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Bloomfield V, Shahid A, Traubici J, Chiu PPL, Kives S, Allen L. Retrospective Review of Management of Antenatally Diagnosed Ovarian Cysts at the Hospital for Sick Children. J Pediatr Surg 2024:S0022-3468(24)00369-5. [PMID: 38991897 DOI: 10.1016/j.jpedsurg.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Postnatal management of antenatally diagnosed ovarian cysts is not well-defined. The clinical course, management, and outcomes of patients with antenatally diagnosed ovarian cysts were reviewed. METHODS Infants <1 year of age with antenatally diagnosed ovarian cyst managed at The Hospital for Sick Children between January 2017 and December 2021 were included. Patient charts were reviewed for postnatal ultrasound (US) images, management, clinical course and complications. Mixed linear regression analysis was used to model the change in cyst size over time. RESULTS In total, 52 patients were included and 10 patients had no cyst identified at their first postnatal US. Of the remaining cases, 36% were simple/physiologic and 64% had complex features. Two underwent percutaneous aspiration while 40 patients were managed expectantly with most cysts (62%) resolving. The rate of resolution was significantly higher and faster for simple compared to complex cysts (84% versus 52%, p < 0.05). Cysts that persisted at the end of the study period (n = 14) had all decreased in size, with a rate of resolution similar to resolved cysts. Only one patient managed expectantly required urgent laparoscopy for salpingoophorectomy. CONCLUSION Antenatally diagnosed ovarian cysts exhibit high rates of resolution with expectant management, supporting the safety and efficacy for expectant management for these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Valerie Bloomfield
- Section of Pediatric and Adolescent Gynecology, The Hospital for Sick Children, Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Aiman Shahid
- University of Toronto's Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Traubici
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sari Kives
- Section of Pediatric and Adolescent Gynecology, The Hospital for Sick Children, Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, Unity Health Toronto, Toronto, Ontario, Canada
| | - Lisa Allen
- Section of Pediatric and Adolescent Gynecology, The Hospital for Sick Children, Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
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Safa N, Yanchar N, Puligandla P, Sewitch M, Baird R, Beaunoyer M, Campbell N, Chadha R, Griffiths C, Jones S, Kaur M, Le-Nguyen A, Nasr A, Piché N, Piper H, Prasil P, Romao RLP, VanHouwelingen L, Wales P, Guadagno E, Emil S. Treatment and Outcomes of Congenital Ovarian Cysts A Study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS). Ann Surg 2023; 277:e1130-e1137. [PMID: 35166261 PMCID: PMC10082055 DOI: 10.1097/sla.0000000000005409] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We conducted a multicenter study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts. SUMMARY BACKGROUND DATA Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known. METHODS Female infants diagnosed with congenital intra-abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centers were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter. RESULTS The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally, and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary sparing resection (14, 23%), or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4weeks. Independent predictors of surgery included postnatal cyst diameter ≥40 mm [odds ratio (OR) 6.19, 95% confidence interval (CI) 1.66-35.9] and sonographic complex cyst character (OR 63.6, 95% CI 10.9-1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 -13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131). CONCLUSIONS Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.
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Affiliation(s)
- Nadia Safa
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Natalie Yanchar
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Pramod Puligandla
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Maida Sewitch
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Robert Baird
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Beaunoyer
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Niamh Campbell
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Rati Chadha
- Division of Maternal Fetal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Griffiths
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Jones
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Manvinder Kaur
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Annie Le-Nguyen
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmed Nasr
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Nelson Piché
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Piper
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascale Prasil
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Rodrigo L P Romao
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Lisa VanHouwelingen
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Paul Wales
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Toker Kurtmen B, Divarci E, Ergun O, Ozok G, Celik A. The Role of Surgery in Antenatal Ovarian Torsion: Retrospective Evaluation of 28 Cases and Review of the Literature. J Pediatr Adolesc Gynecol 2022; 35:18-22. [PMID: 34454073 DOI: 10.1016/j.jpag.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/30/2021] [Accepted: 08/07/2021] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Antenatal ovarian torsion (AOT) is rare and requires differentiating from other congenital cystic masses of the abdomen and pelvis in neonates. In this study, it was aimed to evaluate the prenatal characteristics and postnatal outcomes of AOT. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Hospital records of patients (n = 28) with diagnosis of AOT between 2004 and 2020 were reviewed and their prenatal characteristics, postnatal examination, imaging, operative, and histopathological findings were evaluated. RESULTS There were 28 patients during the study period. In most of the patients (25/28; 89.3%) AOTs were detected prenatally. All were term babies with a mean birth weight of 3010 ± 466.6 g. Mean maternal age was 25.75 ± 3.65 years. Prenatal history was event-free in all and none had additional anomalies. Physical examination revealed mobile intra-abdominal cystic lesions in 16 (57.1%) patients. AOTs mimicked other pathologies as intestinal duplication cyst or mesenteric cyst (n = 7), complex ovarian cyst (n = 3), mature cystic teratoma (n = 3), simple renal cyst (n = 1), and ectopic kidney (n = 1) in 15 (53.6%) patients in postnatal ultrasonography. Elective laparoscopic surgery was performed in 26 (92.8%) patients. The other 2 patients required emergency open surgery because of acute symptoms. Ovaries were autoamputated in 17 (60.7%) patients. Histopathological examination revealed necrosis and dystrophic calcification in all specimens. There was neoplastic involvement in 2 patients (serous cystadenoma and gonadoblastoma). No complication occurred in the early follow-up period (mean: 73.9 ± 46.8 months). CONCLUSION AOTs can be detected easily during the antenatal period. Neoplastic involvement with AOTs is rare but possible. Although AOTs might mimic other cystic pathologies, it should be one of the first diagnoses to be considered, in the presence of a palpable intra-abdominal mass and complex cystic lesion in infant girls. It can be efficiently and safely managed using minimally invasive techniques.
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Affiliation(s)
- Bade Toker Kurtmen
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
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Engwall-Gill A, Dougherty D, Rausch S, Perrone E. Autoamputated ovarian mass causing a partial bowel obstruction in an infant with literature review. BMJ Case Rep 2021; 14:e245476. [PMID: 34785517 PMCID: PMC8596041 DOI: 10.1136/bcr-2021-245476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/03/2022] Open
Abstract
An autoamputated ovary (AO) is an extremely rare circumstance with a few reports in the literature. We present a case of a 3-month-old girl with a history of vague abdominal symptoms as well as a known ovarian mass, which was initially suspected to be benign and regressing. On laparoscopy for pain and obstructive symptoms, she was found to have an AO. The pathology was consistent with necrotic and torsed ovarian tissue with superimposed infection and possibly a cystic non-malignant teratoma. AOs are thought to originate from a torsion and are typically diagnosed incidentally. This is an interesting case of an AO causing a partial small bowel obstruction.
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Affiliation(s)
- Abigail Engwall-Gill
- Departement of Surgery, Michigan State University, Lansing, Michigan, USA
- Department of Pediatric Surgery, Sparrow Health System, Lansing, Michigan, USA
| | - Danielle Dougherty
- Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Savannah Rausch
- Department of Pediatric Surgery, Sparrow Health System, Lansing, Michigan, USA
| | - Erin Perrone
- Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
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Ripatti L, Taskinen M, Koivusalo A, Taskinen S. Surgically treated ovarian lesions in preadolescent girls. Acta Obstet Gynecol Scand 2019; 99:105-111. [PMID: 31449329 DOI: 10.1111/aogs.13717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the epidemiology and characteristics of surgically treated ovarian lesions in preadolescent girls. MATERIAL AND METHODS This was a retrospective cohort study including all 0- to 11-year-old girls operated at a single center from 1999 to 2016 for ovarian cysts, neoplasms or torsions. Patient charts were reviewed for symptoms, preoperative radiological imaging, operative details and histopathology. RESULTS We identified 78 girls, resulting in a population-based incidence of 4.2/100 000. Infants (n = 44) presented with benign cysts (42/44, 95%, one bilateral), a benign neoplasm (1/44, 2%) and a torsion without other pathology (1/44, 2%). Torsion was found in 25/29 (86%) ovaries with complex cysts and in 3/15 (21%) ovaries with simple cysts in preoperative imaging (P < 0.001). Most infants were symptomless. Lesions in 1- to 11-year-old girls (n = 34) included benign neoplasms (n = 21/34, 62%), malignant neoplasms (n = 5/34, 15%), a cyst with torsion (n = 1/34, 3%) and torsions without other pathology (n = 7/34, 21%). Torsion was more common in benign (17/21, 81%) than in malignant neoplasms (1/5, 20%) (P < 0.020). Ovarian diameter did not differ between ovaries with or without torsion (P = 0.238) or between benign and malignant neoplasms (P = 0.293). The duration of symptoms in lesions with or without torsion was similar. CONCLUSIONS The majority of surgically treated ovarian lesions in preadolescent are benign lesions with torsion. Surgery should be ovary-preserving and performed without delay.
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Affiliation(s)
- Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland.,Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Antti Koivusalo
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Taskinen
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
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