1
|
Min J, Tang R, Zhi W, Gu Z, Huang S, Wang J. Clinical outcomes of fetal ovarian masses diagnosed by prenatal ultrasonography and literature review. Medicine (Baltimore) 2022; 101:e30962. [PMID: 36254031 PMCID: PMC9575801 DOI: 10.1097/md.0000000000030962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With the advancement of prenatal examination technology, more and more fetus with ovarian masses are diagnosed. However, whether such children need intervention measures after delivery, there is no more unified diagnosis and treatment measures in the world. In this study, postnatal data and clinical outcome of fetal diagnosed with ovarian masses were analyzed. We also combined with relevant literature to explore the postpartum intervention measures and timing of such children. A total of 57 cases of abdominal masses from the reproductive system were included in the study. These children were diagnosed with ovarian masses after birth. We collected from 2012 to 2020, the prenatal examination revealed the presence of abdominal masses from the reproductive system, and diagnosis was confirmed by imaging examinations after childbirth. We counted the fetal period data of these children, compared the changes in the postnatal pathology and intervention measures. A total of 57 cases of ovarian masses were diagnosed prenatally, 1 case was lost to follow-up, and 56 cases were finally included in the study. After birth a total of 21 cases of ovarian masses were treated conservatively, of which 18 cases resolved spontaneously during the follow-up process, with an average follow-up period of 30.88 ± 18.16 weeks. There were statistically significant differences in the nature and the maximum diameter of the mass between the two groups receiving conservative treatment or surgical treatment after delivery (P < .05).Univariate and multivariate Logistic regression analysis showed that there were significant differences in the nature and diameter of the mass between two groups (P < .05). In addition, we divided the children undergoing postpartum surgery into a laparoscopic surgery group and a conventional open surgery group. Through data analysis, we found that there were statistically significant differences in the age of operation, operation time, and hospitalization days in the two groups of these children (P < .05). Children diagnosed with ovarian masses prenatally generally have a good prognosis. For these children, the treatment plan should be developed according to the child general condition. If child with ovarian mass is treated with surgery, the preservation of ovarian tissue should be emphasized regardless of the size, nature, and torsion of the mass.
Collapse
Affiliation(s)
- Jie Min
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Ruze Tang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Wenxian Zhi
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Zhicheng Gu
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Shungen Huang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
- *Correspondence: Jian Wang, Department of Pediatric Surgery,Children’s Hospital of Soochow University, Suzhou 215123, China (e-mail: )
| |
Collapse
|
2
|
Sakai S, Nomura K, Tomida M, Hayashi K, Tsutsuno T, Mizushima H, Mitani Y. Strangulated ileus due to an ovarian cyst in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
3
|
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
|
4
|
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
|
5
|
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
|
6
|
|
7
|
Abstract
The daughter cyst sign is a specific indicator of an uncomplicated ovarian cyst and pathologically represents a stimulated ovarian follicle. This finding must be differentiated from an ectopic pregnancy in a patient who has the potential to become pregnant. We report an uncomplicated ovarian cyst in a 3-year-old female with McCune-Albright syndrome and precocious puberty mimicking an ectopic pregnancy.
Collapse
|
8
|
Chinchure D, Ong CL, Loh AHP, Rajadurai VS. Neonatal Ovarian Cysts: Role of Sonography in Diagnosing Torsion. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n6p291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The purpose of this case series was to determine the sonographic features of neonatal ovarian torsion. Materials and Methods: Seven surgically proven cases of neonatal ovarian cysts were included in this retrospective study. The patients were divided into 2 groups, torsion and non-torsion. These 7 patients were evaluated for the clinical presentation, sonographic features, surgical and pathological findings. The findings on follow-up sonography after surgery were also noted. Results: The sonographic appearance was variable. Of the 4 cases with torsion, 2 lesions had internal echoes with ‘fish-net appearance’. The other 2 lesions were predominantly cystic on the sonography with internal echoes and echogenic nodule. A calcific focus was present in 1 of these echogenic nodules. One of the cysts had fluid-fluid level. In the non-torsion group, only 1 lesion had mixed echogenic appearance. The other 2 lesions were cystic with low level internal echoes in 1 of the cysts. The surgical procedure performed in the torsion group was salpingo-oophorectomy in 2 patients and oophorectomy in 1 patient. In 1 patient, cystectomy was attempted without success. In the non-torsion group, only cystectomy was performed with preservation of normal ovaries, which was confirmed on follow-up sonography. Conclusion: The sonographic features of cysts with ‘fish-net appearance’, fluid-debris level and cysts with echogenic nodule favour torsion. The former sign has so far not been described as a sonographic predictor for neonatal ovarian torsion.
Key words: Ultrasound, Ovary, Doppler, Fish-net appearance, Haemorrhage
Collapse
Affiliation(s)
| | | | - Amos HP Loh
- KK Women’s and Children’s Hospital, Singapore
| | | |
Collapse
|
9
|
Dimitraki M, Koutlaki N, Nikas I, Mandratzi T, Gourovanidis V, Kontomanolis E, Zervoudis S, Galazios G, Liberis V. Fetal ovarian cysts. Our clinical experience over 16 cases and review of the literature. J Matern Fetal Neonatal Med 2011; 25:222-5. [PMID: 21615230 DOI: 10.3109/14767058.2011.575484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Fetal ovarian cysts are intra-abdominal structures frequently diagnosed prenatally, tending to present as isolated unilateral lesions in normal fetuses in the third trimester. These cysts may present with complications and their diameter and echogenicity are the main criteria for establishing their prognosis. Spontaneous regression of fetal ovarian cysts is very usual. In the present study, we present our clinical experience on fetal ovarian cyst surveillance and treatment, as well as a review of the literature in the same field. MATERIAL AND METHOD In this study, we reviewed pre- and postnatal medical records and ultrasonography of 16 fetuses that were diagnosed with ovarian cysts, in Obstetrics Department of University Hospital of Alexandroupolis, between January 2000 and April 2010. We have also reviewed the available literature about fetal ovarian cysts. RESULTS In a total of 16 cases, postnatal surgery was performed in one infant due to ovarian cyst torsion. In the remaining 15 cases, cysts regressed completely in two fetuses during pregnancy and all the rest of the cysts, including four complex ones, resolved spontaneously after birth. CONCLUSIONS When fetal ovarian cysts are detected, they should be followed up by serial ultrasonographic examinations. The majority of them will regress spontaneously in a period of 12 months after birth, independent of their sonographic findings. Only symptomatic cysts or cysts with a diameter >5 cm, which do not regress or enlarge, should be treated.
Collapse
Affiliation(s)
- Marina Dimitraki
- Department of Obstetric Gynecology, Demokritus University of Thrace, Alexandroupolis, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
OBJECTIVES The aim of the present study was to analyze the antenatal and postnatal outcome of fetal ovarian cysts in relation to their ultrasonographic pattern and size. METHODS Sixteen fetal ovarian cysts were diagnosed in 16 fetuses and followed with serial ultrasonograms in utero and after birth until spontaneous or surgical resolution. RESULTS Eleven fetal ovarian cysts were simple cysts at first prenatal scan but 3 of the 11 became complex cysts at last prenatal scan and required postnatal laparoscopic surgery. Seven of the 11 simple cysts (63%) disappeared on follow-up imaging by ultrasonograms or MRI during pregnancy or within 2 months after birth. The rate of spontaneous resolution of simple cysts was higher than that of complex cysts (40.0%). The mean maximum diameter of the ovarian cysts before delivery that were subsequently excised surgically at postnatal period (50+/-13.4 mm) was not different from that of ovarian cysts that resolved spontaneously (42.8+/-12.8 mm, P=0.2918). CONCLUSION In our study, cyst size did not predict the risk of ovarian loss. The opportunity of laparoscopic exploration versus conservative management needs to be investigated because some complex cysts resolved spontaneously in the postnatal period.
Collapse
|
11
|
Monnery-Noché ME, Auber F, Jouannic JM, Bénifla JL, Carbonne B, Dommergues M, Lenoir M, Lepointe HD, Larroquet M, Grapin C, Audry G, Hélardot PG. Fetal and neonatal ovarian cysts: is surgery indicated? Prenat Diagn 2008; 28:15-20. [DOI: 10.1002/pd.1915] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Abstract
BACKGROUND/PURPOSE Since Tan and Bianchi (Br J Surg. 1986;73:399) reported umbilical incision as an access for pyloromyotomy in infantile hypertrophic pyloric stenosis, many pediatric surgeons have used this approach for a number of other procedures. Because of the long pedicle with good mobility and the frequent intraabdominal position of the neonatal ovarian cyst, we attempted to manage it via the transumbilical route. METHODS All patients were treated under intubation general anesthesia. Semicircular infraumbilical incision was made, and the abdomen was entered through a transverse fascial incision. The partially collapsed cyst after aspiration was exteriorized through the incision for cystectomy, partial deroofing, or adnexectomy. RESULTS From May 2000 to December 2006, 6 female newborns with ovarian cysts were treated via the transumbilical route. There were no complications from surgery. The operation time and duration of hospital stay were short. The cosmetic appearance after the procedure was good. CONCLUSIONS The initial result suggests that transumbilical management for neonatal ovarian cysts may be a good alternative procedure when laparoscopic equipment is unavailable or experienced technique is lacking.
Collapse
|
13
|
Herman TE, Siegel MJ. Neonatal follicular ovarian hemorrhagic cyst. J Perinatol 2007; 27:805-7. [PMID: 18034168 DOI: 10.1038/sj.jp.7211858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T E Herman
- Department of Radiology, St Louis Children's Hospital, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA.
| | | |
Collapse
|
14
|
Abstract
Ovarian cysts are the most frequent, prenatally diagnosed intra-abdominal cysts. Fetal ovarian cyst often presents complication such as torsion and seems to be an indication for surgical intervention. In this study, we reviewed pre- and post-natal medical records and ultrasonography of 17 fetuses that were diagnosed with ovarian cysts. In a total of 17 cases, postnatal surgery was performed in 7 infants. Of these cases, four cases of ovarian cyst torsion were confirmed. In the remaining 10 fetuses, one case regressed completely during pregnancy, and the other nine cases including two complex cysts resolve spontaneously after birth. Postnatal symptomatic cysts or cysts with a diameter greater than 5 cm that do not regress or enlarge should be treated, but uncomplicated asymptomatic cysts less than 5 cm in diameter should only be observed and reassessed by serial ultrasonography. If they regress spontaneously, no surgical intervention is necessary independent of their sonographic findings.
Collapse
Affiliation(s)
- Dong Wook Kwak
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seok Sohn
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sei Kwang Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - In Kyu Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Won Park
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Kuroiwa M, Hatakeyama SI, Suzuki N, Murai H, Toki F, Tsuchida Y. Neonatal Ovarian Cysts: Management with Reference to Magnetic Resonance Imaging. Asian J Surg 2004; 27:43-8. [PMID: 14719514 DOI: 10.1016/s1015-9584(09)60243-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Ultrasound (US) has been used as a tool to determine the indication for surgery for neonatal ovarian cysts. The purpose of this study was to investigate whether magnetic resonance imaging (MRI) contributes to optimal management. METHODS Between 1993 and 2001, US and MRI studies were simultaneously performed on 13 consecutive infants younger than 2 months of age with ovarian cysts. The US Patterns were classified as complex or simple. Signal intensity (SI) of the cysts on MRI was compared with that of the liver on T1-weighted images (T1WI) and with urine on T2-weighted images (T2WI). We assumed that high SI on T1WI and iso or low SI on T2WI indicated complications. RESULTS There were 10 complex and three simple cysts on US. Of the 10 complex cysts, two had no complications at surgery or resolved spontaneously. These two cysts showed low SI on T1WI. Eight complex cysts showed high SI on T1WI and all were haemorrhagic. The US diagnosis corresponded to the MRI findings in three simple cysts. The sensitivity of US for haemorrhage was 80%, and that of MRI was 100%. CONCLUSIONS We found that MRI was a more reliable diagnostic modality than US for diagnosing neonatal ovarian cysts.
Collapse
Affiliation(s)
- Minoru Kuroiwa
- Department of Surgery, Gunma Children's Medical Center, Hokkitsu, Seta-gun, 377-8577, Japan.
| | | | | | | | | | | |
Collapse
|
16
|
Avni FE, Garel L, Hall M, Rypens F. Perinatal Approach to Anomalies of the Urinary Tract, Adrenals and Genital System. ACTA ACUST UNITED AC 2002. [DOI: 10.1007/978-3-642-56402-4_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
|
17
|
Danzer E, Schier F, Gorsler C. Laparoscopic Management of Ovarian Cysts in Infants, Children, and Adolescents. ACTA ACUST UNITED AC 2001. [DOI: 10.1089/10926410152776315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- E. Danzer
- Department of Pediatric Surgery, University Medical Center, Jena, Germany
| | - F. Schier
- Department of Pediatric Surgery, University Medical Center, Jena, Germany
| | - C. Gorsler
- Department of Pediatric Surgery, University Medical Center, Jena, Germany
| |
Collapse
|
18
|
Abstract
Prenatal sonography uncovers many fetal ovarian masses that previously would have gone unrecognized. This challenges clinicians to learn the natural history of these asymptomatic lesions so as to provide the best care postnatally. Spontaneous resolution of simple ovarian cysts is expected by about 6 months of age, which is attributed to predicted changes in the postnatal hormonal milieu. After birth, levels of human chorionic gonadotropin (HCG) and estrogen plummet. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) rise until about 3 months of age and then fall as the "gonadostat" matures. Although symptomatic cysts demand intervention, simple asymptomatic cysts less than 5 cm in diameter should be left alone but reassessed sonographically. If simple cysts are larger than 5 cm in diameter the risk of torsion may be significant, and intervention often is advocated. However, the risk of torsion versus the likelihood of resolution is not well established. The therapeutic goal for a clinician managing a newborn with a simple ovarian cyst is to maximize ovarian salvage. Aspiration alone may be a reasonable option. The laparascopic approach to the neonatal ovarian cyst provides a view of both ovaries and allows aspiration, unroofing, cystectomy, or ovariectomy. The sonographically complex cyst usually represents adnexal torsion but could be a neoplasm and warrants intervention because the morbidity from untreated neonatal adnexal torsion can be significant beyond loss of the ovary (eg, hemorrhage, peritonitis, intestinal obstruction, or a wandering tumor).
Collapse
Affiliation(s)
- S E Dolgin
- Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA
| |
Collapse
|
19
|
Lee HJ, Woo SK, Kim JS, Suh SJ. "Daughter cyst" sign: a sonographic finding of ovarian cyst in neonates, infants, and young children. AJR Am J Roentgenol 2000; 174:1013-5. [PMID: 10749241 DOI: 10.2214/ajr.174.4.1741013] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the value of the "daughter cyst" sign, a sonographic finding of neonatal ovarian cysts, in differentiating ovarian cysts from other cystic masses in neonates, infants, and young children. SUBJECTS AND METHODS In a prospective study, 23 neonates, infants, and young children (age range, 1 day to 36 months) with a lower abdominal cystic mass underwent sonography. We defined the daughter cyst sign as the presence of a small cyst along the wall of a cystic mass. The diagnosis of ovarian cyst was made when this sign was present. Detailed pathologic correlation was available in four ovarian cysts. The size, wall thickness, and contents of the cysts were also evaluated. RESULTS The 23 cystic lesions included ovarian cyst (n = 11), lymphangioma (n = 3), enteric duplication cyst (n = 3), enteric cyst (n = 1), meconium pseudocyst (n = 2), hydrometrocolpos (n = 2), and urachal cyst (n = 1). The daughter cyst sign was seen in nine (82%) of 11 ovarian cysts but in none of the other cystic lesions. Sensitivity, specificity, and positive predictive value of the daughter cyst sign for differentiating ovarian cysts from other cystic lesions were 82%, 100%, and 100%, respectively. The daughter cyst corresponded to an ovarian follicle on pathologic examination. CONCLUSION The daughter cyst sign is a specific sonographic finding for an ovarian cyst and may be useful in differentiating uncomplicated ovarian cysts from other cystic masses in neonates, infants, and young children.
Collapse
Affiliation(s)
- H J Lee
- Department of Diagnostic Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Taegu, Korea
| | | | | | | |
Collapse
|
20
|
Mizuno M, Kato T, Hebiguchi T, Yoshino H. Surgical indications for neonatal ovarian cysts. TOHOKU J EXP MED 1998; 186:27-32. [PMID: 9915104 DOI: 10.1620/tjem.186.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ante- or neonatal ovarian cysts can be often diagnosed by routine ultrasonography. Small simple ovarian cysts, which can be followed with serial ultrasonography, usually resolve spontaneously. Large simple cysts and complicated cysts should undergo surgical treatment to reduce the potential for serious complications. Seventeen ovarian cysts were experienced between 1983 and 1997. Sixteen cases underwent surgical treatment at less than 1 month of age according to our protocols. In this report, we reviewed these cases for clinical presentation, ultrasound data, management, intraoperative findings, complications, and outcome. At operation, nine of them showed torsion, and seven of them showed necrotic changes. Only five of them was considered to fall into torsion by preoperative ultrasonography. In five cases whose blood flow could not improve after reduction of torsion, salpingo-oophorectomy was performed. We consider that small simple ovarian cysts under 4 cm in diameter can be observed carefully with serial ultrasonography. But, not only complicated ovarian cysts and simple cysts over 5 cm in diameter, but smaller cysts showing no decrease in size should be considered for surgical indication to rescue the ovarian tissue.
Collapse
Affiliation(s)
- M Mizuno
- Department of Pediatric Surgery, Akita University School of Medicine, Japan.
| | | | | | | |
Collapse
|
21
|
Koç E, Türkyilmaz C, Atalay Y, Basaklar C, Bideci A. Neonatal ovarian cyst associated with intestinal obstruction. Indian J Pediatr 1997; 64:555-7. [PMID: 10771887 DOI: 10.1007/bf02737767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cystic and solid tumors of the ovary are rare during the newborn period and infancy. We present the case of a term female infant born to a mother with 24 years of age and found to have a cystic abdominal mass through prenatal sonographic evaluation in the third trimester. The cyst was also demonstrated by postnatal abdominal ultrasonography. Because of the clinical and radiological findings of intestinal obstruction, laparatomy was performed at the age of three days and a cyst of 10' 8' 8 cm was found in the right ovary. Pathological examination of cyst revealed a teach-lutein cyst.
Collapse
Affiliation(s)
- E Koç
- Department of Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | | | | | | | | |
Collapse
|
22
|
Yokoyama Y, Kagiya A, Ozaki T, Ogasawara T, Saito Y, Sugai M. Two cases of twisted fetal ovarian cysts. J Obstet Gynaecol Res 1996; 22:85-8. [PMID: 8624899 DOI: 10.1111/j.1447-0756.1996.tb00942.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two twisted fetal ovarian cysts were detected antenatally by routine ultrasonographic examination. Serial changes of twisted ovarian cysts can be monitored by ultrasonic observation. If signs of torsion appear, obstetricians should consider prompt delivery in order to preserve the patient's fertility.
Collapse
Affiliation(s)
- Y Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Aomori, Japan
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
A right ovarian cyst was detected in a 34-week-gestation fetus on antenatal ultrasound scan (USS). Postnatal USS confirmed the presence of the cyst and showed it to be 4.6 cm in diameter. The cyst failed to resolve after a period of conservative management, and therefore surgical removal was performed. During the operation a free autoamputated right ovarian cysts was found. The complication had not been detected preoperatively in spite of regular USS follow-up.
Collapse
Affiliation(s)
- A Aslam
- Department of Paediatric Surgery, Bristol Royal Hospital for Sick Children, England
| | | | | | | |
Collapse
|
24
|
Giorlandino C, Bilancioni E, Bagolan P, Muzii L, Rivosecchi M, Nahom A. Antenatal ultrasonographic diagnosis and management of fetal ovarian cysts. Int J Gynaecol Obstet 1994; 44:27-31. [PMID: 7907055 DOI: 10.1016/0020-7292(94)90019-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate the outcome of fetal ovarian cysts in relation to their ultrasonic appearance and size. METHODS Forty-two fetal ovarian cysts were diagnosed in 41 fetuses and followed with serial ultrasonograms in utero and after birth until spontaneous or surgical resolution. RESULTS Twelve fetal ovarian cysts that were echogenic at diagnosis and six that were anechoic at diagnosis but became echogenic at subsequent prenatal sonograms were all submitted to postnatal surgery. Of the remaining 24 cysts, all anechoic, four were successfully aspirated in utero, 11 resolved spontaneously after birth, and nine underwent postnatal surgery for complication. The outcome of cysts that were anechoic at diagnosis was significantly correlated with size (P = 0.01). CONCLUSIONS Echogenic fetal ovarian cysts should be always surgically removed. The outcome of anechoic cysts depends on the size at diagnosis, and serial ultrasonographic assessment is recommended; although not randomized, the present series suggests that in utero aspiration of cysts > 5 cm may prevent complication and subsequent oophorectomy.
Collapse
|
25
|
Affiliation(s)
- H A Srair
- Departments of Pediatrics and Pediatric Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | | | | | | |
Collapse
|
26
|
|
27
|
Spence J, Domingo M, Pike C, Wenning J. The resolution of fetal and neonatal ovarian cysts. ACTA ACUST UNITED AC 1992. [DOI: 10.1016/s0932-8610(12)80103-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Müller-Leisse C, Bick U, Paulussen K, Tröger J, Zachariou Z, Holzgreve W, Schuhmacher R, Horvitz A. Ovarian cysts in the fetus and neonate--changes in sonographic pattern in the follow-up and their management. Pediatr Radiol 1992; 22:395-400. [PMID: 1437358 DOI: 10.1007/bf02013494] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a multicenter trial we retrospectively evaluated the clinical and sonographic data of 49 neonatal ovarian cysts, 44 of which were detected prenatally and 5 on the first day after delivery. Of the 44 prenatally detected cysts 39 were purely cystic, 5 echogenic or had a mixed pattern. In 20 patients the cystic appearance changed during delivery from purely cystic to a mixed pattern being independent on the size of the cyst. 26 of the 44 cysts were treated surgically. Salpingotorsion was found in 8 and was independent on the size of the cyst. In 15 a salpingo-oophorectomy or oophorectomy was performed, in 11 the ovary was saved. 23 patients were followed sonographically: 15 cysts showed complete resolution within 14 months without correlation to the sonographic pattern. The volume of these cysts varied between 5 and 71 ml. Neonatal ovarian cysts disappear spontaneously frequently and rarely cause severe symptoms. The authors recommend follow-up by ultrasound as the primary modality. Surgical intervention is recommended only if the cyst is space-occupying and percutaneous puncture can not be performed or in the case of emergency.
Collapse
Affiliation(s)
- C Müller-Leisse
- Department of Diagnostic Radiology, University of Technology, Aachen, FRG
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Croitoru DP, Aaron LE, Laberge JM, Neilson IR, Guttman FM. Management of complex ovarian cysts presenting in the first year of life. J Pediatr Surg 1991; 26:1366-8. [PMID: 1765908 DOI: 10.1016/0022-3468(91)91034-v] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With more frequent antenatal and postnatal diagnosis, the management of ovarian cysts has become somewhat controversial. Management protocols for simple ovarian cysts have been proposed. The purpose of this study was to establish a management protocol for complex ovarian cysts presenting antenatally and in the first year of life. We reviewed the records of nine infants who underwent surgical treatment for ovarian cysts over a 10-year period (1980 through 1989). Antenatal ultrasound performed between 24 and 34 weeks of gestation showed ovarian cysts in six infants. All six infants had complex cysts ranging in size from 3 to 10 cm on postnatal ultrasound. Exploration with oophorectomy or salpingooophorectomy was carried out at 2 days to 3 months of age for ovarian torsion. Ovarian cysts measuring up to 7 cm were diagnosed postnatally in three infants from 1 day to 7 months of age with ultrasound confirmation of complex, cystic intraabdominal masses. All patients underwent salpingooophorectomy, two for tuboovarian torsion and the third patient for a juvenile granulosa cell tumor. We recommend that all complex ovarian cysts, regardless of size, be surgically removed because they represent torsion, neoplasm, or alternate diagnoses, and removal can prevent possible complications.
Collapse
Affiliation(s)
- D P Croitoru
- Department of Surgery, Montreal Children's Hospital, Quebec, Canada
| | | | | | | | | |
Collapse
|
30
|
Brandt ML, Luks FI, Filiatrault D, Garel L, Desjardins JG, Youssef S. Surgical indications in antenatally diagnosed ovarian cysts. J Pediatr Surg 1991; 26:276-81; discussion 281-2. [PMID: 1827651 DOI: 10.1016/0022-3468(91)90502-k] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The antenatal diagnosis of ovarian cysts poses a therapeutic dilemma because the natural history of these lesions is not well known. A retrospective review from 1980 to 1989 showed 29 ovarian cysts in 27 patients diagnosed by prenatal ultrasonography performed between 28 and 36 weeks of gestation. Nineteen cysts were initially observed. Eleven cysts resolved (diameter less than 2 cm), three are decreasing, three were lost to follow-up, and two underwent resection. Eight patients underwent surgical exploration immediately following birth. The diagnosis of benign ovarian cyst was confirmed histologically in all cases. A review of the literature showed an additional 230 cases of antenatally diagnosed ovarian cysts. Simple cysts of the ovary tend to resolve spontaneously and, therefore, may be treated conservatively. Serial ultrasonography allows accurate diagnosis and long-term assessment of ovarian cysts in the neonate and may prevent unnecessary oophorectomy. Patients with cysts larger than 4 cm may be candidates for percutaneous aspiration, or should undergo removal of the cyst because of a significant risk of torsion. Complex cystic masses, symptomatic ovarian cysts, and cysts that do not resolve should be removed.
Collapse
Affiliation(s)
- M L Brandt
- Department of Surgery, Hôpital Ste-Justine, Montreal, Quebec, Canada
| | | | | | | | | | | |
Collapse
|
31
|
Sakaguchi T, Suita S, Nakano H, Kukita J, Ueda K. Significance of prenatal diagnosis in a patient with a huge neck tumor. J Perinat Med 1991; 19:191-7. [PMID: 1748941 DOI: 10.1515/jpme.1991.19.3.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Due to the great advancements in fetal ultrasonography, the number of prenatal diagnoses are increasing, greatly contributing to improved neonatal surgery. It is now relatively easy to detect huge fetal cystic masses, and we have experienced three cases with a huge neck tumor detected in utero, one case with teratoma and two cases with cystic hygroma. Each case was complicated by neonatal asphyxia, and the neonate needed resuscitation by means of endotracheal intubation. The infant with teratoma unfortunately died of respiratory distress due to compression of the trachea before a perinatal team could be organized. Although the remaining cases with cystic hygroma were treated by a perinatal team, one died 19 hours after birth and the other has survived with the aid of endotracheal intubation in the hospital for three years. In addition, all four cases of cystic hygroma detected antenatally in our institute, which were not delivered, also had fetal hydrops which suggested a general lymphatic derangement. Cystic hygroma detected in utero is considered to be different from that detected after birth, since the former is associated with genetic lymphatic derangement. Prenatal diagnosis enables such patients to survive the perinatal period, but may not improve the prognosis of fetal cystic hygroma so much.
Collapse
Affiliation(s)
- T Sakaguchi
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
| | | | | | | | | |
Collapse
|
32
|
Garel L, Filiatrault D, Brandt M, Grignon A, Boisvert J, Perreault G, Patriquin H. Antenatal diagnosis of ovarian cysts: natural history and therapeutic implications. Pediatr Radiol 1991; 21:182-4. [PMID: 2047154 DOI: 10.1007/bf02011042] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A retrospective study from 1980 to 1990 shows 29 ovarian cysts in 27 patients diagnosed by prenatal ultrasound performed between 28 and 38 weeks of gestation. Ten patients underwent surgery, 17 patients were observed with serial ultrasound. Delayed good quality sonograms after spontaneous resolution of the cyst in a selected group of 7 patients showed restoration of a normal ovarian anatomy. The size of the cyst and/or its sonographic characteristics are the 2 main factors for deciding a conservative or a surgical management.
Collapse
Affiliation(s)
- L Garel
- Department of Radiology, Hôpital Ste-Justine, Montreal, Quebec, Canada
| | | | | | | | | | | | | |
Collapse
|
33
|
Giorlandino C, Rivosecchi M, Bilancioni E, Bagolan P, Zaccara A, Taramanni C, Vizzone A. Successful intrauterine therapy of a large fetal ovarian cyst. Prenat Diagn 1990; 10:473-5. [PMID: 2235907 DOI: 10.1002/pd.1970100710] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fetal ovarian cysts can be managed in different ways, depending upon their size and clinical course: conservatively, by open surgery or by postnatal transabdominal puncture. However, in cases of large cysts detected antenatally and affecting the ongoing pregnancy, in utero transabdominal puncture can be undertaken, without increase of risk. A case of such a puncture at 30 weeks gestation is reported.
Collapse
Affiliation(s)
- C Giorlandino
- Department of Ultrasound and Perinatal Medicine, Artemisia Medical Centre, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
34
|
D'Addario V, Volpe G, Kurjak A, Lituania M, Zmijanac J. Ultrasonic diagnosis and perinatal management of complicated and uncomplicated fetal ovarian cysts: a collaborative study. J Perinat Med 1990; 18:375-81. [PMID: 2292759 DOI: 10.1515/jpme.1990.18.5.375] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ovarian cysts can be demonstrated in the ovaries of fetuses and full term infants at birth. Small cysts involute spontaneously during fetal life or within the first few months of life. Large cysts may cause mechanical complications or respiratory distress. Sonographic detection of fetal ovarian cysts has been reported, as well as intrauterine surgical treatment. The sonographic findings and the outcome of the smaller and the complicated cysts were studied in 25 pregnant women. Uncomplicated fetal ovarian cysts should be monitored by weekly examination until delivery. Huge ovarian cysts may be an indication for cesarean section; or, intrauterine aspiration may be the alternative. Complicated fetal ovarian cysts represent an indication for neonatal surgery.
Collapse
Affiliation(s)
- V D'Addario
- 1st Department of Obstetrics and Gynecology, University of Bari, Italy
| | | | | | | | | |
Collapse
|