[Fetal ovarian cyst: prenatal diagnosis, perinatal outcome and treatment. Case series and literature review]

BACKGROUND

Ovarian cysts in fetal abdominal tumors are more frequently diagnosed during pregnancy. Most of the time are usually small, asymptomatic and resolve spontaneously during pregnancy or in early neonatal life.

OBJECTIVE

To describe the clinical and ultrasound cases with prenatal diagnosis of ovarian cyst treated in our center between 2002 and 2005.

MATERIAL AND METHODS

Descriptive and observational cases of fetal ovarian cyst diagnosedbefore birth. The variables maternal and perinatal most relevant clinical data obtained at diagnosis and after birth.

RESULTS

We explored 9.198 fetuses, of which there were 10 cases of ovarian cyst diagnosed between the second and third trimesters of pregnancy. All cases were unilateral andsonographic appearance homogeneous. In four cases there was spontaneous disappearance during the remaining gestational period. In the other six cases, four missing in the first 12 months and only two image persisted more than a year.

CONCLUSIONS

Based on our results and in accordance with the literature, the prenatal diagnosis of fetal ovarian cyst is usually associated with a conservative approach with serialultrasound monitoring to rule out rare serious complications. During the neonatal period spontaneous disappearance is often the case and the surgical approach is indicated in cases with suspected persistent or torsion or hemorrhage, with cystectomy as first choice.

Ovarian Cysts in MRL/MpJ Mice Originate from Rete Ovarii

In MRL mice aged more than 1 year, but not in C57BL/6 mice, ovaries had grossly visible cysts presenting unilaterally or bilaterally. Postnatally, all MRL mice developed ovarian cysts by 8 months of age. Observations by light microscopy, including lectin histochemistry, indicated that the cysts sometimes included papillomatous tissues located at the hilar region and were similar to the rete ovarii system, but not to follicles. Two types of epithelial cells, ciliated and non-ciliated, were arranged on the cysts, in which both cell types had many microvilli projecting in various directions and random ramifications in the cystic lumen. These characteristics suggest that ovarian cysts developing in MRL mice originate mostly from the rete ovarii. Cysts derived from the rete ovarii at 8 months of age were histologically detected in all C3H mice as well as MRL mice, with variable incidence in ICR, AKR, CBA/N and ddY, and none in C57L/6, DBA/2, BALB and A/J mice. However, measurement of the maximum diameters of the ovarian cysts indicated that MRL mice regularly possessed the largest cysts visible to the naked eye. This is the first report of ovarian cysts in this inbred strain, suggesting that ovarian cysts in MRL mice appear with stable incidence and development.

[Prevalence of postmenopausal simple ovarian cyst diagnosed by ultrasound]

INTRODUCTION

The high-resolution ultrasound has taken to discover small ovary cysts in postmenopausal asymptomatic women who in another situation would not been detected; these cysts frequently disappear spontaneously and rarely develop cancer; however, they are treated aggressively.

OBJECTIVE

To know the prevalence, evolution and treatment of ovary simple cysts in the postmenopausal women in our department, since in our country there are not studies that had analyzed these data.

MATERIAL AND METHODS

We made a retrospective and descriptive study in the Service of Biology of the Human Reproduction of the Hospital Juarez de Mexico, in a four-year period (2000-2003) that included 1,010 postmenopausal women. The statistical analysis was made using the SPSS software program with which we obtained descriptive measurements in localization, dispersion and by a graphic analysis.

RESULTS

We found a simple cysts prevalence of 8.2% (n = 83); the average of age at the diagnosis time was 50.76 years with a standard deviation of 5.55; the cysts diameter was between 0.614 to 12,883 cm with a mean and standard deviation of 2.542 and 1.91 cm respectively; in 27.71% of the cases (n = 23), the cysts disappear spontaneously in the follow up of 3 to 36 month (mean of 14.1). Surgery was indicated in 16.46% (n = 13), by increase in the size of the cyst in 9 patients (11.64%) and by changes in morphology from simple to complex in 4 (4.82%). Tumor like markers were made only to 37 patients (44.57%), which were in normal ranks; no carcinoma was found in this group.

CONCLUSIONS

The prevalence of ovary simple cysts was similar to the reported in literature. Risk of cancer of these cysts is extremely low when a suitable evaluation is made, a reason why the conservative treatment is suggested when these are simple cysts lesser than 5cm with Ca-125 levels within normal ranks. We recommend a follow up every 3-6 months by Doppler color ultrasound and tumor like markers for five years.

Does the diameter of an endometrioma predict the extent of pelvic adhesions associated with endometriosis?

OBJECTIVE

To correlate ovarian endometrioma diameter with the extent of pelvic adhesions.

STUDY DESIGN

Forty women with unilateral ovarian cysts thought to be endometriomas were prospectively recruited. The interventions were transvaginal ultrasound to measure the size of the ovarian endometrioma and a laparoscopic surgical procedure, including detailed pelvic assessment. Main outcome measures were pelvic adhesion scores using the American Fertility Society revised classification of endometriosis.

RESULTS

Thirty-two women met the inclusion criteria. Twelve had an endometrioma < 3 cm in diameter; 12, 3-5 cm; and 8, > 5 cm. Adhesion scores from various anatomic areas did not differ across these 3 groups. No correlation between the size of the endometrioma and associated pelvic adhesions was found using multiple regression analysis.

CONCLUSION

The size of an endometrioma measured by transvaginal ultrasound does not correlate with the extent of adhesive disease. Small (< 3 cm) endometriomas may be associated with a considerable degree of pelvic adhesions.

Infected endometrioma in pregnancy masquerading as acute appendicitis

BACKGROUND

A pregnancy complicated by ovarian endometrioma is rare. Other complications of ovarian endometrioma in pregnancy, i.e., rupture and infection are also rare.

CASE

A 35-year-old woman, gravida 2, para 0-0-1-0, at 35 weeks' pregnancy, came to the hospital with a right abdominal pain. She also had a history of diarrhea. She had history of infertility and preexisting right endometrioma. The investigations revealed leukocytosis with neutrophils predominant. The preoperative diagnosis was acute appendicitis. Infected right ovarian endometrioma was demonstrated during exploratory laparotomy, opened and drainage of the right endometrioma and appendectomy were performed. The final diagnosis was infected ovarian endometrioma in pregnancy, later confirmed by a pathological report.

CONCLUSION

Although complication of ovarian endometrioma such as infected endometrioma during pregnancy is rare, it should be included in the differential diagnosis of pelvic pain during pregnancy, especially in the patient who has history of ovarian endometrioma.

[Karyometry of the tumor epitheliocytes in the dysplastic sections of serous tumors and in serous cancers of the ovaries]

With the help of Integral-2MT cytoanalyzer, the average area of nuclei and the percentage of epitheliocytes with small, medium and large nuclei at the site of dysplasia of serous cysts and serous ovarian carcinomas have been evaluated. An increase in the degree of dysplasia of tumorous epithelium is associated with an increase in the average area of nuclei and the number of cells with medium nuclei. A decrease in the degree of differentiation of serous ovarian carcinomas is accompanied by increasing percentage of cells with large nuclei. Preoperative chemotherapy does not affect this regularity.

Spontaneous resolution of neonatal ovarian cyst: report of one case

The treatment of large, asymptomatic, neonatal ovarian cysts is controversial. Some authors recommend surgical intervention if the cyst diameter is greater than 5 cm. We report a case of an antenatally diagnosed ovarian cyst with a diameter of 6.6 cm. It involuted spontaneously within 8 months after birth without complications. We propose a conservative management of large, uncomplicated neonatal ovarian cysts. Close observation with serial ultrasound examinations may help avoid unnecessary operations.

Ciliated bodies in ovarian cyst aspirates

Ciliated bodies, or detached ciliary tufts, are ciliated fragments of cytoplasm from columnar epithelial cells. In gynecologic cytology they have been observed in cervicovaginal smears and peritoneal washings and very occasionally in fluids from the pouch of Douglas. They occur frequently in the fluids of ovarian cysts. The authors detected ciliated bodies in 30 of 326 ovarian cyst fluid samples (9.20% of cases) taken from 27 patients aged 14-68 years. Ciliated bodies were found in the fluids from both bilateral cysts in one patient and in slides from both former and recurrent cysts in two. Surgery was performed in 14 of the cases, with histologic examination revealing 5 simple serous cysts, 3 paraovarian cysts, 3 serous papillary cystoadenofibromas, 1 serous cystoadenoma and 2 mature cystic teratomas. In the remaining cases the pertinent clinical data, including ultrasound ecography, revealed benign paraovarian and ovarian cysts. The existence of ciliated bodies in the fluids of ovarian cysts indicated the presence of ciliated columnar epithelial cells on the wall of the cysts, which would exclude cysts of follicular origin.

Immunohistochemical localization of c-erbB-2 protein and epidermal growth factor receptor in normal surface epithelium, surface inclusion cysts, and common epithelial tumours of the ovary

The c-erbB-2 (HER-2/neu) protein is a membrane glycoprotein growth factor receptor showing molecular homology with the epidermal growth factor receptor (EGFR). We examined the immunohistochemical reactivity of monoclonal antibodies against both of these proteins in normal surface epithelium, surface inclusion cysts, and common epithelial tumours of the ovary. The ovarian tumours were classified as benign (16), borderline malignant (2), and malignant (19). Normal surface ovarian epithelium was weakly positive for both c-erbB-2 protein and EGFR. In surface inclusion cysts, however, the epithelial cells lining the lumen exhibited stronger staining for c-erbB-2 protein, but no staining for EGFR. All 16 benign ovarian tumours and the 2 borderline malignant ovarian tumours were positive for c-erbB-2 protein and negative for EGFR. Of the ovarian carcinomas, 13 of the 19 (68.4%) were positive for c-erbB-2 protein and negative for EGFR, while 4 showed positivity for both c-erbB-2 protein and EGFR. Two cases were negative for both proteins. Expression of both c-erbB-2 protein and EGFR was found in endometrioid carcinoma with squamous differentiation and in clinically advanced poorly differentiated serous carcinomas. Expression of c-erbB-2 protein appears to be increased and that of EGFR is reduced in the early stage of epithelial ovarian oncogenesis. The expression of EGFR with c-erbB-2 protein in ovarian carcinoma is related both to histological differentiation and/or advanced clinical stage.

Cystogenesis of the ovarian antral follicle of the rat: ultrastructural changes and hormonal profile following the administration of dehydroepiandrosterone

Immature 27-day-old female Sprague-Dawley rats were administered daily subcutaneous injections of dehydroepiandrosterone (DHEA, 5 mg/100 g BW) to induce the formation of ovarian follicular cysts. Groups of rats were killed on days 0, 10, 15, 20, 25, and 30. Ovaries from each group of rats were processed for light and electron microscopy and for follicular or cystic fluid hormone analysis. Normal antral follicle fluid, PMSG-treated preovulatory follicular fluid, and cystic fluids were analyzed for progesterone (P), estrone (E1), estradiol (E2), testosterone (T), delta 4-androstenedione (delta 4-A), 5 alpha-dihydrotestosterone (DHT), luteinizing hormone (LH), follicle stimulating hormone (FSH), and prolactin (PRL). DHEA induced anovulation, acyclicity, and the formation of follicular cysts. In certain antral follicles, there was a dramatic increase in the quantities of smooth endoplasmic reticulum (SER) in the granulosa cells and many mitochondria had tubular cristae. Further depletion of granulosa cell number was associated with intense blebbing of the cytoplasm into the follicle antrum. Formation of the ovarian follicular cyst was completed when the entire cyst was lined by a single layer of transformed granulosa cells in contact via adhering, gap, and tight junctions. These cells had little cytoplasm, mitochondria with lamellar cristae, vast basal and apical bands of microfilaments, and an extensive array of smooth-surfaced endocytotic invaginations on the basal plasma membrane. These endocytotic pits may subsequently form smooth-surfaced vesicles and thereby serve as one mechanism for moving fluid from the ovarian interstitium into the cyst. Theca interna cells were rarely observed in the peripheral regions of the cyst. Abundant smooth muscle cells were located beneath the basement membrane of the epithelial cells comprising the cyst wall. These acquired morphological and physiological features may ensure persistence of the ovarian cyst and thus potentiate a chronic pathological condition. In this study it was also shown that progesterone, estrone, and estradiol as well as androgen concentration increased in the follicle after PMSG treatment. With DHEA treatment, the follicular cystic fluid concentrations of these steroids progressively increased to extremely high levels concurrent with the development of the follicular cysts.(ABSTRACT TRUNCATED AT 400 WORDS)

[Transvaginal echography in the diagnosis of endometrioid cysts of the ovaries]

Research into the value of transvaginal echography in the diagnosis of endometrioid ovarian cysts has shown that this pathology is characterized by the presence of a round or oblong formation, filled with small-dotted suspension of mean or high echogeneity, by a dense hyperechogenic component of small sizes and wall thickening up to 0.2-0.3 cm. The accuracy of diagnosis of endometrioid ovarian cysts was 92.3%.

[Behavior of cystic tumor of the ovary after wait-and-see management and hormonal treatment]

The authors have analyzed the results of the treatment of benign ovarian cysts with 30-49mm (group I) or more than 50mm in diameter (group II). 40 patients were treated with progestogen, 41 with contraceptive pill, and another 48 patients were only observed without any treatment (control group). Ovarian cyst regression was observed in 84.6% of patients in group I, and in 83.3% of patients in group II; 85.4% of patients in group I and 88.9% of patients in group II were treated with contraceptive pill; 92.5% of patients in group I and 93.1% of patients in group II were treated with progestogen. The authors have concluded that hormone treatment is not necessary to induce functional regression of ovarian cysts.

Comparison of ultrastructure adenomyotic glandular epithelium with that of attached epithelium of inner wall of chocolate cyst, with particular reference to histogenesis of endometriosis

Clinically we rather frequently treat infertile women with endometriosis, either external or internal. Nowadays the study of the histogenesis of endometriosis is urgently required by patients who suffer from sterility because of endometriotic foci. To evaluate the histogenesis of endometriosis, we first electron microscopically examined the adenomyotic glandular epithelium as a distinct candidate for endometriosis interna. Furthermore we studied the chocolate cyst of the ovary as representative of endometriosis externa which is very important from the standpoint of the infertility clinic. In this report we carefully compared the ultrastructure of the adenomyosis with the ovarian chocolate cyst, and endeavoured to explore the histogenesis of endometriosis through this ultrastructural comparison. As a result it was found that the nuclear membrane showed tremendous irregularity in the ovarian chocolate cyst compared with the smooth nuclear membrane in the adenomyotic glandular epithelium.

An ultrastructural study of the human micropolycystic ovary

The basement membrane of follicles in the micropolycystic ovaries of infertile women was thickened compared to that in the ovaries of normal women or those with typical polycystic ovaries.