Fetal Ovarian Cysts: Prenatal Diagnosis Using Ultrasound and MRI, Management and Postnatal Outcome—Our Centers Experience

Abstract

The present study provides our clinical experience regarding the imaging diagnosis, management and postnatal outcome of neonates prenatally suspected of having developed ovarian cysts. This multicenter observational study included patients diagnosed prenatally with fetal ovarian cysts and follow-up in the postnatal period. Descriptive statistics were used to render the information regarding the prenatal imaging aspect of the fetal pelvic masses using ultrasound and/or MRI, prenatal surveillance and postnatal neonate’s immediate outcome, indications leading to surgery and pathologic aspect. The inclusion criteria were fulfilled by 21 patients. The mean gestational age at the time of initial diagnosis was 31.28 weeks of gestation (WG). Only five out of 21 cysts regressed completely during pregnancy without postnatal complications. In addition, 11 out of 21 infant’s required surgical treatment in the first two weeks after birth, mainly for ovarian torsion. Five out of 21 neonates were referred to postnatal follow-up clinically and by ultrasound, but three out of five cases required emergency surgical treatment for acute complications. Ultrasound plays a major role in the diagnostic of fetal ovarian cyst. From our experience, MRI does not bring supplementary data or change the management. Spontaneous resolution of fetal ovarian cysts is to be expected but the ovarian mass could lead to serious complications, if resolution does not occur in due time.

Ovarian absence: a systematic literature review and case series report

“…This may account for some instances of UOA through the torsion etiology outlined above. As such, we recommend implementing postnatal surveillance protocols that have been previously described [ 87 , 88 ].…”

Challenges in prenatal diagnosis of foetal anorectal malformation and hydrocolpos – Case report

“…Differential diagnoses are very important and can be factored out by identifying the organ of origin, observing the anatomy and placement of the cyst. Gastrointestinal, renal, and genital anomalies are commonly misdiagnosed as ovarian cysts [ 3 ]. When an intra-abdominal cyst is found in a female fetus, the possible differential diagnoses are renal cysts (unilocular or multiple) that are found in the renal area, with or without alterations of the kidneys architecture; hydronephrosis and/or ureterocele which are often associated with the first being described as a mass adjacent to the vertebral column distorting the renal pelvis and the latter located by entry of the bladder.…”

“…Other differential diagnosis that are commonly associated with FOCs are urachal cyst, intestinal duplication abnormalities, hydrometrocolpos, liver cysts and mesenteric cysts [ 3 ]. An intestinal duplication cyst appears as a hypoechoic muscular layer surrounding a hyperechoic mucosal layer and tends to be more tubular or ovoid in shape than other lesions.…”

“…Mesenteric cysts usually occur in the mid-abdominal region and are characteristically observed to be mobile on ultrasound examination. In gastrointestinal abnormalities, concomitant foetal ascites or polyhydramnios may also be present [ 3 ]. Diagnosis of a foetal ovarian cyst is usually presumptive because mesenteric cysts, or enteric duplications cannot be ruled out with absolute certainty prenatally.…”

“…There are three types of imperforate anus according to the distal rectal pouch and the puborectalis muscle [ 1 ]: the high-type, in which the distal pouch ends above the puborectalis muscle [ 2 ]; the intermediate-type, in which the pouch ends at the puborectalis muscle; and [ 3 ] the low-type, in which the pouch ends through the puborectalis muscle. Traditionally, imperforate anus is diagnosed by prenatal ultrasound on detecting the presence of a dilated distal bowel, or rectum or intraluminal meconium calcification, or enterolithiasis; however, it is not always suspected with the presence of a fistula [ 9 ].…”