43. Fetal cyst and follicular cyst in a neonate girl - treatment tactics

Abstract

Background

Ovarian cysts are common in fetuses and neonates and detected in up to 70% of cases on prenatal ultrasound. The size and appearance of cysts help to classify them as simple or complex indicating a physiologic cyst and ovarian torsion or hemorrhage, respectively. This case report presents conservative and operative tactics for the treatment of neonate's ovarian cysts.

Case

A girl was born at 35 weeks of gestation with an abdominal cystic mass measuring 38 mm in diameter detected on ultrasound at 32 weeks. The normal anatomy of other fetal abdominal organs suggested that an ovarian cyst was the most likely diagnosis. Ultrasound was performed every 4 weeks after birth. Two months after birth the USG shows bilateral ovarian cysts – complex at the left, simple at the right. At the age of three months, an abdominal ultrasound showed a right ovarian cyst of 58 × 56 × 62 mm and a left ovarian cystic mass was 44 × 42 × 42 mm with sediment, after that the patient was hospitalized. Operative treatment was chosen. Laparoscopy revealed necrotic antenatal torsion of the right adnexa with a right ovarian cyst and torsion of the left adnexa with a cyst. Adnexas were twisted between themselves twice. Removal of the right adnexa, adhesiolysis, detorsion of the left adnexa, aspiration of the left ovarian cyst, and biopsy of the left ovary were performed. Histological examination of the removed necrotized right ovary showed fragments of connective tissue with dyscirculatory changes, edema, hemorrhages, necrotic changes, foci of calcinosis. The biopsy of cyst revealed a small fragment of ovarian tissue with foci of edema and dystrophic stroma changes, several primordial follicles. The infant was discharged without any complications. Postoperative observation a month later detected a left ovarian cyst 31 × 27 × 35 mm in diameter at the right. Two months after the surgery the ultrasound reveled normal left ovary with follicles at its own place on the left.

Comments

Treatment of neonatal ovarian cysts must be determined according to the size of the ovarian cyst, clinical manifestation, and ultrasonographic findings. Conservative and operative management of ovarian cysts that appear complex on postnatal USG may lead to ovarian loss. Balanced determination of the tactics of managing simple ovarian cysts contributes to the preservation of ovarian tissue.