Fetal abdominal cysts: antenatal course and postnatal outcomes

Abstract

Background There is little information on which to base the prognostic counselling as to whether an antenatally diagnosed fetal abdominal cyst will grow or shrink, or need surgery. This study aims to provide contemporary data on prenatally diagnosed fetal abdominal cysts in relation to their course and postnatal outcomes. Methods Fetal abdominal cysts diagnosed over 11 years in a single centre were identified. The gestational age at diagnosis and cyst characteristics at each examination were recorded (size, location, echogenity, septation and vascularity) and follow-up data from postnatal visits were collected. Results Eighty abdominal cysts were identified antenatally at 28+4 weeks (range 11+0–38+3). Most (87%) were isolated and the majority were pelvic (52%), simple (87.5%) and avascular (100%). Antenatally, 29% resolved spontaneously; 29% reduced in size; 9% were stable and 33% increased in size. Forty-one percent of cysts under 20 mm diameter increased in size, while only 20% of cysts with a diameter of over 40 mm increased in size. The majority of cysts were ovarian in origin (n=45, 56%), followed by intestinal (n=15, 18%), choledochal (n=3, 4%), liver (n=2, 3%) and renal/adrenal origins (n=2, 3%), respectively. In 16% (n=13), the antenatal diagnosis was not obvious. Seventy-five percent of the cysts that persisted postnatally required surgical intervention. Conclusion Most antenatally diagnosed fetal abdominal cysts were ovarian in origin. Though most disappeared antenatally, nearly three quarters required surgical intervention when present after birth. Cysts of intestinal origin are more difficult to diagnose antenatally and often require surgery.

Fetal Non-Ovarian Abdominopelvic Cystic Lesions: A Single-Center Report

“…While it is tempting to speculate as to the varying etiology for resolution, there would be no scientific evidence to support these conjectures. There are several reports that describe the diagnosis and management of cystic or solid abdominal and pelvic prenatal masses, but studies have typically focused on improvement of diagnostic sensitivity rather than clinical prognosis [2,[5][6][7][8]. When comparing our prenatal resolution data to the most recent publications on this topic, our overall resolution rate specifically for non-ovarian simple cystic lesions was in the range of other studies in the literature (Table 2).…”

“…The prenatal management course of these patients is dictated by lesion location, involvement with anatomical structures, observed growth, and immediate risks to the fetus. Unfortunately, we currently have limited ability to anticipate whether the lesion will spontaneously resolve in the antenatal period, persist as a normal structural variant, or require surgical intervention after birth [3][4][5].…”

“…Fetal abdominal cystic lesions are relatively common, occurring in approximately 1 in 1,000 fetuses [3,[5][6][7]. Ovarian fetal cysts are one of the most common cyst types, and a large number of studies exist in the literature Eyerly-Webb/Joshi/Dion/Snowise/ Lillegard/Feltis describing the unique properties and clinical course of ovarian cysts [2,5]. Prenatally discovered fetal simple cystic lesions that are non-ovarian in origin are rarer and not as rigorously described in the literature.…”

“…Prenatally discovered fetal simple cystic lesions that are non-ovarian in origin are rarer and not as rigorously described in the literature. It has been reported that many such cysts spontaneously resolve and do not typically increase fetal morbidity or mortality, but the association between the initial prenatal diagnoses and the postnatal outcomes has been not thoroughly described [2,[5][6][7][8]. Data describing the natural history and postnatal clinical outcomes of such cysts could assist with prenatal counseling and outcome expectations for patients with this diagnosis.…”

Diagnostic and Treatment of Ovarian Cystic Lesions in Premenarcheal Girls: a 3 Year Study

“…In utero, the fetal ovary is under the influence of maternal estrogen, fetal gonadotropins, and placental HCG; this explains the development of the follicular cysts, which can be found on ultrasound starting from week 28 of gestation [15]. In prepubertal pacients, ovarian cysts should be less common because of the low levels of estradiol and gonadotropin.…”