Neonatal Ovarian Cysts

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Neonatal Ovarian Cysts
Praz Patcha
12 Dec 2013
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Case 1
16day F NSVD at full term with known history of
2cm ovarian cyst at 20 weeks, admitted with
sepsis with fever of 101, dehydration,
distension;
Birth u/s at OSH demonstrated 6cm cyst with
layering debris;
Baby was resuscitated in NICU;
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Case 1
VS
101.0
137
40
88/53
Sunken fontanelles; Lethargic;
Abd distended; Ballotable mass RLQ;
cbc 14.7 / 14 / 42 / 694 46%  18.2
bmp 140 / 5.8H / 109 / 18 / 3 / 0.1
51%
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Case 1
Repeat u/s demonstrates 5 x 5 x 4 cm R ovarian
cyst with layering debris;
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OR
Exploratory laparotomy, R salpingoopherectomy,
L ovarian cystectomies
– hemorrhagic intraperitoneal fluid
– R ovarian torsion with atrophy of fallopian tube
– 4 x twists of R adnexa
– L ovary with multiple small cysts, viable ovary
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Case 1
Discharged POD 5 after tolerating feeds;
Path:
R infarcted ovary, fibrotic fallopian
tube; coagulative necrosis;
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Case 2
3day F emergent c/s at term for arrest of labor
with known prenatal ovarian cyst; Follow up u/s
on DOL 2 with b/l cysts with significant layering;
Referred by pediatrician for emergent surgical
consultation;
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Case 2
VS
98.1
108
42
70/39
NAD;
Distended abdomen; Ballotable b/l lower abd
masses;
cbc 8.7 / 15 / 45 / 389
bmp 139 / 6.7 / 111 / 18 / 4 / 0.1 / 110
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Case 2
• Repeat u/s demonstrated b/l large ovarian
cysts with hemorrhagic layering c/w infarction
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OR
• Exploratory laparotomy, b/l
salpingoopherectomy
– purulent intraperitoneal fluid
– terminal ileum adherent to R adnexa
– b/l hemorrhagic infarcted adnexa
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Case 2
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Case 2
Discharged uneventfully on POD 2;
Path:
b/l necrotic ovarian cysts; infarcted
ovaries;
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Neonatal Ovarian Cysts
• Non-neoplastic ovarian tumors
• Arise from mature follicles (FSH, LH, estro,
hCG)
• Typically self-limited due to postnatal
decrease in hormones
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Neonatal Ovarian Cysts
• 84% of 77 imaged patients from birth to 24mo
demonstrated ovarian cysts (Cohen)
• Majority inactive, but occasionally secretory
• Size is the major factor in clinical management
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Risks
• Size 5cm and above, increased risk of torsion
• Simple vs Complex
– prepubertal  complex indicates torsion or
malignancy
– adolescent  complex indicates hemorrhagic
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Distinguishing Features
• Likely torsion
– fluid debris
– clot
– septations
• Likely a prenatal event
• Ovary likely lost despite intervention
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Recommend
• 0 – 4 cm:
observation, serial u/s
• 5cm or long adnexal pedicle: resect or
aspirate, attempt to spare ovarian tissue
• Intrauterine aspiration controversial, highly
risky
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Thank you