A systematic review and meta-analysis on fetal ovarian cysts: impact of size, appearance and prenatal aspiration.

OBJECTIVE: The objective of the study is to compare outcomes of ultrasound-guided aspiration of fetal ovarian cysts with conservative management. METHOD: A systematic review of MEDLINE and Web of Science included studies reporting outcomes (prenatal and postnatal torsion, spontaneous resolution and surgery) of fetuses with ovarian cysts. Subgroup analysis was performed according to cyst diameter at diagnosis and cysts ≥40 mm. RESULTS: Ninety-two non-randomised studies reported on 380 cysts (324 observed and 56 aspirated in utero) in 365 fetuses. All studies were case reports or series with high heterogeneity and risk of bias. The overall spontaneous resolution rate of conservatively managed cysts was 46%, yet decreased with increasing cyst size. Risk of prenatal ovarian torsion in conservatively managed cases depended on cyst size and was particularly important in the range 30 to 59 mm (15-34%). The rate of prenatal torsion in simple cysts ≥40 mm was lower in aspirated than conservatively managed cysts (0% vs 10%, p = 0.03). Aspirated cysts had lower rates of postnatal surgery (7%) compared with conservatively managed cysts (49%, p < 0.001). CONCLUSION: Cysts 30 to 59 mm were at highest risk of torsion. Simple cysts >40 mm had lower rates of torsion when aspirated prenatally. Randomised studies and safety data are needed prior to routine prenatal ovarian cyst aspiration. © 2017 John Wiley & Sons, Ltd.

Fetiform Teratoma in the Ovary of a 7-Year-Old Girl: A Case Report.

BACKGROUND: Fetiform teratoma, a highly differentiated mature cystic teratoma resembling a fetus, is rare and typically found in the ovaries of women of reproductive age. In this report we describe, to our knowledge, the youngest case of ovarian fetiform teratoma. CASE: A 7-year-old girl presented with acute abdominal pain. Radiological examinations revealed a 5.2-cm ovarian complex cystic mass with fetal-like components in favor of fetus in fetu and teratoma. After surgical removal, the mass resembled a fetus consisting of a head, two eye slits, two small upper limb projections, and hair. Pathology indicated mature cystic teratoma supporting the diagnosis of fetiform teratoma. SUMMARY AND CONCLUSION: Although not commonly found in children, fetiform teratoma must be considered in the diagnosis of a child who presents with an adnexal mass resembling a fetus.

[Prenatal diagnosis ovarian cyst with an amputation at three months of age. A case report]. / Diagnóstico prenatal de quiste de ovario con torsión y amputación a los tres meses de edad. Reporte de un caso.

UNLABELLED: In the neonate the pelvic masses regularly are usually benign until in 87%, those of ovarian origin most is of cystic and benign origin. CLINIC CASE: Of a pregnant of 26 years of age, primigesta, was detected to the fetus during the 24 weeks of gestation an abdominal cyst in pelvic hole of 3.5 diameter cm, non motive. The pregnancy culminated for caesarean operation, feminine product was obtained with weight when being born 3.400 kg. They were practiced 3 ultrasounds: when being born, to the month and two months of age, finding ovary cyst with the same characteristics. To the 3 months it is observed in 4th control ultrasound that the cystic image was no longer in pelvic hole, but it liberates in abdominal cavity for what decides to make exploratory laparotomy, where is a cyst of free amputated ovary in abdominal cavity of 3.5 x 4 diameter cm. The pathology results reported an ovary with necrosis areas and content cystic saculado.

Fetal echocardiography before and after prenatal aspiration of a fetal ovarian cyst.

The main criteria for establishing fetal ovarian cysts prognosis are their diameter and echogenicity The choice of management in case of fetal ovarian cyst remains controversial. In the following article we have reported a case of a fetal ovarian cyst with detailed fetal echocardiography before and after prenatal aspiration. The fetus at 35 weeks of gestation presented with an ovarian cyst of 70 mm in diameter and normal heart anatomy and size. However detailed fetal echocardiography revealed functional abnormalities such as: monophasic inflow pattern of tricuspid valve, holosystolic tricuspid regurgitation and pericardial effusion. Two days after prenatal aspiration of the cyst, the functional abnormalities in fetal echocardiography receded. After prenatal aspiration we observed a residual cyst of 15 mm in maximal diameter. The delivery was spontaneous at 36th week of pregnancy and the infant was discharged from Neonatology Dept on the sixth day of postnatal life. The cyst regressed spontaneously in the course of the next two months. This is the first report when detailed fetal echocardiography revealed hemodynamic improvement after prenatal aspiration of a fetal ovarian cyst which may mean that huge fetal ovarian cysts might complicate fetal heart function.

Fetal ovarian cysts management and ovarian prognosis: a report of 82 cases.

BACKGROUND/PURPOSE: Fetal ovarian cysts are frequently complicated by intracystic hemorrhage without associated clinical signs, which is often secondary to ovarian torsion leading to loss of the ovary. The aim of this study was to evaluate ovarian outcome and the place of prenatal management and surgery in the first few days of life in order to save the ovary. METHODS: Between January 1987 and June 2006, 82 fetal ovarian cysts in 79 patients were managed and clinically and ultrasonographically followed up for several months (median, 11 months; range, 6 months to 10 years) in all of the cases where the ovary was not removed. The ultrasonographic results regarding the ovarian parenchyma were broken down into 3 categories: follicular ovary, homogeneous ovary, and undetected ovary. RESULTS: Twenty-seven cysts remained simple throughout their evolution, and 55 were complicated by intracystic hemorrhage usually several weeks before birth. Overall, after disappearance of the cyst, a follicular ovary was detected in only 39% of the cases (32/82) and more often when the cyst was simple than when it presented an intracystic hemorrhage (85% vs 16.4%, chi(2), P < .0001). CONCLUSIONS: A review of our series confirms the poor ovarian outcome linked to ultrasonographic signs of intracystic hemorrhage. Preventive action by puncture of "simple" cysts is still being studied. The presence of a bilateral cyst can, if pulmonary maturity has been reached, be an argument for inducement of premature birth with a view to performing conservative surgery. After birth, surgery in the first few days of life is only justified if the signs of intracystic hemorrhage appeared in the period very close to birth.

[Thecalutein ovarian cyst in a newborn]. / Quiste ovárico tecaluteínico en una recién nacida.

Ovarian cysts are frequent findings in fetuses and neonates, and their optimal therapy is not yet properly established. We report the finding of a fetal thecalutein ovarian cyst (6.6 x 5.3 cm) diagnosed prenataly through sonography. Pregnancy was interrupted by cesarean section during 38th gestation week. Ovarian cyst was removed twelve hours after cesarean section (laparotomy). Patient evolution was satisfactory. Literature was reviewed. When ovarian cyst is higher than 5 cm and non-complicated, surgical therapy in an option.

[Fetal echocardiography in fetal ovarian cysts]. / Badanie echokardiograficzne u plodów z torbiela jajnika.

OBJECTIVES: The aim of the study was to evaluate the outcome of fetuses with ovarian cysts in relation to fetal echocardiography. MATERIAL AND METHODS: In the Department for Diagnosis and Prophylaxis of Birth Defects at the Polish Mother's Memorial Hospital in Lodz fetal echocardiography was performed in 21 fetuses with ovarian cysts between the years 1995-2006. OUTCOMES: In 18 out of 21 (86%) fetuses we have found normal heart anatomy (NHA) and in 3 fetuses congenital heart defect (CHD). In 7 out of 18 (39%) fetuses with NHA there were functional anomalies, including 5 fetuses with hypertrophy Four neonates with hypertrophy required surgical procedures after the delivery. Prenatal hypertrophy was not observed in case of only one neonate which was operated after the delivery. CONCLUSIONS: 1. Fetal echocardiography studies were very often abnormal in fetus with ovarian cysts (mainly as functional anomalies). 2. Functional anomalies detected in fetal echocardiography more often resulted in surgical procedures after the birth, whereas normal heart study was more often connected with spontaneous regression of ovarian cyst (p=0.0265).

[Assessment of the usefulness of ultrasound screening in fetal ovarian cysts]. / Ocena przydatnosci ultrasonografii u plodów z torbiela jajnika.

OBJECTIVES: The aim of the study was to assess the usefulness of ultrasound in management and prognosis in fetal ovarian cysts. MATERIAL AND METHODS: The study included 38 fetuses with cyst in abdominal cavity, who, between 1995 and 2006, underwent an ultrasound examination in our unit at the Polish Mother's Memorial Hospital in Lodz, The Department for Diagnosis and Prevention of Birth Defects. RESULTS: In all 38 fetuses with cyst in abdominal cavity we have diagnosed 27 (74%) cases of ovarian cyst. In 14 (74%) fetuses cysts regressed spontaneously, including all cysts < or = 40mm (n = 7). In 3 cases with cysts > 40mm needle aspiration has been successfully performed, without any further complications. Surgical neonatal treatment has been performed in 5 cases in prenatal cysts > 40mm without prenatal aspiration. In 3 cases cysts > 40mm regressed spontaneously. Ovarian cysts in 22 (87%) cases were an isolated malformation; in 5 (19%) cases other malformations were present CONCLUSIONS: 1. Fetal ovarian cysts < or = 40mm required only ultrasound assessment and, in majority of cases, revealed the tendency to spontaneous regression. 2. Cysts > 40mm in maximal diameter have signaled complications more often and required surgical procedure after birth. 3. In utero, aspiration of fetal ovarian cyst > 40mm may lead to cyst regression, making the surgery after birth unnecessary.

Foetal and neonatal ovarian cysts: a 5-year experience.

BACKGROUND: Abdominal cystic formations in newborns are relatively common and often diagnostic suspicion arises in this regard even before birth as a result of ultrasound scans carried out during pregnancy. The aim of this study is to highlight the problems posed by the prenatal diagnosis of abdominal cysts in order to outline the most appropriate therapeutic approach in case of suspected ovarian cysts. MATERIALS AND METHODS: Between January 2003 and January 2007, 57 women were enrolled in this study for a prenatal ultrasound (US) that revealed the presence of an echo-rare or echo-free area in the foetal abdomen. After birth all babies underwent blood tests and abdominal US scans in order to confirm or identify the nature of the cyst. If abdominal US could not show the nature of the cystic formation, magnetic resonance imaging with sedation was performed. When the radiological tests were not useful to identify the nature of the cysts and surgery was then necessary, surgical procedures were performed with laparoscopy. RESULTS: Ultrasounds were useful to identify the diameter of the cysts but not all their origins; also MRI confirmed the morphology and volume of the cysts, but could not give further details about their origin. DISCUSSION: Abdominal ultrasound and finally laparoscopy used to treat and remove the cysts were useful to monitor all simple abdominal cysts. MRI seemed not to be useful for the treatment of this condition, especially in the pediatric age when mild sedation is required.

Clinical experience of five fetal ovarian cysts: diagnosis and follow-up.

BACKGROUND: Ovarian cysts are the most frequent type of abdominal tumor, in female newborns. The most of the cases resolve spontaneously with no clinical significance. However, ovarian cysts often present complications such as torsion. CASE: The authors reviewed the pre- and postnatal records and ultrasonograms of five fetuses, who were diagnosed with ovarian cysts. No complication was observed prenatally. However, one infant 2 months after birth required surgical intervention because of cyst torsion. The cysts of the other four infants showed complete resolution in a time interval of 3-9 months. CONCLUSION: An ovarian cyst is not a life-threatening condition, so they should be just closely monitored pre- and postnatally until spontaneous resolution. When torsion of the cyst is suspected, surgical intervention is necessary.

[Fetal ovarian cysts--420 cases from literature--metaanalysis 1984-2005]. / Torbiel jajnika u plodu--przeglad 420 przypadków z pismiennictwa z lat 1984-2005.

Despite an improvement in prenatal ultrasonographic diagnosis, the management of fetal ovarian cysts remains controversial. 420 fetuses with ovarian cyst from Medline data base have been analyzed. In 209 cases (50%), the cysts regressed spontaneously and in 145 cases (35%) cysts were complicated by torsion and intracystic hemorrhage. Surgical treatment was performed in 174 cases (41%) of neonates. Cysts < 50mm regressed spontaneously in 98% (n = 79), and cysts > 50mm in 93% resulted in complications (n = 14). After the diagnosis of fetal ovarian cysts < 50mm, serial ultrasound monitoring was recommended by the vast majority of the authors. In cases of > 50mm cysts, needle aspiration was an option in selected cases (n = 28). Spontaneous regression cysts > 50mm after needle aspiration was observed in 89% (n = 25) of the cases. Prenatal aspiration of ovarian cysts appears effective and safe, however, in the course of the last twenty years it has been performed relatively rarely.

A novel mutant phenotype implicates dicephalic in cyst formation in the Drosophila ovary.

The establishment of polarity in Drosophila requires the correct specification of the oocyte in early stages of oogenesis, its positioning at the posterior of the egg chamber, and signalling events between the oocyte and the adjacent posterior follicle cells. As a consequence, the anterior-posterior and the dorsal-ventral axes are fixed. The posterior localisation of the oocyte depends on cadherin-mediated adhesion between the oocyte and the follicle cells. Here we show that dicephalic mutants affect the posterior positioning of the oocyte without interfering with oocyte specification in the germarium. Unlike other mutants that also affect the posterior placement of the oocyte, dicephalic mutants affect neither gurken expression nor karyosome formation during meiosis. By analysing in detail the mutant phenotypes of dicephalic, we find that cyst formation in mutant germaria is defective and that it shares some similarities with cysts that lack DE-cadherin in the germline cells. We propose a model in which dicephalic is involved in the proper adhesion between the oocyte and the somatic follicle cells.

[Chance finding of foetal and neonatal ovarian cysts on echography]. / Foetale en neonatale ovariumcysten als toevalsbevinding bij echografie.

Cystic abnormalities of the adnex were found by chance in 2 baby girls, one aged 2.5 months and the other aged 2 months. Both had been born dysmaturely and the abnormalities were found on echographic investigation carried out for suspected urinary-tract infection. On monitoring investigation one month later, the abnormalities had become smaller and some time later had disappeared altogether. With the increasing use of ultrasound, ovarian cysts are being detected more often in the foetus and neonate. The majority of these cysts are benign functional follicular cysts and resolve spontaneously. The decision to perform surgery depends on the clinical symptoms and appearance on ultrasound. Large uncomplicated cysts can be managed by antenatal or postnatal aspiration in order to prevent torsion and the subsequent loss of the adnex.

[Natural history of fetal/newborn ovarian cyst]. / Historia naturalna plodowych/noworodkowych torbieli jajnika.

OBJECTIVE: Fetal and neonatal ovarian cysts are detected freguently by ultrasonography. Prenatal ovarian cysts have a follicular or luteal origin. Their natural history is a spontaneous involution. Pre- and postnatal changes in the sonographic aspects allow to choose the appropriate therapeutical indications: conservative approach, surgery, or percutaneous aspiration. MATERIALALS AND METHODS: In retrospective review from 1992-2004 authors present 26 patients with ovarian cysts. RESULTS: Fifteen patients were diagnosed by prenatal ultrasonography carried out between 33 and 39 weeks of gestation. Postnatally 14 were observed only and their cysts regressed, 10 with cysts larger than 4 cm, had surgical exploration, 2 patients with cysts between 2 to 4 cm were candidates for percutaneous aspiration. CONCLUSION: 1. The conservative treatment and clinical observation using ultrasonography is recommended when the ovari cystic is 40 mm in diameter. 2. When the ovari cystic is bigger then 40 mm in diameter it is recommended to perform puncture and fluid aspiration from the cystis under ultrasonography control. 3. The surgical intervention was planned when the ovari cystis was heterogenous and has been growing for a few months.

Fetal and neonatal ovarian cysts: what's their real meaning?

PURPOSE OF INVESTIGATION: The management of fetal ovarian cysts is still controversial despite the improvement in prenatal diagnosis with ultrasonography. Some studies suggest an aggressive management, while others opt for a conservative one. The prognosis of the majority of congenital ovarian cysts is good since they have a benign origin. Sometimes, however, complications such as torsion or rupture can occur which often require surgical intervention after delivery. In this paper we report our experience and a brief review of the literature. METHODS: The authors report on 32 pregnant women in whom ultrasonography revealed the presence of an echo-rare or echo-free area in the fetal abdomen suggestive of an ovarian cyst. All women were followed-up during pregnancy with serial ultrasound examinations. Postnatal ultrasound controls confirmed the prenatal diagnosis in all cases. The diameters of the cysts ranged from 2.7 to 7.5 cm. RESULTS: In the 16 cases (50%) in which the cyst diameter was below 4 cm, periodic ultrasound examinations revealed a tendency towards spontaneous regression of the cysts. In the other 16 cases (50%) in which the cyst diameter exceeded 4 cm, cystectomy was necessary due to subsequent complications (torsion in 6 cases, 37.5%, and intracystic hemorrhage in the other 10, 62.5%). CONCLUSION: The most appropriate clinical approach in the management of benign feto-neonatal ovarian cysts is to adopt a wait-and-see policy, assessing the course of the condition by means of periodic ultrasound monitoring. Only when tumefactions measure more than 4 cm in diameter with attendant complications is surgical therapy indicated. Without complications, however, aspiration of the cystic contents is possible even in ovarian cysts exceeding 4 cm in diameter.

Quistes de ovario fetales: características prenatales y evolución posnatal / Fetal ovarian cysts: prenatal diagnosis and postnatal outcome

Introducción. Los quistes de ovario son la patología tumoral más común del abdomen fetal. Analizamos sus características ecográficas y la evolución prenatal y posnatal. Material y métodos. Analizamos retrospectivamente todos los casos con sospecha prenatal de quiste de ovario fetal y cuya evolución posterior es conocida en el período 1990-2002. El número total fue de 37 casos. Los de estructura anecoica y límites nítidos se definieron como quistes "simples" y los de estructura heterogénea, bordes irregulares y/o con líquido libre intraaabdominal como "complejos", sospechándose alguna complicación (hemorragia, torsión).Cuando existían ecorrefringencias el diagnóstico fue de posible teratoma ovárico. Resultados. El diagnóstico se hizo siempre en el tercer trimestre (media: 33 semanas; rango: 26-41). El tamaño medio fue 36 mm (rango: 17-80). El aspecto más común (n = 26; 70 por ciento) fue el de quiste "simple". En 26 casos (70 por ciento) el quiste desapareció espontáneamente, tanto prenatalmente (n = 4) como posnatalmente (n = 22), siendo 20 de ellos quistes "simples". En 11 (30 por ciento) se realizó cirugía posnatal por la persistencia o tamaño del quiste (n = 3), por sospecha de torsión (n = 7) o por sospecha de teratoma (n = 1). En todos se realizó ooforectomía. Diez fueron quistes foliculares y el otro un teratoma quístico. Hubo siete quistes torsionados (19 por ciento). Su tamaño medio fue 45 mm (rango: 35-60), ligeramente superior al de los que no tuvieron torsión (40 mm; rango: 20-80) (p > 0,05). Se torsionaron tres de los 11 quistes 5 cm (27 por ciento) y cuatro de los 26 0,05). La mayoría de los quistes torsionados (4/7) eran < 5 cm. Conclusiones. Los quistes de ovario fetales son una entidad benigna. Dada su dependencia hormonal puede adoptarse un manejo conservador, esperando su resolución espontánea, que sucede en la mayoría de los casos, fundamentalmente si son quistes "simples" e independientemente de su tamaño. En ocasiones es necesario el tratamiento quirúrgico al aparecer complicaciones, que pueden incluso requerir una ooforectomía. Por ello debe recomendarse que el nacimiento ocurra en un centro con adecuados recursos perinatológicos (AU)