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Bai R, Bonanni JR, Guo J, Li Z, Yu X, Zhao J, Zeng J, Garvin G, Yan Y. Opting for conservative management over surgery for neonatal ovarian cysts. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:705-716. [PMID: 38629899 DOI: 10.1002/jcu.23693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To explore the suitability of conservative management for neonatal ovarian cysts in newborns. METHODS A retrospective cohort study was conducted, involving infants diagnosed with neonatal abdominal/pelvic cysts at two separate medical institutions from January 2015 through July 2021. Data collection included clinical characteristics, imaging results, pathological findings, and postnatal outcomes. Statistical analyses were performed using the Student's t-test, Mann-Whitney U-test, and receiver operating characteristic (ROC) curve. RESULTS In total, 34 cases of neonatal abdominal/pelvic cystic masses were detected, with mean birth weight of 3401 ± 515 g. Of these, 22 patients underwent postnatal cystectomy/oophorectomy. Pathological assessments revealed 16 uncomplicated cysts, 5 complex cysts, and 1 ovarian cyst with torsion complications. Notably, the cysts' dimensions at the time of surgical intervention had significantly decreased from the initial measurements (p = 0.015). The ROC curve analysis presented an area under the curve of 0.642, indicating moderate accuracy in employing cyst size as a discriminative feature to differentiate complex from simple ovarian cysts. Additionally, a short-term follow-up of nonsurgical cases indicated a 100% resolution rate by 24 months of age (n = 9). CONCLUSION Given their predominantly benign nature, the majority of neonatal ovarian cysts seem to be amenable to conservative management. This approach remains justified for larger cysts with minimal torsion risk, as well as considering the observed reduction in cyst size at birth, which further supports the case against surgical intervention.
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Affiliation(s)
- Ruimiao Bai
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - John Ross Bonanni
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Radiology, Max Rady College of Medicine Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jinzhen Guo
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Xiping Yu
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Jinru Zhao
- Department of Neonatal Surgery, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, Province, China
| | - Junan Zeng
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Gregory Garvin
- Department of Medical Imaging, St. Joseph's Health Care London, London, Ontario, Canada
| | - Yi Yan
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Imaging, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Radiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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Melinte-Popescu AS, Popa RF, Harabor V, Nechita A, Harabor A, Adam AM, Vasilache IA, Melinte-Popescu M, Vaduva C, Socolov D. Managing Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040715. [PMID: 37109673 PMCID: PMC10145213 DOI: 10.3390/medicina59040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Fetal ovarian cysts (FOCs) are a very rare pathology that can be associated with maternal-fetal and neonatal complications. The aim of this study was to assess the influence of ultrasound characteristics on FOC evolution and therapeutic management. Materials and Methods: We included cases admitted to our perinatal tertiary center between August 2016 and December 2022 with a prenatal or postnatal ultrasound evaluation indicative of FOC. We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation protocols, and pathology reports. Results: This study investigated 20 cases of FOCs, of which 17 (85%) were diagnosed prenatally and 3 (15%) postnatally. The mean size of prenatally diagnosed ovarian cysts was 34.64 ± 12.53 mm for simple ovarian cysts and 55.16 ± 21.01 mm for complex ovarian cysts (p = 0.01). The simple FOCs ≤ 4 cm underwent resorption (n = 7, 70%) or size reduction (n = 3, 30%) without complications. Only 1 simple FOC greater than 4 cm reduced its size during follow-up, while 2 cases (66.6%) were complicated with ovarian torsion. Complex ovarian cysts diagnosed prenatally underwent resorption in only 1 case (25%), reduced in size in 1 case (25%), and were complicated with ovarian torsion in 2 cases (50%). Moreover, 2 simple (66.6%) and 1 complex (33.3%) fetal ovarian cysts were postnatally diagnosed. All of these simple ovarian cysts had a maximum diameter of ≤4 cm, and all of them underwent size reduction. The complex ovarian cyst of 4 cm underwent resorption during follow-up. Conclusions: Symptomatic neonatal ovarian cysts, as well as those that grow in size during sonographic follow-up, are in danger of ovarian torsion and should be operated on. Complex cysts and large cysts (with >4 cm diameter) could be followed up unless they become symptomatic or increase in dimensions during serial ultrasounds.
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Affiliation(s)
- Alina-Sinziana Melinte-Popescu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, 'Ștefan cel Mare' University, 720229 Suceava, Romania
| | - Radu-Florin Popa
- Department of Vascular Surgery, University of Medicine and Pharmacy "Grigore T. Popa", 700111 Iasi, Romania
| | - Valeriu Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Aurel Nechita
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - AnaMaria Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Ana-Maria Adam
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Marian Melinte-Popescu
- Department of Internal Medicine, Faculty of Medicine and Biological Sciences, 'Ștefan cel Mare' University, 720229 Suceava, Romania
| | - Cristian Vaduva
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
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López Soto Á, Bueno González M, Urbano Reyes M, Carlos Moya Jiménez L, Beltrán Sánchez A, Garví Morcillo J, Velasco Martínez M, Luis Meseguer González J, Martínez Rivero I, García Izquierdo O. Imaging in fetal genital anomalies. Eur J Obstet Gynecol Reprod Biol 2023; 283:13-24. [PMID: 36750003 DOI: 10.1016/j.ejogrb.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Genital anomalies are a heterogeneous group of congenital pathologies that have become increasingly relevant since the Chicago Consensus of 2005. Their postnatal diagnosis has developed significantly in the last two decades, while prenatal diagnosis seems to be underdeveloped, with few protocols available, fragmented scientific literature, and low diagnostic rates. This review aims to examine the current status of this subspecialty from the perspective of prenatal imaging. Indications for the evaluation of fetal genitalia can be divided into medical and non-medical reasons. Medical reasons include sex-linked disorders, detection of other anomalies, relevant family history, or multiple pregnancy. Non-medical reasons include parental request for sex disclosure. Disclosure of fetal sex may be associated with ethical, legal, and medical issues. The main imaging technology used is 2D ultrasound, although there are other complementary techniques such as 3D, MRI, or Color Doppler. Regarding working methodology, several authors have drawn attention to the lack of standardized protocols and guidelines. Most guidelines tend to limit their recommendations to study indications and ethical issues. Technical proposals, measurements, or working methods have not yet been standardized. Fetal sex determination is usually divided into early and late gestation. Early gestation is based on the sagittal sign. Late gestation is based on direct visualization. There are several measurements to describe male and female genitalia, such as penile length, bilabial diameter, or scrotal diameter. Prenatal diagnosis of genital pathologies presents some particularities such as the wide spectrum of phenotypes, the high frequency of associated deformities, or the time of diagnosis. Some of the most frequent pathologies are ambiguous genitalia, fetal sex discordance, hypospadias, micropenis, clitoromegaly, ovarian cysts, hydro(metro)colpos, and cloacal anomalies. Higher-quality studies and direction from scientific societies through the implementation of clinical guidelines are needed.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain.
| | | | - Maribel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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Fetal Ovarian Cysts: Prenatal Diagnosis Using Ultrasound and MRI, Management and Postnatal Outcome—Our Centers Experience. Diagnostics (Basel) 2021; 12:diagnostics12010089. [PMID: 35054256 PMCID: PMC8775004 DOI: 10.3390/diagnostics12010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/25/2022] Open
Abstract
The present study provides our clinical experience regarding the imaging diagnosis, management and postnatal outcome of neonates prenatally suspected of having developed ovarian cysts. This multicenter observational study included patients diagnosed prenatally with fetal ovarian cysts and follow-up in the postnatal period. Descriptive statistics were used to render the information regarding the prenatal imaging aspect of the fetal pelvic masses using ultrasound and/or MRI, prenatal surveillance and postnatal neonate’s immediate outcome, indications leading to surgery and pathologic aspect. The inclusion criteria were fulfilled by 21 patients. The mean gestational age at the time of initial diagnosis was 31.28 weeks of gestation (WG). Only five out of 21 cysts regressed completely during pregnancy without postnatal complications. In addition, 11 out of 21 infant’s required surgical treatment in the first two weeks after birth, mainly for ovarian torsion. Five out of 21 neonates were referred to postnatal follow-up clinically and by ultrasound, but three out of five cases required emergency surgical treatment for acute complications. Ultrasound plays a major role in the diagnostic of fetal ovarian cyst. From our experience, MRI does not bring supplementary data or change the management. Spontaneous resolution of fetal ovarian cysts is to be expected but the ovarian mass could lead to serious complications, if resolution does not occur in due time.
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Diagnosis, Management, and Therapy of Fetal Ovarian Cysts Detected by Prenatal Ultrasonography: A Report of 36 Cases and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11122224. [PMID: 34943461 PMCID: PMC8700714 DOI: 10.3390/diagnostics11122224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. METHODS We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥40 mm was performed. RESULTS We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter <40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to <35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. CONCLUSIONS IUA is a promising therapy for preserving ovaries with simple cysts ≥40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.
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Akalin M, Demirci O, Dayan E, Odacilar AS, Ocal A, Celayir A. Natural history of fetal ovarian cysts in the prenatal and postnatal periods. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:822-827. [PMID: 34245032 DOI: 10.1002/jcu.23044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/01/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To determine the natural history of fetal ovarian cysts and to investigate whether the prognosis can be predicted by prenatal ultrasonography (US). METHODS This retrospective study includes cases of fetal ovarian cysts diagnosed by prenatal US over a 6-year period. Cases were divided into four subgroups of cysts (small and simple, small and complex, large and simple, large and complex) according to their size and echotexture. US examinations were repeated every 2 weeks from the time of diagnosis to treatment. RESULTS A total of 37 cases were included in the study. 32.4% of the cases regressed spontaneously in the prenatal period and 32.4% did so in the infantile period. Prenatal resolution occurred more frequently with small cysts than with large cysts (p = 0.03). Neonates with complex cysts required surgical treatment more often than neonates with simple cysts (p = 0.009). 27.0% of the cases underwent surgery due to ovarian torsion. The torsion rate of fetal ovarian cysts that progressed in the prenatal period was significantly higher than in the case of stable cysts (p = 0.001). CONCLUSION The size of the fetal ovarian cysts, their US appearance and the progression of the cysts during follow-up are the main determinants of the neonatal outcome.
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Affiliation(s)
- Munip Akalin
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Eda Dayan
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ali Sahap Odacilar
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Aydin Ocal
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Aysenur Celayir
- Department of Pediatric Surgery, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
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Soto ÁL, González MB, Reyes IU, Meseguer González JL, Pérez MÁJ, Izquierdo OG. Fetal sex discordance. Taiwan J Obstet Gynecol 2021; 59:652-655. [PMID: 32917312 DOI: 10.1016/j.tjog.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/01/2022] Open
Abstract
Fetal sex discordance is an entity that is becoming more frequent due to the expansion of the cfDNA for prenatal diagnosis. Its incidence can be estimated in 1/1500-2000 pregnancies, a frequency as high as that of some common chromosomopathies. The causes of this phenomenon are multiple and diverse, ranging from laboratory errors to important pathologies such as disorders of sexual differentiation. The management of a case of fetal sex discordance must be structured, starting with the review of the clinical history and the tests performed, and may require the performance of invasive tests to reach a diagnosis. Prevention through adequate pretest counseling and ultrasound confirmation can help to reduce its incidence.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain.
| | - Mar Bueno González
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
| | - Isabel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
| | | | - M Ángeles Jódar Pérez
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
| | - Olivia García Izquierdo
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
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Gupta S, Mohi JK, Gambhir P, Mohi MK. Prenatal diagnosis of congenital anomalies of genito-urinary system on fetal magnetic resonance imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00278-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
Background
The aim of this study is to elucidate the spectrum of commonly encountered anomalies affecting fetal genito-urinary system (GUS) on fetal MRI and examine its utility in providing better morphological information resulting in improved diagnostic accuracy and in detecting additional malformations. The study also aims to highlight the promising role of fetal MRI in the detection and characterization of renal fusion anomalies like the horseshoe kidney or developmental abnormalities such as renal agenesis/ectopia.
Results
The mean age of study participants was 29 years ± 3 years. The gestation age of pregnant mothers ranged from 18 weeks and 1 day to 39 weeks and 0 day. Amniotic fluid was reduced or absent in 41% (N = 13) and normal in 59% (N = 18) of participating mothers. Overall, urinary obstruction was the commonest anomaly encountered (29%) followed by the multicystic dysplastic kidney (MCDK) (22%). Bilateral renal disease was seen in all mothers having features of anhydramnios {B/L MCDK (N = 3), autosomal recessive polycystic kidney disease (ARPKD) (N = 2), posterior urethral valves (PUV) (N = 2), B/L renal agenesis (N = 3), and megacystis (N = 1)}. Fusion anomalies (horseshoe kidney) and rotation anomaly (malrotation) were detected in one case each. Additional extrarenal findings were seen on fetal MRI in 35% (N = 11) cases.
Conclusions
Fetal MRI improves diagnostic accuracy in anomalies affecting the fetal kidney and genito-urinary systems by better morphological delineation. It has the ability to detect additional extra-renal malformations and perform a more accurate assessment of associated pulmonary hypoplasia. The diffusion-weighted sequence is particularly useful in confirming the diagnosis of renal agenesis/ectopia.
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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.
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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
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Diagnosis and management of a giant ovarian cyst in the gravid-puerperium period: a case report. BMC Pregnancy Childbirth 2019; 19:523. [PMID: 31878899 PMCID: PMC6933931 DOI: 10.1186/s12884-019-2678-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant ovarian cyst is very rare in gravid-puerperium period. It is a cause of a maternal-fetal morbidity. We report a case of a giant benign ovarian cyst in gravid-puerperium period which was diagnosed and managed in a hospital of a low-resource country. CASE PRESENTATION Data were collected by historical review, clinical examination, laboratory investigations, imaging examination, and by histopathological study of the excised surgical specimen. It is the case of a 25-year-old woman who was third gravida and third para with unknown pathological history. After she had given birth through vagina, a giant ovarian cyst, unknown during pregnancy, was diagnosed. A left oophorectomy carrying the cyst was performed after laparotomy in Yalgado Ouedraogo University Hospital Center of Ouagadougou (Burkina Faso). The cyst was 42 cm long and weighed 19.7 kg. The histology of the operative specimen revealed serous cystadenoma of the ovary. The postoperative course was uneventful. CONCLUSION This case reports that vaginal delivery is possible with a giant ovarian cyst associated with pregnancy. Surgical management of the cyst can be performed in the postpartum with satisfaction.
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Matos APP, Duarte LDB, Castro PT, Daltro P, Werner Júnior H, Araujo Júnior E. Evaluation of the fetal abdomen by magnetic resonance imaging. Part 1: malformations of the abdominal cavity. Radiol Bras 2018; 51:112-118. [PMID: 29743740 PMCID: PMC5935407 DOI: 10.1590/0100-3984.2016.0140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although ultrasound continues to be the mainstay modality for the evaluation of
fetal disorders, fetal magnetic resonance imaging (MRI) has often been used as a
valuable adjunct in recent years. The exponential growth of the use of fetal MRI
has been facilitated by technological advancements such as ultrafast T2-weighted
sequences and diffusion-weighted imaging. Fetal MRI can achieve results that are
comparable to or better than those of ultrasound, particularly in cases of
maternal obesity, severe oligohydramnios, or abnormal fetal position. Because of
its superior soft tissue contrast, wide field of view, and multiplanar imaging,
fetal MRI is able to evaluate the large fetal organs, such as the lungs, liver,
bowel, and kidneys. In addition, fetal MRI allows large or complex malformations
to be examined, facilitating the understanding of the malformation within the
context of the body as a whole. Initial fetal MRI studies were focused on the
central nervous system. With advances in software and hardware, fetal MRI gained
importance in the evaluation of the fetal abdomen. The purpose of this article
is to review the recent literature and developments in MRI evaluation of the
fetal abdomen, with an emphasis on imaging aspects, protocols, and common
clinical indications.
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Affiliation(s)
- Ana Paula Pinho Matos
- MD, Specialist in Fetal Medicine, Masters Student, Department of Maternal and Child Care, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Luciana de Barros Duarte
- PhD, Adjunct Professor, Department of Maternal and Child Care, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Pedro Teixeira Castro
- MSc, MD, Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Pedro Daltro
- PhD, MD, Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Heron Werner Júnior
- PhD, MD, Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Tenured Adjunct Professor, Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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12
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Abstract
Recent improvements in fetal therapies and perinatal care and the multidisciplinary involvement in fetal medicine have increased the demand for more accurate prenatal diagnosis. Fetal Magnetic Resonance Imaging (MRI) is a complementary imaging technique for the assessment of thoraco-abdominal anomalies for which Ultrasonography (US) is not conclusive. It is indicated in selected situations to precise the prognosis in diaphragmatic hernia, to characterise the nature and extension of a pulmonary malformation, to locate a bowel atresia or to better depict an abdominal cystic lesion or tumoural extension. It has become a mandatory complementary diagnostic tool and improves the management of the fetuses and newborns.
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13
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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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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.
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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
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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.
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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
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Hugele F, Dumont C, Boulot P, Couture A, Prodhomme O. Does prenatal MRI enhance fetal diagnosis of intra-abdominal cysts? Prenat Diagn 2015; 35:669-74. [DOI: 10.1002/pd.4590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Florence Hugele
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Coralie Dumont
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Pierre Boulot
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Alain Couture
- Service de radiologie pédiatrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Olivier Prodhomme
- Service de radiologie pédiatrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
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Adekola H, Mody S, Bronshtein E, Puder K, Abramowicz JS. The clinical relevance of fetal MRI in the diagnosis of Type IV cystic sacrococcygeal teratoma--a review. Fetal Pediatr Pathol 2015; 34:31-43. [PMID: 25183379 DOI: 10.3109/15513815.2014.949934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The introduction of fetal magnetic resonance imaging (MRI) has improved the prenatal evaluation of uterine, placental and fetal anatomy. However, its utilization has mostly been restricted to fetal central nervous system anomalies. We review how adjunct fetal MRI was performed and diagnosis of cystic type IV sacrococcygeal teratoma was made. We also discuss the clinical relevance of fetal MRI in differentiating this lesion from other selected abdominal/pelvic cystic malformations and lesions.
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Affiliation(s)
- Henry Adekola
- 1Department of Obstetrics and Gynecology, Hutzel Women Hospital, Wayne State University School of Medicine, Detroit Michigan
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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.
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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
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Abstract
Both benign and malignant pelvic masses are encountered in the pediatric population. Although ultrasonography remains the modality of choice for initial evaluation of a pediatric pelvic mass, in selected cases magnetic resonance (MR) imaging can add important diagnostic information. MR imaging has several advantages over ultrasonography and computed tomography, including superior contrast resolution and an ability to characterize abnormalities based on unique tissue characteristics. MR evaluation assists in lesion characterization, presurgical planning, and staging when a malignancy is suspected. MR imaging also offers a nonionizing imaging modality for long-term follow-up of patients undergoing therapy for malignant pelvic masses.
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Affiliation(s)
- Deepa R Pai
- Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1540 E. Hospital Drive, Ann Arbor, MI 48109-4252, USA
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Amies Oelschlager AME, Sawin R. Teratomas and Ovarian Lesions in Children. Surg Clin North Am 2012; 92:599-613, viii. [DOI: 10.1016/j.suc.2012.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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