Diagnosis, Management, and Therapy of Fetal Ovarian Cysts Detected by Prenatal Ultrasonography: A Report of 36 Cases and Literature Review

Abstract

Background: Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. Methods: We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥40 mm was performed. Results: We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter <40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to <35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. Conclusions: IUA is a promising therapy for preserving ovaries with simple cysts ≥40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.

Case Report: Congenital Ovarian Cyst Surgically Approached in the Neonatal Period With Favorable Evolution

“…In the examination, the family reported the presence of a maternal ovarian cyst, diagnosed by the gestational USG, with no possibility of comparison with the reported diagnostic criteria, only the confirmation of the female sex. 1,3,5,7 However, since the echogenicity of the cyst is the main criterion for establishing a prognosis, we can mention that the microscopic examination was dispensed with due to the macroscopic and benign evaluation of the specimen, not being possible to compare it to determine the prognosis. 1,4,5 Regarding the treatment performed, although still controversial, surgical management was chosen in view of the important repercussions presented, presence of visible collateral circulation, congestion and edema of the labia majora in the genitalia, in agreement with the recommended given the symptoms.…”

“…Fetal ovarian cysts (FOC) are the second most common type of abdominal mass, after urinary tract mass, with an incidence of 1 in 2,500 live births, being more common in female newborns (NB). 1,2,3,4,5,6,7 In most cases, OFCs are small, unilateral, benign, asymptomatic, diagnosed in the third trimester, and spontaneously regress during pregnancy or during the first months of life, a fact attributed to predicted changes in postnatal hormone. The incidence is higher in pregnancies complicated by Rhesus factor incompatibility, preeclampsia, obesity and diabetes mellitus.…”

“…The incidence is higher in pregnancies complicated by Rhesus factor incompatibility, preeclampsia, obesity and diabetes mellitus. 1,5,6 The first neonatal ovarian cyst was reported in 1889 as an autopsy finding in a stillbirth, but the first ultrasound (USG) diagnosis of OFC was made in 1975. Since then, the improvement of USG techniques and the systematic examination of fetal anatomy based on protocols have led to an increase in the number of FOC cases detected.…”

“…3,5 The prenatal detection and prenatal and postnatal follow-up of OFC are mainly based on USG. Diagnostic criteria include: confirmation of female sex, presence of a cystic structure of regular shape and located outside the midline, size smaller than 20 mm in diameter, identification of normal urinary tract anatomy, and identification of normal gastrointestinal structures, with echogenicity being of the cyst is the main criterion to establish the prognosis of OFC 1,3,5,7 . On US, simple cysts are anechoic, round, unilocular, intrapelvic or, more often, intra-abdominal, uni or rarely bilateral, thin-walled, and more or less mobile with the mother's position.…”

“…The benefits of surgical management must be aimed at removing the cyst for optimal ovarian preservation, histological confirmation and division of any adhesions between the ovary and adjacent organs. 1,2,4,5,6,7…”