Lower abdomen cystic masses diagnosed in female infants in fetoneonatal period: diagnosis and management

Abstract

Cystic masses in female fetuses and neonates are in waste majority of cases identified in screening ultrasound during pregnancy. Often they are detected as early as in second trimester screening sonography (18–22 weeks). When they are identified, problems with differential diagnosis and management modalities arise. In majority of cases, the cystic formation is simple ovarian cyst. It might be misinterpreted with other conditions such as: hydronephrosis, bowel obstruction, mesenterial cysts, etc. We attempt to identify US criteria for reliable prenatal diagnosis of simple not complicated ovarian cysts. Define treatment possibilities and recommendations. Forty‐three cases of such formation in lower abdomen were reported in our hospital either in pediatric gynecology or pediatric surgery departments. Thirty‐three were diagnosed prenataly, nine diagnosed postnataly. Cysts were unilateral in all cases. Twenty‐two cases were treated surgically by ovarectomy. Nine of the treated cases were cysts larger than 60 mm, in four cases the diameter was less than 40 mm, Nine cases were cyst between 40 and 60 mm. Histological examination proved 18 cases with hemorrhagic necrosis of the ovarian cyst, four cases were diagnosed as follicular cysts and one case of malignant retroperitoneal sarcoma. Twenty cases of cystic formation were observed and expectation management was applied. All of them were smaller than 40 mm in largest diameter and they resolved spontaneously within 1 year of age. We conclude that basic criteria for accurate diagnosis include mandatory visualization of the kidneys and stomach in the time of diagnosis. Simple ovarian cyst has following features on ultrasound: one chamber cystic formation in lower abdomen, smooth walls, anechogenic. Expectation management with serial follow up is recommended for cysts smaller than 40 mm in diameter, Surgical treatment should be instituted only in case of ovarian torsion (cyst diameter seems to be of good predictive value) or rupture with bleeding. Simple cysts with diameter larger than 40 mm remains controversial. Should we treat them to prevent torsion? We conclude that conservative approach is adequate in certain cases, when risk of acute abdomen is low and spontaneous disappearance is presumable in respect to preservation of future reproductive function of female infant.