Neonatal Ovarian Cysts Research Articles

Neonatal ovarian cysts: management and follow-up.

Twenty-seven neonatal ovarian cysts were diagnosed in utero during a 13-year period; 9 were complicated and 18 were initially simple, but 8/18 showed evidence of complications in utero or soon after birth, leaving only 10 simple cysts. One simple and 4 complicated cysts were surgically excised early in the study period; 2 simple cysts were treated by needle aspiration at birth because of their large size. The remaining 20 cases were initially managed conservatively. All simple cysts and 10/13 complicated cysts regressed completely within 12 months; 3 that failed to regress were surgically excised. Nineteen patients who did not undergo a laparotomy had ultrasonographic (US) examinations from 3 months to 9 years after birth. Echography showed both ovaries in all 9 girls who had simple cysts at birth and in 2 of the 10 with complications. In the other 8 complicated cases only one ovary was detected at follow-up. Pre- or post-natal aspiration of simple cysts 4 cm or more in diameter is recommended, while conservative management seems appropriate in the absence of symptoms for simple cysts of less than 4 cm and complicated cysts of any size tending to involute after birth.

Laparoscopic management of ovarian cysts in newborns.

Cysts are the most common ovarian masses found in newborn girls. Spontaneous regression, which occurs in approximately 25-50% of cases, is more frequent with smaller cysts. Pre- or postnatal complications are common; these complications may consist of intracystic bleeding, torsion of the cyst or corresponding annex, or self-amputation of the cyst. When the cyst is <4 cm it is possible to perform a simple echographic monitoring to check for the possibility of spontaneous involution; all other cases require surgery. Between February 1985 and June 1997, we treated 22 neonatal ovarian cysts laparoscopically. In 14 cases, the right side was involved; in eight cases, it was the left. The patients' ages ranged between 7 days and 5 months (median, 45 days). In all cases, we used three trocars. An intraperitoneal cystectomy was done in eight cases, a transparietal cystectomy in four cases, an ovariectomy in seven cases, and the simple removal of the cyst in one case where self-amputation had occurred. In two cases of bilateral pathology, the cysts, which were <1 cm, were left untreated. Average operating time was 40 min (range, 25-60 min). Intraabdominal pressure never exceeded 6-8 mmHg during the intervention. The postoperative course was always under 3 days. No intra- or postsurgical complications were recorded, and long-term ultrasonographic follow-ups were all normal. Our experience indicates that the laparoscopic approach is a reliable and safe technique in the treatment of neonatal ovarian cysts.

Surgical indications for neonatal ovarian cysts.

Ante- or neonatal ovarian cysts can be often diagnosed by routine ultrasonography. Small simple ovarian cysts, which can be followed with serial ultrasonography, usually resolve spontaneously. Large simple cysts and complicated cysts should undergo surgical treatment to reduce the potential for serious complications. Seventeen ovarian cysts were experienced between 1983 and 1997. Sixteen cases underwent surgical treatment at less than 1 month of age according to our protocols. In this report, we reviewed these cases for clinical presentation, ultrasound data, management, intraoperative findings, complications, and outcome. At operation, nine of them showed torsion, and seven of them showed necrotic changes. Only five of them was considered to fall into torsion by preoperative ultrasonography. In five cases whose blood flow could not improve after reduction of torsion, salpingo-oophorectomy was performed. We consider that small simple ovarian cysts under 4 cm in diameter can be observed carefully with serial ultrasonography. But, not only complicated ovarian cysts and simple cysts over 5 cm in diameter, but smaller cysts showing no decrease in size should be considered for surgical indication to rescue the ovarian tissue.

Neonatal ovarian cysts: pathogenesis, diagnosis and management.

This review discusses problems concerning the neonatal ovary. Neonatal ovarian cysts may undergo torsion and amputation. We discuss the pathogenesis, diagnosis, and management of these conditions.

Effect of Neonatal Ovarian Cysts on Infant Growth

Ovarian follicular cysts were diagnosed antenatally or postnatally by routine obstetric ultrasound scanning in 7 infants. In 5 of them the serum levels of estradiol (E2), insulin-like growth factor-I (IGF-I), osteocalcin and other hormones were measured serially after birth for almost one year. The patients' growth and skeletal maturation were also assessed. The elevated serum E2 levels (242-8, 300 pg/mL) in cases with ovarian cysts fell after cystectomy/cyst aspiration or conservative management, but their serum E2 levels remained high compared with those of control infants for 1-5 months. The IGF-I and osteocalcin serum levels of some patients were also relatively high. Furthermore, a tendency to growth acceleration during early infancy and advancement of skeletal age were each observed in two patients.Our present observations suggest that neonatal ovarian cysts associated with elevated serum E2levels during early infancy may affect the statural growth and bone maturation of female infants.

Management of Ovarian Cyst Detected by Prenatal Ultrasounds

As a result of refinements in Prenatal Ultrasonography (US), neonatal ovarian cysts are more frequently encountered than in the past. Between January 1981 and December 1990, 21 consecutive fetuses with ovarian cysts were followed up by ultrasonography. 23 ovarian cysts were diagnosed between 28 and 38 weeks gestation. 18 cysts were initially large cysts (more than 50 mm in diameter). In 9 cases, an anechoic cyst was observed and a US-guided needle aspiration of the cyst was performed (2 antenatally and 7 postnatally). Ultrasonographic patterns of complicated cyst were observed in 3 fetuses. After a postnatal ultrasound control, 11 infants were operated on: 8 surgical interventions were required for complicated cysts (torsion: 4, hemorrhage: 4), 3 cases irrespective of their sonographic appearance in our initial experience. In the remaining cases, spontaneous resolution was followed by repeated ultrasonographic examination. Prenatal ultrasonography today allows diagnosis of ovarian cysts and may suggest antenatal complications. To preserve as much ovarian tissue as possible, cysts greater than 50 mm in diameter should be candidates for percutaneous aspiration and complex cystic masses should be operated on.

Ovarian cysts in the fetus and neonate—changes in sonographic pattern in the follow-up and their management

In a multicenter trial we retrospectively evaluated the clinical and sonographic data of 49 neonatal ovarian cysts, 44 of which were detected prenatally and 5 on the first day after delivery. Of the 44 prenatally detected cysts 39 were purely cystic, 5 echogenic or had a mixed pattern. In 20 patients the cystic appearance changed during delivery from purely cystic to a mixed pattern being independent on the size of the cyst. 26 of the 44 cysts were treated surgically. Salpingotorsion was found in 8 and was independent on the size of the cyst. In 15 a salpingo-oophorectomy or oophorectomy was performed, in 11 the ovary was saved. 23 patients were followed sonographically: 15 cysts showed complete resolution within 14 months without correlation to the sonographic pattern. The volume of these cysts varied between 5 and 71 ml. Neonatal ovarian cysts disappear spontaneously frequently and rarely cause severe symptoms. The authors recommend follow-up by ultrasound as the primary modality. Surgical intervention is recommended only if the cyst is space-occupying and percutaneous puncture can not be performed or in the case of emergency.

The resolution of fetal and neonatal ovarian cysts

The diagnosis of a fetal or neonatal ovarian cyst presents a dilemma for the pediatric gynecologist or pediatric surgeon because of their lack of experience with the clinical features and evolution of these cysts. The diagnosis and management of eight suspected cases of perinatal ovarian cysts are reviewed. Classically, these cysts were managed surgically, but in five of the eight cases, infants were managed conservatively with observation and serial ultrasounds, and all resolved spontaneously. Perinatal ovarian cysts may result from disturbed folliculo-genesis. When the gonadotropins fall physiologically, the cyst can be expected to regress.

Management of Antenatally Diagnosed Fetal Ovarian cysts

1. Fetal ovarian cysts are usually unilateral, diagnosed in the third trimester and are uncommon. 2. Average ovarian cyst size is 5 x 5 cm at diagnosis and size does not change throughout the pregnancy. 3. Most cysts are functional in origin and histologically benign, simple cysts. 4. Polyhydramnios is a common finding but associated anomalies are rare. 5. Although large cysts can compress other viscera and torsion or rupture can occur, in utero aspiration has limited value in prenatal management. 6. Vaginal delivery with confirmed fetal pulmonary maturity or at term is appropriate. 7. Soft tissue dystocia is rare. Cesarean delivery should be reserved for obstetrical indications only. 8. The best predictor of neonatal cyst torsion risk is length of the cyst pedicle rather than cyst size. 9. When surgery is indicated a cystectomy, with preservation of maximal ovarian tissue is to be preferred over oophorectomy. 10. Ultrasound-guided aspiration of neonatal ovarian cysts may be an alternative to surgical management.

NEONATAL OVARIAN CYSTS -REPORT OF FIVE CASES AND REVIEW OF THE LITERATURE-

Recently, widespread use of ultrasonic examination during the perinatal period has increased an opportunity to detect asymptomatic or small cysts in newborns, and it has also become known that these cysts have a natural tendency to disappear. From this, we can not reach any consensus of its correct treatment. We experienced 5 cases of neonatal ovarian cysts, of which 2 were diagnosed before birth. In 4 of the 5 cases, natural course was observed; in 2 cases cysts started to reduce within 1 week and disappeared within 1 month after birth; and in the other 2 cases, no reduction was observed and the lesions were excised on the 20th and 40th day of life, respectively. The remaining one case was found to have a large cyst on the 28th day after birth and operated on. From these findings, we think proper to treat the cysts according to the following guidelines: when cysts with a diameter of less than 4 cm are detected before birth or during an early postnatal period, the natural course should initially be observed. If a tendency for regression is not observed in 1-2 weeks, or if the cyst is larger than 4 cm, it should be treated by aspiration of the contents. While thus preventing torsion, it is though best to observe course of such ovarian cysts.

Neonatal ovarian cysts: Therapeutic dilemma: D.J. Widdowson, D.W. Pilling, and R.C.M. Cook. Arch Dis Child 63:737–742, (July), 1988

Neonatal ovarian cysts: Therapeutic dilemma: D.J. Widdowson, D.W. Pilling, and R.C.M. Cook. Arch Dis Child 63:737–742, (July), 1988

Neonatal Ovarian Cysts: Sonographic-Pathologic Correlation

The authors reviewed the prenatal (11 infants) and postnatal (17 infants) sonograms and the clinical, surgical, and pathologic findings in 17 infants with an ovarian cyst to determine the sonographic features and natural history of neonatal ovarian cysts. An uncomplicated cyst (nontwisted, nonhemorrhagic) was completely anechoic and the cyst wall was imperceptible with sonography (five cases). A twisted or hemorrhagic cyst was cystic with a fluid-debris level, cystic with a retracting clot, septated with or without internal echoes, or solid (12 cases). These complicated cysts contained liquid and/or organized hematoma. Eleven of the 12 complicated cysts had a thin, highly echogenic wall. Cyst torsion commonly occurred in utero and could be diagnosed on prenatal sonograms by a typical sonographic appearance (eight cases). All of these infants were asymptomatic after birth. Four infants with hemorrhagic or twisted cysts were symptomatic. All cysts except one that resolved spontaneously were treated surgically, including three twisted cysts that showed no change in size over a 1-8-month interval. All of the cysts were of follicular origin.

Neonatal Ovarian Cysts: Therapeutic Dilemma

Seven cases of neonatal ovarian cysts that presented over the past seven years were studied. Complications included torsion and rupture and usually occurred in cysts more than 5 cm in diameter. Surgical removal, either oophorectomy or cystectomy, was the treatment of choice. Because even cystectomy results in loss of normal ovarian tissue, and because spontaneous regression of cysts less than 5 cm in diameter can occur, a more conservative approach is now proposed. Regular ultrasonography alone is recommended if the cysts are less than 5 cm in diameter, and aspiration of the cysts followed by regular ultrasonographs if the cysts are more than 5 cm in diameter. Operation should be reserved for recurrent cysts or for those with complications. Cysts diagnosed antenatally may be aspirated in utero if there are signs of thoracic compression.

Neonatal ovarian cysts: J. Gaudin, C. Le Treguilly, P. Parent, et al. Pediatr Surg Internat 3:158–164, (March), 1988

Neonatal ovarian cysts: J. Gaudin, C. Le Treguilly, P. Parent, et al. Pediatr Surg Internat 3:158–164, (March), 1988

Neonatal ovarian cysts: sonographic-pathologic correlation.

The authors reviewed the prenatal (11 infants) and postnatal (17 infants) sonograms and the clinical, surgical, and pathologic findings in 17 infants with an ovarian cyst to determine the sonographic features and natural history of neonatal ovarian cysts. An uncomplicated cyst (nontwisted, nonhemorrhagic) was completely anechoic and the cyst wall was imperceptible with sonography (five cases). A twisted or hemorrhagic cyst was cystic with a fluid-debris level, cystic with a retracting clot, septated with or without internal echoes, or solid (12 cases). These complicated cysts contained liquid and/or organized hematoma. Eleven of the 12 complicated cysts had a thin, highly echogenic wall. Cyst torsion commonly occurred in utero and could be diagnosed on prenatal sonograms by a typical sonographic appearance (eight cases). All of these infants were asymptomatic after birth. Four infants with hemorrhagic or twisted cysts were symptomatic. All cysts except one that resolved spontaneously were treated surgically, including three twisted cysts that showed no change in size over a 1-8-month interval. All of the cysts were of follicular origin.

Management of ovarian cyst detected antenatally

Ovarian cyst was diagnosed in nine fetuses by antenatal ultrasonographic examination. All deliveries were uncomplicated; two were delivered by cesarean section. The clinical condition in all cases was good. Five of the neonates with a large cyst (more than 5 cm in diameter) were managed surgically, while four were merely followed with repeated ultrasonic examinations. In three of the latter four infants, the cysts disappeared without clinical complications during the subsequent 12 months, and one has been followed for only 2 weeks. The treatment of neonatal ovarian cyst is controversial. Since small ovarian cysts are not clinically significant and may involute, conservative treatment after birth is possible. Repeated ultrasonographic examination may be used to follow small cysts in asymptomatic patients. However, surgical excision in the newborn period has been suggested for larger lesions and/or those with solid components inside the cyst before life-threatening complications occur.

Neonatal ovarian cysts

Twelve cases of ovarian cysts are reported. The diagnosis was made antenatally by ultrasound scan. The authors consider the ultrasonic images of these cysts and signs of in-utero torsion, the antenatal and postnatal evolution, the pathological findings at surgery, and the histological results for six children that were operated. A review of the literature enables us to describe the possible complications in the evolution of this tumor and to discuss the perinatal management of the ovarian cyst, which depends on the appearance and diameter of the cyst and on its evolution.

Ultrasonic Detection of Bilateral Ovarian Cysts in the Fetus

Reports of neonatal ovarian cysts are few, partly because only large tumors, or tumors causing complications, have been diagnosed clinically in the past. The early diagnosis of cystic intraabdominal masses in the fetus was accidental before the introduction of ultrasonic screening examinations for the gravid population. Consequently, there was no adequately documented basis for discussing their real frequency, differential diagnosis, follow-up, and therapy. The present case report is put forward in order to elucidate the diagnostic and therapeutic problems associated with ovarian cystic masses in the fetus. A routine ultrasonic examination with real-time equipment was performed on a 29-year-old woman, gravid 2, at the 39th week of pregnancy. A single fetus with relatively large head and body diameters (biparietal diameter, 10.0 cm; transverse abdominal diameter, 11.2 cm) was verified in breech presentation. Transverse examination of the lower abdomen of the fetus revealed two large cystic masses on either side of a medially located cystic structure, which was thought to represent the urinary bladder. The diameters of the cysts were 6 cm (right) and 2.5 to 3 cm (left). Both kidneys were normal in size, shape, and location. A detailed ultrasonic examination of the fetus showed no other abnormalities, and the tumor finding remained constant. An elective cesarean section was performed 5 days after admission because of the relatively narrow pelvis, the breech presentation, and the strong suspicion of large ovarian cysts in the fetus. The newborn girl weighed 3910 g and had Apgar scores of 9 at one minute and 9 at five minutes. A soft resistance was felt in the lower right quadrant upon abdominal palpation. An ultrasonic examination of the infant, carried out at the age of 2 days, showed normal kidneys on both sides, with a slightly enlarged renal pelvis on the right. Two cystic structures (diameters, 6 cm on the right and 3 cm on the left) were diagnosed in the lower abdominal area. Intravenous urography was performed 2 days later. The excretion from the kidneys was symmetrical, and no tumor formations were observed in the areas of the kidneys or ureters. When the palpable tumors in the abdomen remained unchanged at the age of 8 days, a laparotomy was performed because of the risk of complications from such large tumors. Large cystic tumors originating from both ovaries were found, with diameters approximately 6 cm (right) and 4 cm (left). Both of these were excised macroscopically from the ovaries, great care being taken to leave the main ovarian structures intact on both sides. Both cysts were uni-locular and contained a serous yellow fluid. Histopatho-logical examination showed the insides of the cysts to be lined with theca-lutein cells of a benign character. Immediate recovery was good, and the condition of the child at the age of a month-and-a-half was excellent.

悪性を思わせた乳児 (1 カ月児) 卵巣嚢胞の 1 治験例

悪性を思わせた乳児 (1 カ月児) 卵巣嚢胞の 1 治験例

Total body opacification and neonatal ovarian cysts

Total body opacification and neonatal ovarian cysts