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Saxena AK, Mutanen A, Gorter R, Conforti A, Bagolan P, De Coppi P, Soyer T. European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts. Eur J Pediatr Surg 2024; 34:215-221. [PMID: 37557903 DOI: 10.1055/s-0043-1771211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). METHODS The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. RESULTS There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. CONCLUSION A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.
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Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Annika Mutanen
- Department of Pediatric Surgery, University of Helsinki Children's Hospital, Helsinki, Finland
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Children's Hospital UMC, Amsterdam, the Netherlands
| | - Andrea Conforti
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Paolo De Coppi
- Department of Paediatric Surgery, UCL Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
- Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Safa N, Yanchar N, Puligandla P, Sewitch M, Baird R, Beaunoyer M, Campbell N, Chadha R, Griffiths C, Jones S, Kaur M, Le-Nguyen A, Nasr A, Piché N, Piper H, Prasil P, Romao RLP, VanHouwelingen L, Wales P, Guadagno E, Emil S. Treatment and Outcomes of Congenital Ovarian Cysts A Study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS). Ann Surg 2023; 277:e1130-e1137. [PMID: 35166261 PMCID: PMC10082055 DOI: 10.1097/sla.0000000000005409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We conducted a multicenter study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts. SUMMARY BACKGROUND DATA Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known. METHODS Female infants diagnosed with congenital intra-abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centers were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter. RESULTS The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally, and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary sparing resection (14, 23%), or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4weeks. Independent predictors of surgery included postnatal cyst diameter ≥40 mm [odds ratio (OR) 6.19, 95% confidence interval (CI) 1.66-35.9] and sonographic complex cyst character (OR 63.6, 95% CI 10.9-1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 -13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131). CONCLUSIONS Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.
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Affiliation(s)
- Nadia Safa
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Natalie Yanchar
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Pramod Puligandla
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Maida Sewitch
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Robert Baird
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Beaunoyer
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Niamh Campbell
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Rati Chadha
- Division of Maternal Fetal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Griffiths
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Jones
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Manvinder Kaur
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Annie Le-Nguyen
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmed Nasr
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Nelson Piché
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Piper
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascale Prasil
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Rodrigo L P Romao
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Lisa VanHouwelingen
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Paul Wales
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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3
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Min J, Tang R, Zhi W, Gu Z, Huang S, Wang J. Clinical outcomes of fetal ovarian masses diagnosed by prenatal ultrasonography and literature review. Medicine (Baltimore) 2022; 101:e30962. [PMID: 36254031 PMCID: PMC9575801 DOI: 10.1097/md.0000000000030962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With the advancement of prenatal examination technology, more and more fetus with ovarian masses are diagnosed. However, whether such children need intervention measures after delivery, there is no more unified diagnosis and treatment measures in the world. In this study, postnatal data and clinical outcome of fetal diagnosed with ovarian masses were analyzed. We also combined with relevant literature to explore the postpartum intervention measures and timing of such children. A total of 57 cases of abdominal masses from the reproductive system were included in the study. These children were diagnosed with ovarian masses after birth. We collected from 2012 to 2020, the prenatal examination revealed the presence of abdominal masses from the reproductive system, and diagnosis was confirmed by imaging examinations after childbirth. We counted the fetal period data of these children, compared the changes in the postnatal pathology and intervention measures. A total of 57 cases of ovarian masses were diagnosed prenatally, 1 case was lost to follow-up, and 56 cases were finally included in the study. After birth a total of 21 cases of ovarian masses were treated conservatively, of which 18 cases resolved spontaneously during the follow-up process, with an average follow-up period of 30.88 ± 18.16 weeks. There were statistically significant differences in the nature and the maximum diameter of the mass between the two groups receiving conservative treatment or surgical treatment after delivery (P < .05).Univariate and multivariate Logistic regression analysis showed that there were significant differences in the nature and diameter of the mass between two groups (P < .05). In addition, we divided the children undergoing postpartum surgery into a laparoscopic surgery group and a conventional open surgery group. Through data analysis, we found that there were statistically significant differences in the age of operation, operation time, and hospitalization days in the two groups of these children (P < .05). Children diagnosed with ovarian masses prenatally generally have a good prognosis. For these children, the treatment plan should be developed according to the child general condition. If child with ovarian mass is treated with surgery, the preservation of ovarian tissue should be emphasized regardless of the size, nature, and torsion of the mass.
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Affiliation(s)
- Jie Min
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Ruze Tang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Wenxian Zhi
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Zhicheng Gu
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Shungen Huang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
- *Correspondence: Jian Wang, Department of Pediatric Surgery,Children’s Hospital of Soochow University, Suzhou 215123, China (e-mail: )
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Nitta H, Kinjo T, Kinjyo Y, Yamada H, Masamoto H, Aoki Y. Fetal ovarian cyst with prenatal torsion of the pedicle diagnosed in the third trimester: A case report. Case Rep Womens Health 2022; 36:e00443. [PMID: 36051433 PMCID: PMC9424354 DOI: 10.1016/j.crwh.2022.e00443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 10/29/2022] Open
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Review of a 25-Year Experience in the Management of Ovarian Masses in Neonates, Children and Adolescents: From Laparoscopy to Robotics and Indocyanine Green Fluorescence Technology. CHILDREN 2022; 9:children9081219. [PMID: 36010109 PMCID: PMC9406417 DOI: 10.3390/children9081219] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Background: Ovarian masses in pediatric populations are the most common abdominal masses in young girls. In neonates, the majority of masses are benign while in children and teen-agers the risk of malignancy exists. The aim of this study is to perform a 25-year experience retrospective analysis of clinical and therapeutic aspects of ovarian tumors in girls, in order to show how the development of minimally invasive technology has changed the management of this pathology. Methods: The records of patients under the age of 18 who were operated in three pediatric surgical units due to ovarian mass, in the last 25 years, were reviewed retrospectively. The study group comprised 147 patients operated between 1996 and 2021 with a diagnosis of ovarian masses. Data involved were demographical, surgical, follow-up and final diagnosis. We analyzed the type of surgical technique, intra-operative data (operative time, the use of different technologies), complications, length of stay and long-term follow-up. Based on these data, we assessed how the surgical approach to ovarian masses has changed in the last 25 years in newborns and young girls. Results: The patients ages ranged between 7 days and 15 years (median, 59 days). All the procedures were completed in laparoscopy or robotics without conversion in open surgery. One-hundred and eleven patients were neonates; they all had follicular cysts and they were all managed in laparoscopy using 1 or 3 trocars. In 80/111 patients (72%), a small part of ovarian parenchyma was saved; in 31/111 patients (28%), in which the ovarian parenchyma was not available, an ovariectomy was performed. Patients in which we saved a small part of ovary, at long term follow-up (minimum follow-up of 12 years) (29/80, 36%), developed a normal ovary at US control. Thirty-six were older patients. They had a histological diagnosis of benign (30) or malign (6) tumors. All the patients (8/36) with a pre-operative suspicion of ovarian malignancy received an ovariectomy and an adnexectomy using sealing devices. In the last 10 years in all the children, except neonates, we adopted sealing devices and, in the last 4 years, in 20 cases, we always adopted ICG fluorescence technology to check ovarian vascularization in case of torsion or to check lympho-nodes condition in case of malignancy. Conclusions: In neonatal ovarian cysts, surgical management remained unchanged and an ovarian sparing procedure is always indicated and the long-term follow-ups confirm this hypothesis. The principal innovation in this age period is the use of ICG fluorescence technology to check ovarian vascularization in case of torsion. In teenagers, the decision-making strategy is based on the tumoral markers and on the morphological aspects of the mass. Robotics cystectomy or ovariectomy now-days represents the safer and faster way to perform this. Sealing devices are essential tools for dissection and resection to avoid bleeding. ICG fluorescence technology in all ages is fundamental to check ovary vascularization after detorsion or to check lympho-node status in case of malignancy. All the suspected lesions have to be removed with an endo-bag.
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6
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Aldeeb B, Goodloe JM. Abdominal pain in an adolescent female. J Am Coll Emerg Physicians Open 2022; 3:e12759. [PMID: 35662898 PMCID: PMC9161699 DOI: 10.1002/emp2.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bassam Aldeeb
- Department of Emergency Medicine University of Oklahoma School of Community Medicine Tulsa Oklahoma USA
| | - Jeffrey M Goodloe
- Department of Emergency Medicine University of Oklahoma School of Community Medicine Tulsa Oklahoma USA
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Toker Kurtmen B, Divarci E, Ergun O, Ozok G, Celik A. The Role of Surgery in Antenatal Ovarian Torsion: Retrospective Evaluation of 28 Cases and Review of the Literature. J Pediatr Adolesc Gynecol 2022; 35:18-22. [PMID: 34454073 DOI: 10.1016/j.jpag.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/30/2021] [Accepted: 08/07/2021] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Antenatal ovarian torsion (AOT) is rare and requires differentiating from other congenital cystic masses of the abdomen and pelvis in neonates. In this study, it was aimed to evaluate the prenatal characteristics and postnatal outcomes of AOT. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Hospital records of patients (n = 28) with diagnosis of AOT between 2004 and 2020 were reviewed and their prenatal characteristics, postnatal examination, imaging, operative, and histopathological findings were evaluated. RESULTS There were 28 patients during the study period. In most of the patients (25/28; 89.3%) AOTs were detected prenatally. All were term babies with a mean birth weight of 3010 ± 466.6 g. Mean maternal age was 25.75 ± 3.65 years. Prenatal history was event-free in all and none had additional anomalies. Physical examination revealed mobile intra-abdominal cystic lesions in 16 (57.1%) patients. AOTs mimicked other pathologies as intestinal duplication cyst or mesenteric cyst (n = 7), complex ovarian cyst (n = 3), mature cystic teratoma (n = 3), simple renal cyst (n = 1), and ectopic kidney (n = 1) in 15 (53.6%) patients in postnatal ultrasonography. Elective laparoscopic surgery was performed in 26 (92.8%) patients. The other 2 patients required emergency open surgery because of acute symptoms. Ovaries were autoamputated in 17 (60.7%) patients. Histopathological examination revealed necrosis and dystrophic calcification in all specimens. There was neoplastic involvement in 2 patients (serous cystadenoma and gonadoblastoma). No complication occurred in the early follow-up period (mean: 73.9 ± 46.8 months). CONCLUSION AOTs can be detected easily during the antenatal period. Neoplastic involvement with AOTs is rare but possible. Although AOTs might mimic other cystic pathologies, it should be one of the first diagnoses to be considered, in the presence of a palpable intra-abdominal mass and complex cystic lesion in infant girls. It can be efficiently and safely managed using minimally invasive techniques.
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Affiliation(s)
- Bade Toker Kurtmen
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
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Diagnosis, Management, and Therapy of Fetal Ovarian Cysts Detected by Prenatal Ultrasonography: A Report of 36 Cases and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11122224. [PMID: 34943461 PMCID: PMC8700714 DOI: 10.3390/diagnostics11122224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. METHODS We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥40 mm was performed. RESULTS We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter <40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to <35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. CONCLUSIONS IUA is a promising therapy for preserving ovaries with simple cysts ≥40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.
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9
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Cheng Y, Cheng Y. Ovarian cysts. Am J Obstet Gynecol 2021; 225:B23-B25. [PMID: 34507793 DOI: 10.1016/j.ajog.2021.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Singh P, Singh SP, Lal H. Daughter cyst sign in the congenital ovarian cyst. BMJ Case Rep 2021; 14:14/6/e243963. [PMID: 34083202 DOI: 10.1136/bcr-2021-243963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Priya Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Surya Pratap Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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11
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Gynecological Problems in Newborns and Infants. J Clin Med 2021; 10:jcm10051071. [PMID: 33806632 PMCID: PMC7961508 DOI: 10.3390/jcm10051071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Pediatric-adolescent or developmental gynecology has been separated from general gynecology because of the unique issues that affect the development and anatomy of growing girls and young women. It deals with patients from the neonatal period until maturity. There are not many gynecological problems that can be diagnosed in newborns; however, some are typical of the neonatal period. This paper aims to discuss the most frequent gynecological issues in the neonatal period.
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12
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Sakai S, Nomura K, Tomida M, Hayashi K, Tsutsuno T, Mizushima H, Mitani Y. Strangulated ileus due to an ovarian cyst in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Chen L, Hu Y, Hu C, Wen H. Prenatal evaluation and postnatal outcomes of fetal ovarian cysts. Prenat Diagn 2020; 40:1258-1264. [PMID: 32441348 DOI: 10.1002/pd.5754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/07/2022]
Abstract
To evaluate the natural history and outcome of cases of fetal ovarian cyst under conservative prenatal treatment. A retrospective cohort study included patients diagnosed with fetal ovarian cysts was conducted between January 2008 to December 2016. Data including clinical data, sonographic feature and postnatal outcomes were obtained. One hundred and two cases were included for statistical analysis. The rate of spontaneous resolution was significantly higher among cases with simple than complex cysts (70/92 or 76.1% vs 2/10 or 20%, P < .01) and for cysts <4 cm than cysts ≥4 cm (50/56 or 89.3% vs 22/46 or 47.8%, P < .01). Ovarian torsion was confirmed in 5/102 (4.9%) cases; neither prenatal characteristics of cysts (complex: 2/10 or 20% vs simple: 3/92 or 3.3%, P = .07), nor their size (≥40 mm: 4/46 or 8.7% vs < 40 mm: 1/56 or 1.8%, P = .17) was predictive for ovarian torsion. 25/102 (24.5%) of cysts change in size or sonographic characteristics prenatally. Half of the complex cysts at the last prenatal scan are not ovarian in origin. 98/102 neonates (96.1%) were able to preserve both ovaries. Spontaneous resolution of ovarian cysts is predicted by cyst size and characteristics, whereas likelihood of torsion cannot be predicted.
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Affiliation(s)
- Lu Chen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Hu
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chanchan Hu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Wen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Signorelli M, Gregorini M, Platto C, Orabona R, Zambelloni C, Torri F, Franceschetti L, Gambino A, Sartori E. The prognostic value of antenatal ultrasound in cases complicated by fetal ovarian cysts. J Neonatal Perinatal Med 2020; 12:339-343. [PMID: 30883366 DOI: 10.3233/npm-1870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ovarian cysts are relatively common prenatal findings in female fetuses. The aim of this study is to evaluate the ability of antenatal ultrasound in predicting spontaneous regression or a need for surgery. DESIGN All cases of fetal ovarian cysts treated in our Department between 2007 and 2016 were included. Patients underwent a sonographic monitoring in utero and after birth until spontaneous or surgical resolution. Subjects were divided into two groups according to their postnatal management. Receiver-operating characteristics (ROC) curves were used to test the predictive ability for postnatal surgery of the cyst's mean and maximum diameters; their optimal cut off points were also determined. RESULTS 38 cases of antenatally-detected fetal ovarian cysts were included. 12/38 cases underwent surgery (Group A). 26/38 cases were resolved spontaneously (Group B). Cyst size of those which were surgically excised significantly differed from those that regressed spontaneously. ROC curve pointed to 45 mm and 47 mm as optimal cut off points for the mean and the maximum cystic diameters, respectively. CONCLUSIONS Cyst size and echo-structure seemed good predictors for prognosis after birth. The optimal cut off points of the cysts mean and maximum diameters in predicting postnatal surgery have been identified as 45 mm and 47 mm, respectively.
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Affiliation(s)
- M Signorelli
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - M Gregorini
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - C Platto
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - R Orabona
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - C Zambelloni
- Department of Neonatology, University of Brescia, Brescia BS, Italy
| | - F Torri
- Department of Pediatric Surgery, Spedali Civili Children's Hospital of Bescia, Brescia BS, Italy
| | - L Franceschetti
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - A Gambino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - E Sartori
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
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Schallert EK, Abbas PI, Mehollin-Ray AR, Price MC, Dietrich JE, Orth RC. Physiologic Ovarian Cysts versus Other Ovarian and Adnexal Pathologic Changes in the Preadolescent and Adolescent Population: US and Surgical Follow-up. Radiology 2019; 292:172-178. [PMID: 31112089 DOI: 10.1148/radiol.2019182563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Ovarian and adnexal cysts are frequently encountered at US examinations performed in preadolescent and adolescent patients, yet there are few published studies regarding the outcomes of cysts in this population. Purpose To identify characteristics at US that help to distinguish physiologic ovarian cysts from nonphysiologic entities. Materials and Methods Female patients who underwent pelvic US with or without Doppler from January 2009 through December 2013 were identified by using a centralized imaging database. Patients older than 7 years and younger than 18 years with ovarian or adnexal cysts at least 2.5 cm were included. Demographic characteristics, date of surgery, surgical notes, and pathologic reports were extracted from the electronic medical record. Initial and follow-up dates of US, cyst size and complexity, imaging diagnosis, and change on subsequent US images were recorded. Statistical analysis was performed with the Wilcoxon rank sum and Kruskal-Wallis tests for continuous variables and the Fisher exact test for categorical variables. Results Of 754 patients who met inclusion criteria (age, 8-18 years; mean age, 14.6 years ± 1.9 [standard deviation]; mean cyst size, 5 cm ± 3.3), 409 patients underwent complete follow-up that included resolution at imaging (n = 250) or surgery (n = 159). In the patients with complete imaging follow-up, mean time to US documentation of resolution was 194 days ± 321; 59.6% (149 of 250) patients had nonsimple cyst characteristics. One-hundred fifty-nine patients underwent surgical intervention (mean cyst size, 8.5 cm ± 5.3), and 69.8% (111 of 159) of the cysts had simple characteristics. Of the 159 cysts, 100 (62.8%) were defined in the pathologic report as paratubal cysts. Of 409 patients, no malignancies were encountered in this study population with surgical or imaging resolution. Conclusion No malignancies were encountered in the study population and the majority of cysts resolved at follow-up imaging. Large size, persistence, and separability from the ovary were most helpful for identification of nonphysiologic paratubal cysts. © RSNA, 2019.
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Affiliation(s)
- Erica K Schallert
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Paulette I Abbas
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Amy R Mehollin-Ray
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Martin C Price
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Jennifer E Dietrich
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Robert C Orth
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
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Rialon KL, Akinkuotu A, Fahy AS, Shelmerdine S, Traubici J, Chiu P. Management of ovarian lesions diagnosed during infancy. J Pediatr Surg 2019; 54:955-958. [PMID: 30795909 DOI: 10.1016/j.jpedsurg.2019.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively. METHODS A retrospective study was performed of ovarian lesions in children <1 year-old from 2000 to 2014. RESULTS Forty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid-fluid or fluid-debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution. CONCLUSIONS The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kristy L Rialon
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adesola Akinkuotu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Traubici
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Priscilla Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Chandrasekaran A. Neonatal solid tumors. Pediatr Neonatol 2018; 59:65-70. [PMID: 28736178 DOI: 10.1016/j.pedneo.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/02/2016] [Accepted: 12/30/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neonatal tumors are different from tumors of the older children and knowledge gained from treating older children can not be extrapolated to neonates. Neonates have immature physiology and their haematopoietic and immune systems are not fully developed and the response to therapy is unpredictable. Hence it is imperative to study these tumors as separate entity. The aim of this study is to analyse this rare set of tumors in terms of their incidence, clinical features and management. MATERIALS AND METHODS All babies admitted in our hospital with tumors from January, 2011 to January 2016 were studied. Tumor-like conditions like haemangioma, lymphangioma and hamartomas were included. The age, sex distribution, type of tumor and management were studied. RESULTS A total of 51 cases were registered out of which, 29 cases were haemangiomas and lymphangiomas. Of remaining 20 cases, 5 were benign ovarian cysts, 3 were neuroblastomas, 3 were congenital fibrosarcomas, 3 were sacrococcygeal teratomas. Wilm's tumor, congenital mesoblastic nephroma, haemangioendothelioma of liver and others formed the remaining six cases. CONCLUSION Our study insists that the neonatal tumors are distinct subset of pediatric tumors, requiring careful selection of treatment modalities and most of the solid tumors can be successfully managed if diagnosed and treated early. Neonatal tumors are defined as tumors which are diagnosed before the first month of life. Some of them can be congenital (present at birth). Neonatal tumors are different from tumors in older children in terms of etiopathogenesis, behavior and response to therapy as well as long-term outcomes.
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Tyraskis A, Bakalis S, David AL, Eaton S, De Coppi P. A systematic review and meta-analysis on fetal ovarian cysts: impact of size, appearance and prenatal aspiration. Prenat Diagn 2017; 37:951-958. [DOI: 10.1002/pd.5143] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Athanasios Tyraskis
- Stem Cells and Regenerative Medicine; UCL Institute of Child Health and Great Ormond Street Hospital; London UK
| | - Spyros Bakalis
- Institute for Women's Health; University College London; London UK
| | - Anna L. David
- Institute for Women's Health; University College London; London UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine; UCL Institute of Child Health and Great Ormond Street Hospital; London UK
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine; UCL Institute of Child Health and Great Ormond Street Hospital; London UK
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Sintim-Damoa A, Majmudar AS, Cohen HL, Parvey LS. Pediatric Ovarian Torsion: Spectrum of Imaging Findings. Radiographics 2017; 37:1892-1908. [DOI: 10.1148/rg.2017170026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Akosua Sintim-Damoa
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Anand Shyamcharan Majmudar
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Harris L. Cohen
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Louis Swig Parvey
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
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akçora B, Çelikkaya ME. Yenidoğan Döneminde Nadir bir İntra-abdominal Kistik Kitle: Over Otoampütasyonu. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2017. [DOI: 10.17944/mkutfd.289224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Manjiri S, Padmalatha SK, Shetty J. Management of Complex Ovarian Cysts in Newborns - Our Experience. J Neonatal Surg 2017; 6:3. [PMID: 28083489 PMCID: PMC5224760 DOI: 10.21699/jns.v6i1.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/19/2016] [Indexed: 11/11/2022] Open
Abstract
Aims: To analyse the clinical presentation, clinicopathological correlation and management of complex ovarian cysts in newborn and infants.
Materials and Methods: Over a period of 6 years (2009-2015), 25 newborns who were diagnosed to have ovarian cyst on antenatal ultrasound, were followed up. We collected data in the form of clinical features, radiological findings, pathology and mode of treatment.
Results: Of the 25 fetuses who were diagnosed to have ovarian cysts, fourteen (56%) underwent spontaneous regression by 6-8 months. Eight were operated in newborn period while 3 were operated in early infancy. Seven had ovarian cyst on right side, 4 had on left side. Eight babies underwent laparoscopy while 3 underwent laparotomy. Histopathology showed varied features of hemorrhagic cyst with necrosis and calcification, serous cystadenoma with hemorrhage, benign serous cyst with hemorrhage and simple serous cyst. Post-operative recovery was uneventful in all.
Conclusion: All the ovarian cysts detected antenatally in female fetuses need close follow-up after birth. Since spontaneous regression is known, only complex or larger cysts need surgical intervention, preferably by laparoscopy. Majority of the complex cysts show atrophic ovarian tissue hence end up in oophorectomy but simple cysts can be removed preserving normal ovarian tissue whenever possible.
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Affiliation(s)
- S Manjiri
- Department of Pediatric Surgery, M.S. Ramaiah Medical College, Bangaluru-560054, India
| | - S K Padmalatha
- Department of Pediatric Surgery, M.S. Ramaiah Medical College, Bangaluru-560054, India
| | - J Shetty
- Department of Pediatric Surgery, M.S. Ramaiah Medical College, Bangaluru-560054, India
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Rathore R, Sharma S, Arora D. Spectrum of Childhood and Adolescent Ovarian Tumors in India: 25 Years Experience at a Single Institution. Open Access Maced J Med Sci 2016; 4:551-555. [PMID: 28028390 PMCID: PMC5175498 DOI: 10.3889/oamjms.2016.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Ovarian tumour in children and adolescent girls form an uncommon but important part of gynaecological malignancies. They account for 1% of all the childhood malignancies and 8% of all abdominal tumours in children. Since the ovarian cysts are thought to arise from mature follicles, these tumours were considered to be infrequent in the paediatric population. AIM: The rarity of this condition prompted us to conduct this study and share our experience on the incidence and clinicopathological features of different ovarian tumours in girls up to 20 years of age observed in last 25 years at a single tertiary care hospital. MATERIAL AND METHODS: This was a retrospective study conducted in the Department of Pathology at a tertiary hospital, Delhi. All ovarian tumours up to the age of 20 years in the past 25 years (1990-2014) were included for the purpose of studying the clinicopathological aspects of ovarian tumours in this age group. Descriptive statistics for prevalence and age-wise prevalence was done. Chi-square test, to find an association between the age, laterality and size with malignancy was performed. RESULTS: We received a total of 1102 cases of ovarian tumours over the period of 25 years (1990 to 2014), of which 112 (10%) cases were seen in girls up to 20 years of age. The mean age of the patients was 15.3 ± 4 years. The most common presenting complaint was pain abdomen (46.4 %) There was a statistically significant correlation found between size and malignancy status of tumours in our study (p = 0.00). Of 112 cases of ovarian tumours, 39/112 (34.8%) were malignant and 73/112 (65.2%) were benign. Mature cystic teratoma (27.6%) was the most common type of benign tumour in this age group and immature teratomas were the most common type of malignant ovarian neoplasms. CONCLUSION: Premenarchal girls with ovarian masses may have varied presentations. Abdominal pain is the most common presenting complaint of young adolescent girls with adnexal masses. So the index of suspicion should be kept high and prompt investigations like ultrasound must be performed early to rule out such adnexal masses. Immature Teratoma was the most common malignant and mature cystic teratoma was the most common benign tumour in our study.
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Affiliation(s)
- Ruchi Rathore
- Department of Pathology, NDMC Medical College and Hindu Rao Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences, Delhi University, New Delhi, India
| | - Deepshikha Arora
- Department of Pathology, University College of Medical Sciences, Delhi University, New Delhi, India
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Khedkar K, Shah H, Tiwari C, Makhija D, Waghmare M. Our experience with adnexal masses in the pediatric age group and review of literature. Int J Pediatr Adolesc Med 2016; 3:169-174. [PMID: 30805488 PMCID: PMC6372456 DOI: 10.1016/j.ijpam.2016.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 11/19/2022]
Abstract
Background and objectives Adnexal masses are rare in the pediatric age group. We present our experience with 20 patients with adnexal masses. Design and setting This retrospective observational analysis was performed on 20 children with adnexal masses who were treated at our institute between May 2011 and November 2015. Patients and methods Fifteen pediatric patients who were admitted between May 2011 and November 2015 were reviewed and retrospectively analyzed based on their age at the time of admission, their presenting complaints, clinical and radiological findings, tumor markers, management and follow-up. Results The patients' age at the time of admission ranged between 3 days and 12 years. Abdominal pain and lump were the most common presenting complaints.Four patients (20%) had antenatally diagnosed cystic ovarian lesions. On postnatal scan, two patients had a simple cyst measuring less than 6 cm, which resolved on follow-up ultrasound at 3 months. One neonate had a simple cyst, larger than 6 cm on postnatal scan, which was managed by marsupialization. One antenatally diagnosed patient had a dermoid cyst that required oophorectomy.Ten patients (50%) had dermoid cyst and underwent complete surgical excision of the mass. Based on histopathologic results, two of these patients had immature teratoma and required adjuvant chemotherapy (Bleomycin, Etoposide, and Cisplatin). The serum AFP levels of these patients were carefully monitored.One patient with bilateral ovarian cysts was diagnosed with Van Wyk-Grumbach syndrome, which resolved significantly after a 3-month regimen of thyroxin supplementation.Five patients presented with torsion and required emergency surgery-three had mature teratoma, one had an immature teratoma and one had large simple cysts. Conclusion The majority of ovarian tumors are benign. Accurate staging, complete resection and chemotherapy for the treatment of malignant tumors have contributed to excellent survival rates in these patients.
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Affiliation(s)
| | - Hemanshi Shah
- Corresponding author. Dept of Paediatric Surgery, TNMC & BYL Nair Hospital, Mumbai Central, Mumbai, 400008, Maharashtra, India. Tel.: +91 02223027671.
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Kim HS, Yoo SY, Cha MJ, Kim JH, Jeon TY, Kim WK. Diagnosis of neonatal ovarian torsion: Emphasis on prenatal and postnatal sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:290-297. [PMID: 27154434 DOI: 10.1002/jcu.22327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/28/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Our aim was to retrospectively review the imaging findings of patients with neonatal ovarian torsion, emphasizing prenatal and postnatal sonographic findings. METHODS Eleven patients who had had neonatal ovarian torsion diagnosed surgically (n = 9) or clinicoradiologically (n = 2) were enrolled. Prenatal and postnatal sonographic features, including sequential postnatal change, were reviewed. Clinical and pathologic features were also investigated. RESULTS All patients except one had a fetal ovarian cyst (mean, 5.3 cm) detected on third-trimester sonography, either simple (n = 6) or complex (n = 4). In all 11 patients, initial postnatal sonography had revealed a complex cyst (mean, 4.7 cm) with intracystic clot or debris, the double-wall sign, a fluid-fluid level, and multiple septation. None of the patients had had symptoms or signs related to the ovarian torsion. Follow-up sonography in seven patients had revealed increased echogenicity of the cyst wall with frequent calcification and a decrease in size of the cyst. In two patients, the interval of the change in cyst position was noted, and autoamputation of the torsed ovary had been surgically confirmed. Serous cystadenoma had been identified in one patient. CONCLUSIONS Neonatal ovarian torsion most commonly manifests as an asymptomatic complex cyst on sonography due to torsion of a fetal ovarian cyst. Serial monitoring of a fetal ovarian cyst for its resolution or changes in its appearance is mandatory for making an early diagnosis of torsion. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:290-297, 2016.
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Affiliation(s)
- Hyun Su Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Min Jae Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Wee Kyoung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
- Department of Radiology, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-712, Korea
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Ovarian Cyst Aspiration in the Neonate: Minimally Invasive Surgery. J Pediatr Adolesc Gynecol 2015; 28:348-53. [PMID: 26148782 DOI: 10.1016/j.jpag.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/04/2014] [Accepted: 10/07/2014] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To review our experience with laparoscopic aspirations and minimally invasive surgeries for neonatal ovarian cysts and report the outcome of their follow-up. DESIGN Twenty-one neonates diagnosed as having ovarian cysts were retrospectively reviewed at our hospital from 2006 through 2013. RESULTS Of 21 neonates, 8 showed simple cysts and 13 showed complex cysts in their ultrasound scan. Laparoscopic aspiration was performed for all neonates with simple cysts. Torsion was found in 7 of 13 neonates with complex cysts. Three neonates underwent detorsion, while 2 neonates underwent oophorectomy. Two neonates already showed autoligation, showing a cystic mass, which was removed. The remaining 6 neonates with a complex cyst underwent only aspiration because no torsion was found. Of 14 neonates who underwent only aspiration, 11 showed no cyst, while 3 neonates, having a cyst with a size of less than 2 cm, underwent follow-up. Of 3 neonates who underwent detorsion, 1 showed an ovary without cyst, while 2 showed neither cyst nor ovary. CONCLUSION Laparoscopically, neonatal ovarian cysts may be diagnosed and aspirated simultaneously, simply, and safely.
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Jwa SC, Aoki H, Anami A, Umehara N, Sumie M, Wada S, Sago H. Management of fetal ovarian cyst using in utero aspiration. CASE REPORTS IN PERINATAL MEDICINE 2015. [DOI: 10.1515/crpm-2015-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective: To study the clinical outcome of fetal ovarian cysts managed with in utero aspiration.
Methods: All cases of fetal ovarian cysts diagnosed from 2002 to 2013 were reviewed. In utero aspiration was performed for patients with simple cysts larger than 4 cm before term gestation.
Results: There were 21 cases of fetal ovarian cysts. Four patients (19%) were diagnosed with complex cysts at the time of referral. Among the 17 cases of simple cysts, in utero aspiration was performed in seven patients. There were no complications after the therapy and none of them developed complex cysts. An ovarian cyst was confirmed by cyst fluid that contained high levels of estradiol, progesterone and testosterone. For two patients with simple cysts who met the indications for in utero aspiration but did not receive therapy, one developed a complex cyst. Among the eight patients with simple cysts who did not fulfill the indications for aspiration, seven of them had cysts that regressed spontaneously, and one developed complex cysts during pregnancy.
Conclusion: Torsion of fetal ovarian cysts was common with expectant management. Management of fetal ovarian cysts larger than 4 cm using in utero aspiration may avoid torsion, which could otherwise lead to ovarian loss.
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Affiliation(s)
- Seung Chik Jwa
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroaki Aoki
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ai Anami
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nagayoshi Umehara
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Masahiro Sumie
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Seiji Wada
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Imaging Findings of Fetal-Neonatal Ovarian Cysts Complicated With Ovarian Torsion and Autoamputation. AJR Am J Roentgenol 2015; 205:185-9. [PMID: 26102397 DOI: 10.2214/ajr.14.13426] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Large nonresolving neonatal ovarian cysts may be a risk factor for complications such as torsion, mass effect, rupture, intracystic hemorrhage, and autoamputation. Torsed cysts and autoamputated cysts can cause a diagnostic dilemma. The objective of our study was to correlate the imaging findings of intrauterine ovarian torsion and autoamputated ovaries with their pathologic findings. MATERIALS AND METHODS We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation notes, and pathologic reports of 15 patients with ovarian torsion. All patients had complex cysts noted on postnatal sonographic examination. A complex heterogeneous ovarian cyst was defined by the presence of a fluid-debris level indicating hemorrhage within the cyst, a retracting clot, septations with or without internal echoes, calcification, and a solid component. RESULTS On ultrasound examination, four cysts had solid components, and 11 were heterogeneous and had a fluid-debris level. Calcifications were seen in two patients. The mean patient age at the time of surgery was 3.9 months. Exploratory laparotomy was performed on all patients. Torsed ovaries were identified in five patients. Ten patients had ovaries that were floating free in the peritoneal cavity at the time of surgery. Histopathologic evaluation revealed that 11 of the cysts consisted of extensive hemorrhagic, necrotic autolytic tissue with dystrophic calcification. None of the cysts contained any ovarian tissue. CONCLUSION A complex heterogeneous ovarian cyst with a fluid-debris level indicating hemorrhage is a significant sonographic hallmark for the diagnosis of ovarian torsion. A calcified abdominal mass, with or without wandering, can be an autoamputated ovary.
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Trinh TW, Kennedy AM. Fetal Ovarian Cysts: Review of Imaging Spectrum, Differential Diagnosis, Management, and Outcome. Radiographics 2015; 35:621-35. [DOI: 10.1148/rg.352140073] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Postnatal sonographic spectrum of prenatally detected abdominal and pelvic cysts. AJR Am J Roentgenol 2015; 203:W684-96. [PMID: 25415735 DOI: 10.2214/ajr.13.12371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to illustrate the sonographic findings of a spectrum of neonatal abdominal and pelvic cystic lesions. CONCLUSION Neonatal abdominal and pelvic cystic lesions can arise from many organs, and they have a broad differential diagnosis. Distinctive sonographic findings may be present and can help establish the correct cause and guide proper management.
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Adekola H, Mody S, Bronshtein E, Puder K, Abramowicz JS. The clinical relevance of fetal MRI in the diagnosis of Type IV cystic sacrococcygeal teratoma--a review. Fetal Pediatr Pathol 2015; 34:31-43. [PMID: 25183379 DOI: 10.3109/15513815.2014.949934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The introduction of fetal magnetic resonance imaging (MRI) has improved the prenatal evaluation of uterine, placental and fetal anatomy. However, its utilization has mostly been restricted to fetal central nervous system anomalies. We review how adjunct fetal MRI was performed and diagnosis of cystic type IV sacrococcygeal teratoma was made. We also discuss the clinical relevance of fetal MRI in differentiating this lesion from other selected abdominal/pelvic cystic malformations and lesions.
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Affiliation(s)
- Henry Adekola
- 1Department of Obstetrics and Gynecology, Hutzel Women Hospital, Wayne State University School of Medicine, Detroit Michigan
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Nakamura M, Ishii K, Murata M, Sasahara J, Mitsuda N. Postnatal Outcome in Cases of Prenatally Diagnosed Fetal Ovarian Cysts under Conservative Prenatal Management. Fetal Diagn Ther 2014; 37:129-34. [DOI: 10.1159/000365146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/07/2014] [Indexed: 11/19/2022]
Abstract
Aim: To evaluate the outcome of cases of prenatally diagnosed fetal ovarian cyst under conservative prenatal management. Methods: This retrospective cohort study included patients diagnosed between January 2005 and August 2013. They were managed expectantly during pregnancy and followed up until spontaneous regression of the cyst or postnatal surgery. The outcomes of fetal ovarian cysts were compared combined appearance as being simple or complex at prenatal scan and maximum size of cysts ≥40 or <40 mm. Results: There were 33 study cases. Prenatally 3/33 cases (9%) had spontaneous cyst regression during pregnancy. 14 cysts (42%) were treated surgically, of which torsion was confirmed in 4 (29%). Another 14/33 cases (42%) regressed spontaneously under conservative management after birth. The ovaries could be preserved in 28 patients (85%). The incidence of torsion between complex cysts and simple cysts was not statistically different. The incidence of torsion between patients with cyst size ≥40 and <40 mm was similar. Conclusions: The ovaries could be preserved in approximately 85% of patients under conservative management. The present study could not reveal the significance of prenatal ultrasonographic findings of fetal ovarian cyst for predicting the outcome of patients' ovaries.
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Management of neonatal ovarian cysts and its effect on ovarian preservation. J Pediatr Surg 2014; 49:990-3; discussion 993-4. [PMID: 24888849 DOI: 10.1016/j.jpedsurg.2014.01.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Management of asymptomatic neonatal ovarian cysts varies. Some surgeons advocate initial observation, while others recommend immediate operation depending on cyst size and complexity. This study aims to compare outcomes of initial observation versus primary surgery, focusing on incidence of postnatal torsion and ovarian preservation. METHODS A retrospective study (1997-2012) of neonates with an ovarian mass was performed. Data on cyst size, ultrasound characteristics, clinical course, complications, and pathology were extracted. RESULTS Thirty-seven neonates with asymptomatic ovarian cysts were identified (N=25 observed, N=12 primary surgery). Overall, 12/25 (48%) observed had successful cyst regression, including 3/8 (38%) cysts ≥50mm and 6/15 (40%) complex. 13/25 patients (52%) underwent surgery for failure of cyst regression (11/13) or concern for interval torsion (2/13). Postnatal torsion occurred in 1/25 observation patients (4%), or 1/8 (13%) with cysts≥50mm. Overall rate of ovarian preservation between groups was not statistically different [6/8 (75%) observed versus 8/9 (89%) primary surgery; P=0.577]. Pathology found viable ovarian tissue in all oophorectomy specimens (N=3). CONCLUSIONS Postnatal torsion is rare. A period of observation spares half of neonates from an operation, without decreasing ovarian salvage. Initial management should consist of observation, regardless of size or complex characteristics. If operative intervention is necessary, ovary preserving techniques should be utilized.
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Trotman GE, Zamora M, Gomez-Lobo V. Non-surgical management of the auto-amputated adnexa in the neonate: a report on two cases. J Pediatr Adolesc Gynecol 2014; 27:107-10. [PMID: 24075090 DOI: 10.1016/j.jpag.2013.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/12/2013] [Accepted: 06/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prenatal ovarian torsion is a rare but significant gynecologic abnormality. Current literature has yet to establish standard management in the case of auto-amputated adnexa secondary to ovarian torsion in the neonate. CASES We report 2 cases of abdominal masses that were diagnosed in the antenatal period and were clinically consistent with auto-amputated adnexa followed with serial ultrasonography until resolution. SUMMARY AND CONCLUSION To our knowledge this is the first report in the literature to document resolution of 2 pelvic masses due to auto-amputated adnexa with expectant management. This suggests expectant management is an appropriate alternative to surgical management in carefully selected cases.
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Affiliation(s)
- Gylynthia E Trotman
- Department of Women's and Infants' Services, Division of Pediatric and Adolescent Gynecology, Medstar Washington Hospital Center/Georgetown University Hospital/Children's National Medical Center, Washington, DC.
| | - Melodie Zamora
- Georgetown University School of Medicine, Washington, DC
| | - Veronica Gomez-Lobo
- Department of Women's and Infants' Services, Division of Pediatric and Adolescent Gynecology, Medstar Washington Hospital Center/Georgetown University Hospital/Children's National Medical Center, Washington, DC
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The auto-amputated adnexa: a review of findings in a pediatric population. J Pediatr Adolesc Gynecol 2013; 26:305-13. [PMID: 23287601 DOI: 10.1016/j.jpag.2012.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/01/2012] [Accepted: 08/21/2012] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To quantify our experience and that of the literature with diagnosis and management of the auto-amputated adnexa in a pediatric population. DESIGN Case series and literature review. SETTING Tertiary care medical center. PARTICIPANTS Case series of pediatric patients (<18 years of age) with surgically documented adnexal auto-amputation collected from our medical center and the literature. INTERVENTIONS None. MAIN OUTCOME MEASURE Auto-amputated adnexa. RESULTS In addition to the 3 cases discussed from our institution, 91 cases of auto-amputated adnexa were identified in the literature dating back to 1943, for a total of 94 cases. Forty-nine percent (46/94) of the cases involved girls in a pediatric population (<18 years of age). Of these, the majority (n = 26) were identified in a subgroup of girls who were diagnosed with an adnexal cyst by antenatal ultrasound. Most of these neonates were asymptomatic at birth or had a palpable abdominal mass (n = 6) and at the time of surgical exploration were found to have an auto-amputated adnexa. 34 out of 46 cases were analyzed in detail. The right adnexa were involved in 56% of the cases. The most common presenting complaint verbalized by the older girls was pain; however, 8 cases were identified in asymptomatic girls undergoing unrelated diagnostic testing. CONCLUSION The auto-amputated adnexa is a rare finding in the pediatric population, but it must be considered as a possible explanation for the incidental finding of absence of the fallopian tube or ovary in the subgroup of patients who undergo surgery for any reason. Patients with an antecedent history of pelvic pain either chronic or intermittent in nature may be diagnosed with torsion or less frequently auto-amputation of the adnexa. A fetal "pelvic mass" or "ovarian cyst" may predispose the adnexa to torsion and subsequent auto-amputation either in-utero or post-delivery. Many of these antenatally diagnosed cysts and even subsequent auto-amputations are completely asymptomatic, however, and do not compromise fertility assuming the contralateral adnexa are normal. Thus expectant management is appropriate for small (less than 4 cm), asymptomatic simple cysts and even suspected auto-amputated adnexa in an asymptomatic patient.
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Ki EY, Byun SW, Choi YJ, Lee KH, Park JS, Lee SJ, Hur SY. Clinicopathologic review of ovarian masses in Korean premenarchal girls. Int J Med Sci 2013; 10:1061-7. [PMID: 23801894 PMCID: PMC3691806 DOI: 10.7150/ijms.6216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/28/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To review the clinicopathological characteristics of ovarian masses in Korean premenarchal girls. DESIGN The data collected from hospital medical records were reviewed retrospectively regarding age, presentation, diagnosis, treatment, and outcome. PARTICIPANTS There were 65 premenarcheal girls who underwent surgery at Seoul St. Mary's Hospital between January 1990 and March 2012. RESULTS The most common presenting symptom was abdominal pain (n=31, 47.7%), followed by palpable abdominal masses 16 (n=16, 24.6%), abdominal distension (n=8, 12.3%), vaginal bleeding (n=4, 6.2%), incidental finding (n=3, 4.6%), difficulty in urination or defecation (n=2, 3.1%), and prenatal sonographic findings (n=1, 1.5%). Of the patients with benign tumors, including non-neoplastic lesions and benign cysts, 26 (51%) underwent cystectomy, 6 (11.8%) underwent oophorectomy, 17 (33.3%) underwent unilateral salpingo-oophorectomy and none underwent bilateral salpingo-oophorectomy. Of the patients with malignant tumors, 2 (14.3%) underwent bilateral salpingo-oophorectomy, 7 (50%) underwent unilateral salpingo-oophorectomy, 2 (14.3%) underwent oophorectomy, and 2 (14.3%) underwent cystectomy. CONCLUSION Abdominal pain was the most common symptom. However, the incidence of abdominal distension was higher in patients with malignant tumors than in those with benign tumors. We assessed clinical features, operative outcomes, and histological classifications of Korean prememarchal girls with ovarian masses. Further studies with a larger number of subjects are needed to confirm our results.
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Affiliation(s)
- Eun Young Ki
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
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Uygun I, Aydogdu B, Okur MH, Otcu S. The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child. Case Rep Surg 2012; 2012:615734. [PMID: 23119216 PMCID: PMC3478731 DOI: 10.1155/2012/615734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.
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Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey
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Assisted laparoscopic excision of huge abdominal cysts in newborns and infants using the umbilical laparoscopic port incision. J Pediatr Surg 2011; 46:1459-63. [PMID: 21763855 DOI: 10.1016/j.jpedsurg.2011.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 02/08/2011] [Accepted: 03/08/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of this article was to present our experience in successfully managing a variety of abdominal cysts in newborns and infants using a mini-invasive technique performed in 8 cases using an umbilical laparoscopic port incision. METHODS Assisted laparoscopic excision using an umbilical port incision was performed in 8 cases. Six were neonates (5 ovarian cysts and one hepatic cyst) and 2 were infants (6-months old with intestinal duplication and 11-months old with lymphatic malformation). RESULTS The procedure was performed with ease and was successful in all 8 cases. Oral feeding was started early after the surgical intervention. Seven patients were discharged the next day. The last case was discharged on the fifth day after surgery because of intestinal resection. CONCLUSION This proposed mini-invasive technique using the umbilical port incision proved to be less invasive, easier, and less technically demanding than the classic laparoscopic approach and, hence, may be applied to different abdominal cystic pathologies in newborns and infants.
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Chinchure D, Ong CL, Loh AHP, Rajadurai VS. Neonatal Ovarian Cysts: Role of Sonography in Diagnosing Torsion. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n6p291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The purpose of this case series was to determine the sonographic features of neonatal ovarian torsion. Materials and Methods: Seven surgically proven cases of neonatal ovarian cysts were included in this retrospective study. The patients were divided into 2 groups, torsion and non-torsion. These 7 patients were evaluated for the clinical presentation, sonographic features, surgical and pathological findings. The findings on follow-up sonography after surgery were also noted. Results: The sonographic appearance was variable. Of the 4 cases with torsion, 2 lesions had internal echoes with ‘fish-net appearance’. The other 2 lesions were predominantly cystic on the sonography with internal echoes and echogenic nodule. A calcific focus was present in 1 of these echogenic nodules. One of the cysts had fluid-fluid level. In the non-torsion group, only 1 lesion had mixed echogenic appearance. The other 2 lesions were cystic with low level internal echoes in 1 of the cysts. The surgical procedure performed in the torsion group was salpingo-oophorectomy in 2 patients and oophorectomy in 1 patient. In 1 patient, cystectomy was attempted without success. In the non-torsion group, only cystectomy was performed with preservation of normal ovaries, which was confirmed on follow-up sonography. Conclusion: The sonographic features of cysts with ‘fish-net appearance’, fluid-debris level and cysts with echogenic nodule favour torsion. The former sign has so far not been described as a sonographic predictor for neonatal ovarian torsion.
Key words: Ultrasound, Ovary, Doppler, Fish-net appearance, Haemorrhage
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Affiliation(s)
| | | | - Amos HP Loh
- KK Women’s and Children’s Hospital, Singapore
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40
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Abraham RJ, Squire R. Management of fetal ovarian cysts. J OBSTET GYNAECOL 2011; 31:449-50. [PMID: 21627436 DOI: 10.3109/01443615.2011.573105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R J Abraham
- Huddersfield Royal Infirmary, Lindley, Huddersfield, UK
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41
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Dimitraki M, Koutlaki N, Nikas I, Mandratzi T, Gourovanidis V, Kontomanolis E, Zervoudis S, Galazios G, Liberis V. Fetal ovarian cysts. Our clinical experience over 16 cases and review of the literature. J Matern Fetal Neonatal Med 2011; 25:222-5. [PMID: 21615230 DOI: 10.3109/14767058.2011.575484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Fetal ovarian cysts are intra-abdominal structures frequently diagnosed prenatally, tending to present as isolated unilateral lesions in normal fetuses in the third trimester. These cysts may present with complications and their diameter and echogenicity are the main criteria for establishing their prognosis. Spontaneous regression of fetal ovarian cysts is very usual. In the present study, we present our clinical experience on fetal ovarian cyst surveillance and treatment, as well as a review of the literature in the same field. MATERIAL AND METHOD In this study, we reviewed pre- and postnatal medical records and ultrasonography of 16 fetuses that were diagnosed with ovarian cysts, in Obstetrics Department of University Hospital of Alexandroupolis, between January 2000 and April 2010. We have also reviewed the available literature about fetal ovarian cysts. RESULTS In a total of 16 cases, postnatal surgery was performed in one infant due to ovarian cyst torsion. In the remaining 15 cases, cysts regressed completely in two fetuses during pregnancy and all the rest of the cysts, including four complex ones, resolved spontaneously after birth. CONCLUSIONS When fetal ovarian cysts are detected, they should be followed up by serial ultrasonographic examinations. The majority of them will regress spontaneously in a period of 12 months after birth, independent of their sonographic findings. Only symptomatic cysts or cysts with a diameter >5 cm, which do not regress or enlarge, should be treated.
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Affiliation(s)
- Marina Dimitraki
- Department of Obstetric Gynecology, Demokritus University of Thrace, Alexandroupolis, Greece
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Ben-Ami I, Kogan A, Fuchs N, Smorgick N, Mendelovic S, Lotan G, Herman A, Maymon R. Long-term follow-up of children with ovarian cysts diagnosed prenatally. Prenat Diagn 2010; 30:342-7. [PMID: 20209482 DOI: 10.1002/pd.2470] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Koike Y, Inoue M, Uchida K, Kawamoto A, Yasuda H, Okugawa Y, Otake K, Kusunoki M. Ovarian autoamputation in a neonate: a case report with literature review. Pediatr Surg Int 2009; 25:655-8. [PMID: 19513725 DOI: 10.1007/s00383-009-2396-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
Abstract
A case of ovarian autoamputation in an asymptomatic neonate is presented. An abdominal cyst was detected in a 30-week-gestation fetus on an antenatal ultrasound scan (USS). Postnatal USS confirmed the presence of a cyst in the right pelvis and revealed it to be 3.2 cm in diameter. CT and MRI revealed cyst wall calcification and intracystic hemorrhage. To confirm the diagnosis and treatment, the cyst was surgically removed. During the operation, a free autoamputated right ovarian cyst was found and removed from the abdomen. Ovarian cyst autoamputation is an extremely rare complication. In this article, we review the infantile ovarian autoamputation cases reported in the literature and assess their diagnosis and therapeutic management.
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Affiliation(s)
- Yuhki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507, Japan.
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Pienkowski C, Cartault A, Carfagna L, Le Mandat A, Lemasson F, Moscovici J, Galinier P, Guitard J, Kessler S, Vaysse P. Kystes ovariens fœtaux : étude prospective de la prise en charge néonatale. Résultats préliminaires. Arch Pediatr 2009; 16:583-4. [DOI: 10.1016/s0929-693x(09)74075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Soccorso G, Walker J. A giant ovarian cyst in a neonate. J Pediatr Adolesc Gynecol 2009; 22:e17-20. [PMID: 19539190 DOI: 10.1016/j.jpag.2007.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 09/09/2007] [Accepted: 09/11/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antenatally diagnosed abdominal cysts are common, and frequently are ovarian in origin, which usually regress spontaneously. Surgery is indicated in the infantile period in case of very large, persisting or symptomatic cysts. Many surgeons feel that watchful waiting can be justified in newborns with simple and complex cysts. CASE We present a neonate with an ovarian cyst diagnosed antenatally by ultrasound (US) and showing persistent enlargement within 3 months after birth when reached a diameter of 13 cm. Assessment and treatment is described. CONCLUSION The extremely large, non-resolving ovarian cysts in neonates present a major challenge for clinicians and should be treated by surgery to avoid complications. We advocate laparotomy and cystectomy when possible to avoid unnecessary loss of functional ovarian tissue.
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46
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Puligandla PS, Laberge JM. Lethal outcome after percutaneous aspiration of a presumed ovarian cyst in a neonate. Semin Pediatr Surg 2009; 18:119-21. [PMID: 19349004 DOI: 10.1053/j.sempedsurg.2009.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most surgeons agree that complex neonatal ovarian cysts, regardless of size, warrant operative intervention. Management of simple cysts >4 cm is still controversial, although many favor intervention because of the increased risk of torsion. Whereas laparoscopic cyst resection is favored by some, others prefer less invasive percutaneous needle aspiration. We present a newborn infant who was admitted with sepsis and respiratory failure after home delivery. Ultrasound done on day 8 to check for umbilical venous line placement incidentally showed a simple cyst measuring 3.6 x 5.9 x 6.9 cm that was presumed to be of ovarian origin. Percutaneous needle aspiration was atraumatic and revealed serous fluid, with a high estradiol level. Four days later, surgery was indicated for clinical deterioration with suspected hemorrhage into the cyst. We found a midgut volvulus with extensive necrosis secondary to a jejunal duplication cyst. Ovaries were normal and there was no evidence of malrotation. Postoperatively, after discussion with the parents, support was withdrawn and the child died. We should not rely solely on ultrasonographic features and fluid characteristics to diagnose a large neonatal abdominal cyst, but rather confirm the diagnosis with laparoscopy.
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Affiliation(s)
- Pramod S Puligandla
- Department of Surgery, Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
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47
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Schenkman L, Weiner TM, Phillips JD. Evolution of the surgical management of neonatal ovarian cysts: laparoscopic-assisted transumbilical extracorporeal ovarian cystectomy (LATEC). J Laparoendosc Adv Surg Tech A 2008; 18:635-40. [PMID: 18721022 DOI: 10.1089/lap.2007.0193] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Since its first detailed description in 1995, the laparoscopic management of neonatal ovarian cysts has typically required multiple incisions, specialized equipment, and advanced laparoscopic skills. After some initial frustration with neonatal laparoscopy, we developed a simplified single-incision laparoscopic-assisted transumbilical extracorporeal cystectomy (LATEC). This paper reviews our experience with this technique and compares outcomes to those of our other surgically managed neonatal ovarian cyst patients. MATERIALS AND METHODS A retrospective record review of 20 patients treated surgically between 1992 and 2006. Student's t-tests were used for comparisons (P<0.05 was significant). RESULTS Means were: age, 11 days; weight, 3.7 kg; and cyst diameter, 5.0 cm. Nineteen patients were diagnosed prenatally, at the mean gestational age of 33 weeks. Twelve of 20 (60%) had torsed cysts (1 bilateral). Three of 13 torsed cysts (23%) were less than 4 cm diameter (range, 2.9-3.5). Laparotomies were transverse lower abdominal incisions. Laparoscopic operations used 2 (3 patients) or 3 incisions (2 patients). LATEC involved transumbilical laparoscopy, complete cyst aspiration, and then cyst evisceration through the umbilicus for either ovarian cystectomy (simple cysts) or salpingo-oophorectomy (torsed cysts). Laparoscopic patients had similar time to feeds, length of stay, and postoperative narcotic requirements, when compared to laparotomy patients (P=nonsignificant). LATEC patients had shorter surgical times, more rapid advancement to full enteral feedings, shorter length of hospital stay, and equal ovarian preservation, when compared to laparoscopy. Cosmetic results with LATEC were outstanding. CONCLUSIONS Both laparoscopic and "open" approaches have acceptable perioperative morbidity and rapid recovery. LATEC is a relatively simple procedure, which combines laparoscopy and traditional extracorporeal surgery, and may be successfully performed by experienced pediatric surgeons and with a single incision.
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Affiliation(s)
- Lucy Schenkman
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA
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Politylo P, Zaparackaite I, Khan K, Mahomed A. Ovarian reconstitution following laparoscopic decapsulation of congenital cyst. J Laparoendosc Adv Surg Tech A 2008; 18:895-7. [PMID: 19105677 DOI: 10.1089/lap.2007.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laparoscopic management of congenital ovarian cysts is widely practiced but there is a dearth of information on the performance of the gonad where organ-preserving surgery is undertaken. Presented is a radiological diary documenting the progress of a complex congenital ovarian cyst from the antenatal period to a year post-laparoscopic decapsulation.
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Affiliation(s)
- Pawel Politylo
- Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom
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Geley TE, Gassner I. Lower Urinary Tract Anomalies of Urogenital Sinus and Female Genital Anomalies. PEDIATRIC URORADIOLOGY 2008. [DOI: 10.1007/978-3-540-33005-9_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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50
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Galinier P, Carfagna L, Juricic M, Lemasson F, Moscovici J, Guitard J, Baunin C, Menendez M, Cartault A, Pienkowski C, Kessler S, Sarramon MF, Vaysse P. Fetal ovarian cysts management and ovarian prognosis: a report of 82 cases. J Pediatr Surg 2008; 43:2004-9. [PMID: 18970932 DOI: 10.1016/j.jpedsurg.2008.02.060] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 02/20/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Fetal ovarian cysts are frequently complicated by intracystic hemorrhage without associated clinical signs, which is often secondary to ovarian torsion leading to loss of the ovary. The aim of this study was to evaluate ovarian outcome and the place of prenatal management and surgery in the first few days of life in order to save the ovary. METHODS Between January 1987 and June 2006, 82 fetal ovarian cysts in 79 patients were managed and clinically and ultrasonographically followed up for several months (median, 11 months; range, 6 months to 10 years) in all of the cases where the ovary was not removed. The ultrasonographic results regarding the ovarian parenchyma were broken down into 3 categories: follicular ovary, homogeneous ovary, and undetected ovary. RESULTS Twenty-seven cysts remained simple throughout their evolution, and 55 were complicated by intracystic hemorrhage usually several weeks before birth. Overall, after disappearance of the cyst, a follicular ovary was detected in only 39% of the cases (32/82) and more often when the cyst was simple than when it presented an intracystic hemorrhage (85% vs 16.4%, chi(2), P < .0001). CONCLUSIONS A review of our series confirms the poor ovarian outcome linked to ultrasonographic signs of intracystic hemorrhage. Preventive action by puncture of "simple" cysts is still being studied. The presence of a bilateral cyst can, if pulmonary maturity has been reached, be an argument for inducement of premature birth with a view to performing conservative surgery. After birth, surgery in the first few days of life is only justified if the signs of intracystic hemorrhage appeared in the period very close to birth.
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Affiliation(s)
- Philippe Galinier
- Department of Pediatric Surgery, Children's Hospital, TSA 70034, 31059 Toulouse Cedex 9, France
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