Natural history of fetal ovarian cysts in the prenatal and postnatal periods

Abstract

Purpose: To determine the natural history of fetal ovarian cysts and to investigate whether the prognosis can be predicted by prenatal ultrasonography (US).Methods: This retrospective study includes cases of fetal ovarian cysts diagnosed by prenatal US over a 6-year period. Cases were divided into four subgroups of cysts (small and simple, small and complex, large and simple, large and complex) according to their size and echotexture. US examinations were repeated every 2 weeks from the time of diagnosis to treatment.Results: A total of 37 cases were included in the study. 32.4% of the cases regressed spontaneously in the prenatal period and 32.4% did so in the infantile period. Prenatal resolution occurred more frequently with small cysts than with large cysts (p = 0.03). Neonates with complex cysts required surgical treatment more often than neonates with simple cysts (p = 0.009). 27.0% of the cases underwent surgery due to ovarian torsion. The torsion rate of fetal ovarian cysts that progressed in the prenatal period was significantly higher than in the case of stable cysts (p = 0.001). Conclusion:The size of the fetal ovarian cysts, their US appearance and the progression of the cysts during follow-up are the main determinants of the neonatal outcome.

Managing Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder

“…We tested two hypotheses in accordance with the existing literature [9,15,16]. The first hypothesis postulates that simple cysts, small cysts (≤4 cm), and those that show a tendency to decrease in size during fetal life through regular follow-up, will regress and thus should be monitored in the postnatal period.…”

“…Regarding the prediction of complications and surgical need in FOC, considering cyst size, many authors support the following determinants of the neonatal outcome: a 4 cm cutoff, the US appearance (simple or complex), and the progression of the cysts during follow-up [7,27,28]. Small, unilocular cysts appear more likely to spontaneously resolve, whereas larger, complex cysts are at higher risk of persistence, complications, and surgical interventions [15].…”

“…The first hypothesis postulates that simple cysts, small cysts (≤4 cm), and those that show a tendency to decrease in size during fetal life through regular follow-up, will regress and thus should be monitored in the postnatal period. The second hypothesis suggests that complex cysts, large cysts (>4 cm), or those with an increasing size during follow-up in fetal life, have a propensity for torsion with ovarian amputation, and thus necessitate surgical intervention in postnatal life [9,15,16].…”

“…Despite clinicians' concerns regarding the safety of fetal cyst aspiration, Bagolan et al [14] recommended prenatal cyst aspiration if the cyst diameter is greater than 5 cm or if the diameter increases by more than 1 cm per week. On the other hand, some authors suggest that there is no need for postnatal surgical treatment for simple ovarian cysts with the largest diameter of <5 cm or <4 cm [11,15].…”