pathology in the imaging tests or in which intraoperative pathology of the adnexa was found without previous suspicion of these changes in the imaging tests. Patients were divided into 2 groups according to the procedure (emergency or elective) and into 4 age groups. RESULTS The most frequent postoperative diagnosis was an adnexal cyst and ovarian tumor. The ratio of malignant to benign lesions was 0.087. In 32.58% of patients appendix pathology was found. Coexistence of adnexa and appendix pathology was statistically significantly more frequent in patients undergoing emergency surgery (p = 0.013). There was no correlation between the size of the tumor or ovarian cyst and the occurrence of adnexal torsion, and no correlation between the size of the tumor and the degree of torsion of the adnexa. Three conversions were performed. The average operation time was 63.7 min. CONCLUSIONS Laparoscopic diagnosis and treatment of adnexal pathology seems to be safe due to the low percentage of perioperative complications. It shows high sensitivity in recognizing adnexal pathologies and other defects.
Collapse
Affiliation(s)
- Aleksandra Raźnikiewicz
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Wojciech Korlacki
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Andrzej Grabowski
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia in Katowice, Zabrze, Poland
| |
Collapse
|
6
|
Signorelli M, Gregorini M, Platto C, Orabona R, Zambelloni C, Torri F, Franceschetti L, Gambino A, Sartori E. The prognostic value of antenatal ultrasound in cases complicated by fetal ovarian cysts. J Neonatal Perinatal Med 2020; 12:339-343. [PMID: 30883366 DOI: 10.3233/npm-1870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ovarian cysts are relatively common prenatal findings in female fetuses. The aim of this study is to evaluate the ability of antenatal ultrasound in predicting spontaneous regression or a need for surgery. DESIGN All cases of fetal ovarian cysts treated in our Department between 2007 and 2016 were included. Patients underwent a sonographic monitoring in utero and after birth until spontaneous or surgical resolution. Subjects were divided into two groups according to their postnatal management. Receiver-operating characteristics (ROC) curves were used to test the predictive ability for postnatal surgery of the cyst's mean and maximum diameters; their optimal cut off points were also determined. RESULTS 38 cases of antenatally-detected fetal ovarian cysts were included. 12/38 cases underwent surgery (Group A). 26/38 cases were resolved spontaneously (Group B). Cyst size of those which were surgically excised significantly differed from those that regressed spontaneously. ROC curve pointed to 45 mm and 47 mm as optimal cut off points for the mean and the maximum cystic diameters, respectively. CONCLUSIONS Cyst size and echo-structure seemed good predictors for prognosis after birth. The optimal cut off points of the cysts mean and maximum diameters in predicting postnatal surgery have been identified as 45 mm and 47 mm, respectively.
Collapse
Affiliation(s)
- M Signorelli
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - M Gregorini
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - C Platto
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - R Orabona
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - C Zambelloni
- Department of Neonatology, University of Brescia, Brescia BS, Italy
| | - F Torri
- Department of Pediatric Surgery, Spedali Civili Children's Hospital of Bescia, Brescia BS, Italy
| | - L Franceschetti
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - A Gambino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - E Sartori
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| |
Collapse
|
7
|
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
| |
Collapse
|
8
|
Shruti A, Wu GS. Case 246: MR Imaging of a Complex Cystic Mass in a Newborn Girl. Radiology 2017; 285:324-328. [PMID: 28926319 DOI: 10.1148/radiol.2017132069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 6-day-old female neonate presented to the outpatient pediatric surgery clinic for evaluation of a possible prenatal abdominal mass. The neonate was delivered at term via cesarean section due to macrosomia, with a reported birth weight of 11 lb 8.7 oz (5.23 kg). The patient's postnatal course was remarkable for resolving neonatal hyperbilirubinemia. A physical examination was remarkable for a palpable mass in the abdomen. Maternal risk factors included class II obesity, type 2 diabetes, and metabolic syndrome. Prenatal images obtained at an outside institution were not available at this time. Ultrasonography (US) of the abdomen and pelvis was performed 6 days after birth. Follow-up US at 29 days of life revealed no substantial change in the appearance of the findings. This patient remained asymptomatic, and gadolinium-enhanced (Magnevist; Bayer Pharma, Berlin, Germany) magnetic resonance (MR) imaging of the abdomen and pelvis was performed at 84 days of life. The mass was excised surgically at 89 days of life, and the patient had an uncomplicated postoperative course.
Collapse
Affiliation(s)
- Aditi Shruti
- From the Department of Radiology, Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822
| | - George S Wu
- From the Department of Radiology, Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822
| |
Collapse
|
9
|
Bascietto F, Liberati M, Marrone L, Khalil A, Pagani G, Gustapane S, Leombroni M, Buca D, Flacco ME, Rizzo G, Acharya G, Manzoli L, D'Antonio F. Outcome of fetal ovarian cysts diagnosed on prenatal ultrasound examination: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:20-31. [PMID: 27325566 DOI: 10.1002/uog.16002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the outcome of fetuses with a prenatal diagnosis of ovarian cyst. METHODS The electronic databases MEDLINE and EMBASE were searched using keywords and word variants for 'ovarian cysts', 'ultrasound' and 'outcome'. The following outcomes in fetuses with a prenatal diagnosis of ovarian cyst were explored: resolution of the cyst, change of ultrasound pattern of the cyst, occurrence of ovarian torsion and intracystic hemorrhage, need for postnatal surgery, need for oophorectomy, accuracy of prenatal ultrasound examination in correctly identifying ovarian cyst, type of ovarian cyst at histopathological analysis and intrauterine treatment. Meta-analyses using individual data random-effects logistic regression and meta-analyses of proportions were performed. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. RESULTS Thirty-four studies (954 fetuses) were included. In 53.8% (95% CI, 46.0-61.5%) of cases for which resolution of the cyst was evaluated (784 fetuses), the cyst regressed either during pregnancy or after birth. The likelihood of resolution was significantly lower in complex vs simple cysts (odds ratio (OR), 0.15 (95% CI, 0.10-0.23)) and in cysts measuring ≥ 40 mm vs < 40 mm (OR, 0.03 (95% CI, 0.01-0.06)). Change in ultrasound pattern of the cyst was associated with an increased risk of ovarian loss (surgical removal or autoamputation) (pooled proportion, 57.7% (95% CI, 42.9-71.8%)). The risk of ovarian torsion was significantly higher for cysts measuring ≥ 40 mm compared with < 40 mm (OR, 30.8 (95% CI, 8.6-110.0)). The likelihood of having postnatal surgery was higher in patients with cysts ≥ 40 mm compared with < 40 mm (OR, 64.4 (95% CI, 23.6-175.0)) and in complex compared with simple cysts, irrespective of cyst size (OR, 14.6 (95% CI, 8.5-24.8)). In cases undergoing prenatal aspiration of the cyst, rate of recurrence was 37.9% (95% CI, 14.8-64.3%), ovarian torsion and intracystic hemorrhage were diagnosed after birth in 10.8% (95% CI, 4.4-19.7%) and 12.8% (95% CI, 3.8-26.0%), respectively, and 21.8% (95% CI, 0.9-40.0%) had surgery after birth. CONCLUSION Size and ultrasound appearance are the major determinants of perinatal outcome in fetuses with ovarian cysts. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- F Bascietto
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M Liberati
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - L Marrone
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - A Khalil
- Fetal Medicine Unit, St George's University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - G Pagani
- Department of Obstetrics and Gynaecology, Fondazione Poliambulanza, Brescia, Italy
| | - S Gustapane
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M Leombroni
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - D Buca
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M E Flacco
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy
| | - G Rizzo
- Department of Obstetrics and Gynaecology, University of Rome, Rome, Italy
| | - G Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
| |
Collapse
|
10
|
Aamir M, Punia H, Dalal P, Sharma D. Conservative management of a large neonatal ovarian cyst: a case report. J Clin Diagn Res 2015; 9:SD04-5. [PMID: 26023615 DOI: 10.7860/jcdr/2015/12717.5805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/20/2015] [Indexed: 11/24/2022]
Abstract
We describe a case of a large simple neonatal ovarian cyst, which was managed successfully using "wait and watch" approach and serial ultrasound monitoring. A cystic lesion arising from right ovary was noted in antenatal ultrasound (USG) which was followed up with postnatal USG which revealed a large simple ovarian cyst without any complications. Patient was kept on expectant management with close clinical and USG monitoring. Cyst resolved spontaneously at 10 wk of age. A brief review of literature for likely aetio-pathogenesis and management is also presented.
Collapse
Affiliation(s)
- Mohd Aamir
- Fellow (Neonatology) Department of Pediatrics, Division of Neonatal Services, PGIMS , Rohtak, Haryana, India
| | - Harish Punia
- Junior Resident, Department of Pediatrics, PGIMS , Rohtak Haryana, India
| | - Poonam Dalal
- Associate Professor, Department of Pediatrics, PGIMS , Rohtak, Haryana, India
| | - Deepak Sharma
- DNB (Neonatology), Fernandez Hospital , Hyderabad, Telangana, India
| |
Collapse
|
11
|
Trinh TW, Kennedy AM. Fetal Ovarian Cysts: Review of Imaging Spectrum, Differential Diagnosis, Management, and Outcome. Radiographics 2015; 35:621-35. [DOI: 10.1148/rg.352140073] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
12
|
Antonakopoulos N, Agrapidis D, Karras G, Stefanidis K, Loutradis D. Torted large prenatally detected foetal ovarian cyst. J OBSTET GYNAECOL 2015; 35:848-9. [PMID: 25671519 DOI: 10.3109/01443615.2015.1009877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Antonakopoulos
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - D Agrapidis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - G Karras
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - K Stefanidis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - D Loutradis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| |
Collapse
|
13
|
Dera-Szymanowska A, Malinger A, Madejczyk M, Szymanowski K, Bręborowicz GH, Opala T. Recurrent fetal complex ovarian cysts with rupture followed by simple cyst in the neonatal period with no adverse sequelae. J Matern Fetal Neonatal Med 2015; 29:328-30. [PMID: 25567557 DOI: 10.3109/14767058.2014.1000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fetal ovarian cysts are the most frequent type of abdominal tumors in female fetuses with prenatal detection rate of more than 30%. The etiology of fetal ovarian cysts is unclear, but hormonal stimulation as well as presence of maternal diabetes, hypothyroidism, Rh iso-immune hemolytic disease and toxemia has been generally considered responsible for the disease. Complications of fetal ovarian cysts include compression of other viscera, cyst rupture, hemorrhage and, most frequently, ovarian torsion with consequent loss of the ovary. Management is controversial with several options described in the literature, including watchful expectancy, antenatal aspiration of simple cysts to prevent torsion and ovarian loss and finally, resection of all complex cysts in the neonatal period. To date, no case report has described recurrent complex cysts with rupture in the fetal period and recurrence of simple cyst in neonatal period. By presenting this case, we wanted to show that surgical intervention in case of prenatally diagnosed fetal ovarian cyst should be considered postnatally and only in symptomatic or complicated cases.
Collapse
Affiliation(s)
| | - Adam Malinger
- b Department of Mother's and Child's Health , K. Marcinkowski University of Medical Sciences in Poznan , Poznan , Poland
| | | | - Krzysztof Szymanowski
- b Department of Mother's and Child's Health , K. Marcinkowski University of Medical Sciences in Poznan , Poznan , Poland
| | | | - Tomasz Opala
- b Department of Mother's and Child's Health , K. Marcinkowski University of Medical Sciences in Poznan , Poznan , Poland
| |
Collapse
|
14
|
Fetal ovarian cyst: 2- and 3-dimensional ultrasound as a new diagnostic method to rule out ovarian torsion. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Owing to the improvement in obstetric ultrasound imaging, prenatal diagnosis of ovarian masses has increased considerably. Fetal ovarian cysts can be suspected when an ultrasound scan shows intra-abdominal structures in female fetuses in the presence of normal bowel and urinary structures. The most common complication is the adnexal torsion, causing partial or complete strangulation of blood supply via ovarian vessels, leading ovarian ischemia, or necrosis. Current information regarding the treatment of fetal ovarian cysts is based on personal experiences and some case series. The management is controversial, characterized by dissimilar approaches, such as “wait and see”, prenatal or postnatal aspiration, or neonatal surgery. In more than half of the cases, spontaneous regression occurs in the prenatal or postnatal period, probably due to the small size and simple aspect. Large cysts may cause both local effects (adnexal torsion, ovarian autoamputation), and distant effects (intestinal and urinary obstruction, adhesion with adjacent organs, abdominal and thoracic mass effect, pulmonary hypoplasia, hemoperitoneum, ascites, polyhyramniosis). In the absence of accurate guidelines for management, we must start with the development of more accurate methods for diagnosing associated complications such as torsion. This case report describes the role of three-dimensional (3-D) ultrasonography as potential diagnostic method for ruling out adnexal torsion when an ovarian cyst is present.
Collapse
|
15
|
Erol O, Erol MB, Isenlik BS, Ozkiraz S, Karaca M. Prenatal diagnosis of fetal ovarian cyst: case report and review of the literature. J Turk Ger Gynecol Assoc 2013; 14:119-22. [PMID: 24592088 DOI: 10.5152/jtgga.2013.58855] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 10/14/2012] [Indexed: 11/22/2022] Open
Abstract
Foetal ovarian cysts are the most frequently encountered intra-abdominal cystic masses diagnosed prenatally. The aetiology of foetal ovarian cysts is still unknown, but hormonal stimulation is generally considered to be responsible for the disease. The diagnosis is made by the exclusion of other cystic lesions confined to the foetal abdomen. In this article we report antenatally-detected foetal ovarian cyst with a review of the available literature. Antenatal ultrasonography (USG) revealed an abdominal cystic mass 41×33 mm in diameter in a 33-week gestation female foetus. The normal anatomy of other foetal abdominal organs suggested that an ovarian cyst was the most likely diagnosis. In the antenatal follow-up period, the cyst diameter increased with time. After delivery, USG scan confirmed the antenatal findings. Due to abdominal distension and respiratory distress, ovarian cystectomy was performed on the second postnatal day. The histopathological evaluation of the surgical material reported a serous cystadenoma of the ovary with non-malignant properties.
Collapse
Affiliation(s)
- Onur Erol
- Department of Obstetrics and Gynecology, Antalya Education and Research Hospital, Antalya, Turkey
| | | | - Bekir Sıtkı Isenlik
- Department of Obstetrics and Gynecology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Servet Ozkiraz
- Department of Neonatology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Mehmet Karaca
- Department of Obstetrics and Gynecology, Antalya Education and Research Hospital, Antalya, Turkey
| |
Collapse
|
16
|
Turgal M, Ozyuncu O, Yazicioglu A. Outcome of sonographically suspected fetal ovarian cysts. J Matern Fetal Neonatal Med 2013; 26:1728-32. [DOI: 10.3109/14767058.2013.799652] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Nemec U, Nemec SF, Bettelheim D, Brugger PC, Horcher E, Schöpf V, Graham JM, Rimoin DL, Weber M, Prayer D. Ovarian cysts on prenatal MRI. Eur J Radiol 2012; 81:1937-44. [DOI: 10.1016/j.ejrad.2011.04.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 04/12/2011] [Accepted: 04/19/2011] [Indexed: 11/28/2022]
|
18
|
|
19
|
Triulzi F, Manganaro L, Volpe P. Fetal magnetic resonance imaging: indications, study protocols and safety. Radiol Med 2011; 116:337-50. [DOI: 10.1007/s11547-011-0633-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/02/2010] [Indexed: 12/17/2022]
|
20
|
Akın MA, Akın L, Özbek S, Tireli G, Kavuncuoğlu S, Sander S, Akçakuş M, Güneş T, Öztürk MA, Kurtoğlu S. Fetal-neonatal ovarian cysts--their monitoring and management: retrospective evaluation of 20 cases and review of the literature. J Clin Res Pediatr Endocrinol 2010; 2:28-33. [PMID: 21274333 PMCID: PMC3005663 DOI: 10.4274/jcrpe.v2i1.28] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/19/2009] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Neonatal ovarian cysts (NOC) are usually self-limiting structures. However, large or complex cysts may lead to severe complications. A standard guide to management, treatment and follow-up of NOC is not yet available. The aim of this study was to evaluate retrospectively the records of NOC patients from two medical centers. METHODS A total of 20 newborns with NOC were included in the study. The size and localization of the cyst, the age, the signs and symptoms at presentation, and the possible maternal and fetal-neonatal etiologic factors were recorded. Follow-up procedures and treatment modalities were evaluated. RESULTS The mean age at diagnosis was 34 gestational weeks. The cysts (mean size 53±15 mm) were predominantly in the right ovary (75%) and were evaluated as large cysts in 16 (80%) of the patients. In 5 of the patients with large cysts and in 1 of the 4 patients with small cysts, the cysts were evaluated as complex cysts. Torsion of the ovary was detected in five (25%) cases and these cases were treated surgically. Patients with simple cysts were closely followed by ultrasonography until the cysts disappeared. CONCLUSION To date, there is no precise guide for the monitoring and treatment of NOCs. Surgical treatment should always be performed in a way to protect the ovaries and to ensure future fertility. In our NOC series, it has been possible to apply a non-invasive follow-up program and minimally invasive surgical procedures.
Collapse
Affiliation(s)
- Mustafa Ali Akın
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, 38039 Kayseri, Turkey.
| | - Leyla Akın
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
| | - Sibel Özbek
- Bakırköy Maternity and Children Hospital, Department of Pediatrics, Division of Neonatology, İstanbul, Turkey
| | - Gülay Tireli
- Bakırköy Maternity and Children Hospital, Department of Pediatric Surgery, İstanbul, Turkey
| | - Sultan Kavuncuoğlu
- Bakırköy Maternity and Children Hospital, Department of Pediatrics, Division of Neonatology, İstanbul, Turkey
| | - Serdar Sander
- Bakırköy Maternity and Children Hospital, Department of Pediatric Surgery, İstanbul, Turkey
| | - Mustafa Akçakuş
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - Tamer Güneş
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - M. Adnan Öztürk
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| |
Collapse
|
21
|
Spinelli C, Di Giacomo M, Cei M, Mucci N. Functional ovarian lesions in children and adolescents: when to remove them. Gynecol Endocrinol 2009; 25:294-8. [PMID: 19340623 DOI: 10.1080/09513590802530932] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
STUDY OBJECTIVE Functional ovarian lesions represent 45% of all pediatric adnexal abnormalities. Their surgical management, even if frequent, is not clear, especially in pediatric age. MATERIALS AND METHODS We retrospectively reviewed 22 pediatric patients surgically treated for functional ovarian lesions from 2000 to 2006. The following characteristics were analysed: age, size of the lesion, ultrasound (US) aspect and clinical presentation. RESULTS The average age was 16.1 years of age (range: 6 months-18 years). Of the 22 functional lesions, 12 (55%) were follicular cysts and 10 (45%) corpus luteum ones. The average size was 6.7 cm (range: 5.1-33 cm). US scan showed simple lesions in 10 cases (45%) and complex ones in 12 cases (55%). In 16 girls (72.8%) the presenting symptom was abdominal pain while 2 patients (9%) presented abdominal distention. In the other 4 patients (16.2%) the lesion was found accidentally during US examination. CONCLUSION In pediatric subjects, functional ovarian cysts rarely required surgical intervention, though no complications or disorder recurrence were reported. To preserve ovarian function, conservative surgery has to be performed whenever feasible.
Collapse
Affiliation(s)
- C Spinelli
- Chair of Pediatric and Infantile Surgery, Department of Surgery, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
| | | | | | | |
Collapse
|