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Melinte-Popescu AS, Popa RF, Harabor V, Nechita A, Harabor A, Adam AM, Vasilache IA, Melinte-Popescu M, Vaduva C, Socolov D. Managing Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040715. [PMID: 37109673 PMCID: PMC10145213 DOI: 10.3390/medicina59040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Fetal ovarian cysts (FOCs) are a very rare pathology that can be associated with maternal-fetal and neonatal complications. The aim of this study was to assess the influence of ultrasound characteristics on FOC evolution and therapeutic management. Materials and Methods: We included cases admitted to our perinatal tertiary center between August 2016 and December 2022 with a prenatal or postnatal ultrasound evaluation indicative of FOC. We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation protocols, and pathology reports. Results: This study investigated 20 cases of FOCs, of which 17 (85%) were diagnosed prenatally and 3 (15%) postnatally. The mean size of prenatally diagnosed ovarian cysts was 34.64 ± 12.53 mm for simple ovarian cysts and 55.16 ± 21.01 mm for complex ovarian cysts (p = 0.01). The simple FOCs ≤ 4 cm underwent resorption (n = 7, 70%) or size reduction (n = 3, 30%) without complications. Only 1 simple FOC greater than 4 cm reduced its size during follow-up, while 2 cases (66.6%) were complicated with ovarian torsion. Complex ovarian cysts diagnosed prenatally underwent resorption in only 1 case (25%), reduced in size in 1 case (25%), and were complicated with ovarian torsion in 2 cases (50%). Moreover, 2 simple (66.6%) and 1 complex (33.3%) fetal ovarian cysts were postnatally diagnosed. All of these simple ovarian cysts had a maximum diameter of ≤4 cm, and all of them underwent size reduction. The complex ovarian cyst of 4 cm underwent resorption during follow-up. Conclusions: Symptomatic neonatal ovarian cysts, as well as those that grow in size during sonographic follow-up, are in danger of ovarian torsion and should be operated on. Complex cysts and large cysts (with >4 cm diameter) could be followed up unless they become symptomatic or increase in dimensions during serial ultrasounds.
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Affiliation(s)
- Alina-Sinziana Melinte-Popescu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, 'Ștefan cel Mare' University, 720229 Suceava, Romania
| | - Radu-Florin Popa
- Department of Vascular Surgery, University of Medicine and Pharmacy "Grigore T. Popa", 700111 Iasi, Romania
| | - Valeriu Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Aurel Nechita
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - AnaMaria Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Ana-Maria Adam
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Marian Melinte-Popescu
- Department of Internal Medicine, Faculty of Medicine and Biological Sciences, 'Ștefan cel Mare' University, 720229 Suceava, Romania
| | - Cristian Vaduva
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
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Zhang H, Ji L, Liu J, Li S, Chen T, Li J, Shang G. Case report: Resection of a massive primary sacrococcygeal mature teratoma in an adult using 3-dimensional reconstruction and mixed reality technology. Front Surg 2022; 9:948388. [PMID: 36338636 PMCID: PMC9632992 DOI: 10.3389/fsurg.2022.948388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Teratomas are rare neoplasms that arise from pluripotent germ cells. Sacrococcygeal teratomas are often diagnosed in infants but are rare in adults; a mature teratoma can contain hair, teeth, bony tissue, and other mature tissue types. Herein, we report for the first time a patient with a teratoma containing intact bones that formed a pseudoarthrosis. Case report A 49-year-old woman was admitted to hospital after a massive life-long sciatic tumor had begun to grow larger over the past year. A 16 cm × 25 cm solid mass with a clear boundary was palpable in the sacrococcygeal region. Radiography, computed tomography, and magnetic resonance imaging indicated a sacrococcygeal teratoma, although blood alpha-fetoprotein levels were normal. The teratoma was completely excised using 3-dimensional reconstruction mixed reality (MR) technology with no notable complications. Postoperative pathological examination of the excised lesion confirmed a mature teratoma. Interestingly, two intact irregular bones that formed a pseudoarthrosis were isolated; one was 11 cm and the other 6 cm. The patient is currently healthy and has experienced no recurrences. Conclusion Sacrococcygeal teratomas are rare, especially in adults, and often comprised lots of components, such as fat, bony tissue. However, it's first reported that formation of pseudoarthrosis in this case so far. It is difficult for surgeons to achieve complete excision without complications owing to the complex anatomic structure of the sacrum. The 3-dimensional reconstruction and mixed reality (MR) technology based on computed tomography can provide spatial visualization, which allows surgeons to examine the teratoma at different angles preoperatively. Combining 3-dimensional reconstruction and mixed reality (MR) technology in this case facilitated complete resection and prevented recurrence.
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Affiliation(s)
- He Zhang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Lu Ji
- Department of Gynecology and Obstetrics, Shengjing Hospital, China Medical University, ShenYang, China
| | - Jinxin Liu
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Shizhe Li
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Ting Chen
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Jiatong Li
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Guanning Shang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
- Correspondence: Guanning Shang
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Ultrasonographic and multimodal imaging of pediatric genital female diseases. J Ultrasound 2019; 22:273-289. [PMID: 30778893 DOI: 10.1007/s40477-019-00358-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Abstract
Ultrasonography is the first-line imaging modality in the evaluation of the female pelvis in childhood and adolescence, because it is easy to perform, non-invasive and it does not require sedation. The transabdominal approach is preferred in children and adolescents, after filling the bladder to move away the bowel loops from the pelvis. The probe frequency must be adapted to age, thickness of tissues and depth of the structures under examination. High-frequency (4-12 MHz) linear or convex probes are used in newborns; high-frequency linear probes (4-12 MHz) in toddler, convex 5-7.5 MHz probes in girls and convex 3.5-5 MHz probes in teenagers. In this article, the main pathological conditions of the genital female tract in pediatric age are examined, such as congenital anomalies, disorders of sex development, ovarian cysts, ovarian tumors, adnexal torsion, primary amenorrhea, precocious puberty and pelvic inflammatory disease.
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Kleinman A. Case 2: Acute Onset of Vomiting, Abdominal Pain, and Constipation in an 18-month-old Girl. Pediatr Rev 2017; 38:332-333. [PMID: 28667236 DOI: 10.1542/pir.2016-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anya Kleinman
- Rainbow Babies and Children's Hospital, Cleveland, OH
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Otero HJ, Rubio E, Blask A. Ovary and testicle and everything in between: lesions and imaging in the newborn. Semin Ultrasound CT MR 2015; 36:178-92. [PMID: 26001946 DOI: 10.1053/j.sult.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Assessment of the neonatal reproductive tract requires an understanding of embryology, awareness of common clinical presentations, and familiarity with normal newborn variation. This review of the neonatal reproductive tract emphasizes the use of sonography in the evaluation of developmental, acquired, and neoplastic conditions in male and female newborns. Anchored in embryologic origins, the discussion also includes descriptions of findings that may be encountered in prenatal imaging. Comments on clinical correlation are included to guide appropriate triaging of these complex cases. Imaging pearls and pitfalls are incorporated into this review, including the recognized effects of maternal hormones in female infants.
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Affiliation(s)
- Hansel J Otero
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.
| | - Eva Rubio
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
| | - Anna Blask
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
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Péroux E, Franchi-Abella S, Sainte-Croix D, Canale S, Gauthier F, Martelli H, Pariente D, Adamsbaum C. Ovarian tumors in children and adolescents: a series of 41 cases. Diagn Interv Imaging 2014; 96:273-82. [PMID: 25220572 DOI: 10.1016/j.diii.2014.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pictorial review with a detailed semiological analysis of ovarian tumors in children and adolescents to provide a relevant diagnostic approach. PATIENTS AND METHODS Retrospective study (2001-2011) of 41 patients under the age of 15 who underwent surgery for an ovarian mass with a definite pathological diagnosis. RESULTS Sixty-two percent of the lesions were benign, 33% were malignant and 5% were borderline. Germ cell tumors were most frequent (77.5%), followed by sex cord stromal tumors (12.5%) and epithelial tumors (7.5%). Malignant tumors were more frequent in children between 0 and 2 years old. On imaging, calcifications and fat were specific for germ cell tumors; the presence of a mural nodule was predictive of a mature teratoma (P<0.001). Predictive factors for malignancy were clinical, including abdominal distension (P<0.01) or a palpable mass (P=0.05), biological, including increased hCG and/or AFP levels (P<0.001) and radiological, including tumors larger than 12 cm (P<0.05), tumoral hypervascularity (P<0.01) and voluminous ascites (P<0.01). CONCLUSION This semiological analysis confirms the role of imaging in diagnosing the etiology of ovarian lesions in children and adolescents and emphasizes the importance identifying tumoral hypervascularity, which, in addition to classic criteria, is highly predictive of malignancy.
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Affiliation(s)
- E Péroux
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - S Franchi-Abella
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - D Sainte-Croix
- Inserm, Santé publique et épidémiologie, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - S Canale
- Service d'imagerie médicale, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France
| | - F Gauthier
- Service de chirurgie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris Sud, Paris, France
| | - H Martelli
- Service de chirurgie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris Sud, Paris, France
| | - D Pariente
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - C Adamsbaum
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris Sud, Paris, France.
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Abstract
This review presents the normal and pathologic development of the gonads and genitourinary tract and addresses the role of ultrasonography in the diagnosis and management of gynecologic disorders of the pediatric pelvis, including ambiguous genitalia, prepubertal bleeding, primary amenorrhea, pelvic mass, and pelvic pain.
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Affiliation(s)
- Harriet J Paltiel
- From the Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02446
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