Fetal ovarian cysts: a report of three cases managed by intrauterine aspiration

Abstract

Small follicular or functional theca-lutein cysts are a common finding in fetal and neonatal ovaries. After delivery, decrease of hormonal stimulation may lead to spontaneous resolution of the cyst. A high rate of complication has been underlined by recent studies, the most common being ovarian torsion with subsequent loss of the ovary. Because torsion may happen with any size of cyst, however large or small, we suggest in utero decompression even in small fetal ovarian cysts (< 5 cm). We report here three cases of such cysts managed by intrauterine aspiration with good outcome and no further need for neonatal surgery. In all cases cytology of the cyst aspirate demonstrated numbers of granulosa cells and fluid biochemistry showed a high amount of estradiol, progesterone, and testosterone that confirmed the etiology as ovarian. Despite the small size of the cysts, no technical difficulties were encountered and no maternal or fetal morbidity occurred. Prenatal management of fetal ovarian cysts remains controversial, however, and our limited experience needs to be assessed on a larger number of cases.

Estudio De La Torsión Ovárica Fetal Intrauterina Mediante Ecografía 3d

“…Otras opciones serían la aspiración con aguja a nivel intrauterino (aconsejable en quistes mayores de 5 cm) y el tratamiento quirúrgico postnatal; en quistes persistentes, con complicaciones (como torsión), de gran tamaño (>5-6 cm) o cuando se sospecha neoplasia tumoral (1,3,6). La cirugía debe ser conservadora en todos los casos que sea posible.…”

Cystic Colon Duplication as Differential Diagnosis to Ovarian Cyst

“…According to the literature estradiol values of fetal ovarian cysts exceed usually 10,000 pmol/l [10,12] . This made the diagnosis of fetal ovarian cyst less probable.…”

“…The cyst was fi rst detected at 22 weeks of pregnancy. In the literature most ovarian cysts are found in the 3rd trimester of pregnancy [7][8][9][10] , but there are also a few cases detected in earlier weeks of pregnancy [11] . Meizner et al [11] found in a retrospective analysis in 8 of 15 cases a gestational age at diagnosis below 24 weeks.…”

“…According to the literature, complications occur in 40-75% of cysts greater than 2 or 3 cm and include hemorrhage, pre-and perinatal torsion with often-subsequent loss of the ovary, or mass effects such as hydramnion, renal compression, and intestinal obstruction, in particular when they are large [7][8][9][10]12] . Therefore several authors recommend prenatal cyst aspiration, most at a cutoff diameter of 4-5 cm [7,13,14] , some even in cysts with smaller diameters [10,12] . At delivery large cysts may cause mechanical complications, such as dystocia with rupture of the cyst and peritonitis [8] .…”

Management of Adnexal Cysts Detected in the Antenatal Period: Review

“…Similar findings were reported in a study by Meager et al [25] in which hemorrhage into the fetal adnexal cysts was suggested on ultrasound and in which percutaneous needle aspiration under ultrasound guidance was performed successfully, obviating the need for surgery. Another case series of 3 patients [26] provided data supporting percutaneous needle aspiration as a viable option. In all 3 patients, surgery was avoided and the cyst aspirate was confirmed to be ovarian in origin as based on fluid biochemistry that showed high amountsof estradiol, progesterone, and testosterone.…”