Prenatal Detection of Ovarian Cysts

PRENATAL DETECTION OF OVARIAN CYSTS: ULTRASOUND FEATURES AND OUTCOME.
Marcela Tombesi, MD*, Carlos Deguer, MD **
* Radiology Service, ** Neonatology Service. Hospital Interzonal "Dr. José Penna" Bahia Blanca. Argentina. [email protected]
INTRODUCTION
Case 1
An increasing detection of ovarian cysts has been reported in the recent years
with the widespread use of ultrasound (US) during pregnancy and the
improvement in US techniqes. Autopsy studies showed that approximately 30 %
of NB has follicular cysts. The incidence estimated of fetal cysts with significant
size is 1 in 2500 live birth. Ovarian cysts are the non renal cystic masses
detected more frequently in obstetric US. While their natural history is the
spontaneous resolution in a significant number of cases, proper management is
still controversial.
PURPOSE
To determine the prenatal and postnatal US ovarian cysts characteristics,
outcome, complications and therapeutics.
Intrautero regression
MATERIAL AND METHODS
Case 2
The charts of 25 female patients born from December 2001 to July 2010 with
pelvic or abdominal cystic images in prenatal US were retrospectively reviewed
assessed. Gestational age at diagnosis, US features: shape, size, mobility,
echogenicity, outcome in terms of: complications, progression, stability, partial or
total spontaneous regression and treatment were determined. Fetus pathology
associated and maternal antecedents also were recorded.
US at birth: signs of partial
regression.
RESULTS
Out of 25 newborns, 23 had ovarian cysts. Of the other 2 patients 1 had a
mesenteric cyst and the second a cystic duodenal duplication. We were able to
check outcome in all of the patients. One NB had a single kidney. None of the
accepted maternal or fetal risks for ovarian cysts such as maternal diabetes,
toxemia, RH isoinmunization and congenital hypothyroidism were present in our
patients. The mean gestational age at diagnosis was 32 weeks (range: 24-35
weeks).Aspect of simple cysts was found in 65% of cases (Fig. 1).
cyst. .
Intrautero: Large simple cysts
Case 3
Fig .1
INTRAUTERO US
FINDINGS
n:23
-15 simple cysts
- in 2 small vesicles
daughters were identified
- 3 had very thin septa
- 3 had complex appearance
(echogenic content and
thick septals and walls).
Ovarian cysts
cyst with signs
of endocistic proliferation
(vesicule daugther)
US at 3 months: total
regression
COMMENTARIES
The physiology of fetal ovarian cysts is
dynamic, with high hormonal
responsive that stimulate the follicle and
formation of fetal ovarian cysts. The
Follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) are
determinant for follicular and cystic
grows. There would be a pick of FSH
between the 20 to 30 weeks of
gestational age and a fall at
approximately 4-6 month of age. This
timeline of neonatal folliculogenesis
correlates with the natural history of
fetal ovarian cyst formation and
regression.
Our purpose was not compared surgical to conservative approaches to ovarian
cysts. We can only draw conclusions based on our limited experience.
CONCLUSION
Cysts outcome
Mean maximum diameter (MD) at diagnosis was
4,1 cm (range: 2.7 to 6.3 cm):
q 9 (44%) patients had a MD greater than 5 cm
q 10 patients < of 4 cm
q 4 patients between 4 to 5 cm
Ø 11 cysts (48%) w ith a mean MD of 3.7 cm
(range:2,7-5,1c m) showed intra-uterine regression.
Ø 8 c ysts showed pos tnatal regress ion in a mean time
of 6 months ( range:1 – 13 m), in 6 of them the
regression began intrautero.
Ø 1 grew up to a MD of 7.6 cm and regres sed totally
at 10 months of life .
Ø O ne patient with a s imple cys t with a MD of 5.5 cm
and mobile as pect ,got complic ated on day 10 .
The 83 % of the ovarian cysts detected by antenatal US regressed
spontaneously. The complications in 3 patients occurred intrautero previous at
the moment of diagnosis. None cyst ≤ than 5 cm complicated. The high
percentage of spontaneous resolution in fetal and newborns with non mobile
simple cysts ≤ than 5 cm of MD suggests clinical and US surveillance. It is
necessary to identify the subgroup of patients who may benefit from intrautero
cyst decompression.
BIBLIOGRAPHY
Cysts outcome
The 3 cysts with heterogeneous aspect at diagnosis were surgical.
Intrautero US: intraabdominal complex
mass
Postnatal US. It was surgical
removed. Ovarian cysts torsion
Intra-uterine torsion
Intra-uterine torsion
Torsion is the most common complication .From 4 complicated cysts in our group, 3
occurred intra-utero previous to the moment of diagnosis , point made by other authors.
COMMENTARIES
Marked differences in rates of complications
and resolution have been reported, which
influences therapeutic recommendations. A
mobile pedicle and its length have been
considered predictors of torsion. There are
many options for management and
therapeutics: in-útero and neonatal
aspiration of cysts, laparoscopy, laparotomy,
expectant management . There is no
consensus on the most appropriate
management.
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