Fetal and neonatal ovarian cysts: is surgery indicated?

Department of Pediatric Surgery, AP-HP, Armand Trousseau Children's Hospital, Paris, France.
Prenatal Diagnosis (Impact Factor: 3.27). 01/2008; 28(1):15-20. DOI: 10.1002/pd.1915
Source: PubMed


To evaluate the frequency of ovarian torsion in neonates with ovarian cysts (OCs) and to analyze the outcome after surgical treatment.
A retrospective review of all infants with OCs managed in our institution during 20 years, was conducted. Our management included a follow-up (FU) of prenatal serial ultrasound (US) scan without prenatal cyst aspiration and early postnatal US scan. Neonatal surgery was indicated for cysts that appeared complex regardless of size and for simple cysts larger than 20 mm.
Sixty-seven OCs detected through prenatal diagnosis were identified. Cysts were detected at a median gestational age (GA) of 33 weeks. At diagnosis, median size of the OCs was 40 mm, and 18% were complex. On the postnatal US scan, 55% were complex. Neonatal surgery was performed for 64 OCs : 56% were torsed, 6% were hemorrhagic, and 38% were uncomplicated. Proportions of complex- and simple-appearing cysts on prenatal or postnatal US scan were the only significantly different parameters found between infants with torsed or not torsed OC.
Our study demonstrated that OC bears a high risk of ovarian loss. These findings have implications regarding information and treatment offered to pregnant women bearing an affected fetus.

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Available from: Bruno Carbonne, Sep 24, 2014
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    • "The ovarian torsion frequently leads to further complications such as rupture resulting in hemoperitoneum, ascites stemming from transudation, adhesion with adjacent organs resulting in urinary and intestinal obstruction, calcification of cyst walls, and auto-amputation of the ovary. On abdominal examination, a mobile mass can be palpable if auto-amputation of a torsioned ovary occurs (1, 3, 4, 5, 6, 7, 8, 14, 15, 16). "
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    ABSTRACT: Neonatal ovarian cysts (NOC) are usually self-limiting structures. However, large or complex cysts may lead to severe complications. A standard guide to management, treatment and follow-up of NOC is not yet available. The aim of this study was to evaluate retrospectively the records of NOC patients from two medical centers. A total of 20 newborns with NOC were included in the study. The size and localization of the cyst, the age, the signs and symptoms at presentation, and the possible maternal and fetal-neonatal etiologic factors were recorded. Follow-up procedures and treatment modalities were evaluated. The mean age at diagnosis was 34 gestational weeks. The cysts (mean size 53±15 mm) were predominantly in the right ovary (75%) and were evaluated as large cysts in 16 (80%) of the patients. In 5 of the patients with large cysts and in 1 of the 4 patients with small cysts, the cysts were evaluated as complex cysts. Torsion of the ovary was detected in five (25%) cases and these cases were treated surgically. Patients with simple cysts were closely followed by ultrasonography until the cysts disappeared. To date, there is no precise guide for the monitoring and treatment of NOCs. Surgical treatment should always be performed in a way to protect the ovaries and to ensure future fertility. In our NOC series, it has been possible to apply a non-invasive follow-up program and minimally invasive surgical procedures.
    Journal of Clinical Research in Pediatric Endocrinology 03/2010; 2(1):28-33. DOI:10.4274/jcrpe.v2i1.28
  • Archives de Pédiatrie 07/2009; 16(6):583-4. · 0.41 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess long-term outcomes of children who had ovarian cysts diagnosed prenatally. METHODS: We reviewed prenatal records of fetuses diagnosed with ovarian cysts in our ultrasound unit between January 1997 and December 2008. During January-April 2009, those children were invited to our institute for transabdominal pelvic sonographic re-examination. Demonstration of the uterus and adnexa was required. RESULTS: Twenty-one children were diagnosed prenatally with either simple (n = 11) or complex (n = 12) ovarian cysts and treated by either conservative management (n = 13) or surgical intervention (n = 10) postnatally. The ipsilateral ovary was not detected in 8 of 11 children in whom a complex cyst had been detected on the first postnatal scan. Significantly higher rate of ovarian loss was diagnosed when the sonographic appearance of the ovarian cyst was simple on the prenatal scan and complex on the postnatal scan (six of seven) compared with when the ovarian cyst was simple on both scans (one of four, P = 0.04). CONCLUSION: Prenatal detection of complex ovarian cyst might indicate close monitoring in order to alert the need for early intervention for preventing impending ovarian loss. Further researches are needed to empower this study. Copyright (c) 2010 John Wiley & Sons, Ltd.
    Prenatal Diagnosis 04/2010; 30(4):342-7. DOI:10.1002/pd.2470 · 3.27 Impact Factor
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