Pathophysiology and Clinical Implications of Ovarian Endometriomas

Ovarian endometriomas affect many patients with endometriosis and have significant effects on quality of life, fertility, and risk of malignancy. Endometriomas range from small (1-3 cm), densely fibrotic cysts to large (20 cm or greater) cysts with varying degrees of fibrosis. Endometriomas are hypothesized to form from endometriotic invasion or metaplasia of functional cysts or alternatively from ovarian surface endometriosis that bleeds into the ovarian cortex. Different mechanisms of endometrioma formation may help explain the phenotypic variability observed among endometriomas. Laparoscopic surgery is the preferred first-line modality of diagnosis and treatment of endometriomas. Ovarian cystectomy is preferred over cyst ablation or sclerotherapy for enabling pathologic diagnosis, improving symptoms, preventing recurrence, and optimizing fertility outcomes. Cystectomy for small, densely adherent endometriomas is made challenging by dense fibrosis of the cyst capsule obliterating the plane with normal ovarian cortex, whereas cystectomy for large endometriomas can carry unique challenges as a result of adhesions between the cyst and pelvic structures. Preoperative and postoperative hormonal suppression can improve operative outcomes and decrease the risk of endometrioma recurrence. Whether the optimal management, fertility consequences, and malignant potential of endometriomas vary on the basis of size and phenotype remains to be fully explored.

Variables Associated With Resolution and Persistence of Ovarian Cysts

OBJECTIVE

To estimate surveillance intervals of incident ovarian cysts, and describe variables associated with cyst resolution times.

METHODS

The UK-OCST (University of Kentucky Ovarian Cancer Screening Trial) was a prospective cohort that enrolled 47,762 individuals over 30 years, including 2,638 individuals with incident cysts. Cyst diameter and structure and patient age, body mass index, use of hormone therapy (HT), family history of ovarian cancer, and menopausal status were examined as variables associated with cyst resolution using t tests, χ 2 test, Kaplan Meier, and Cox multiple regression.

RESULTS

Of 2,638 individuals with incident cysts, 1,667 experienced resolution (63.2%) within 1.2 years, and 971 experienced persistence (36.8%). Within 1 year, unilocular and septated cysts had similar resolution rates (35.4% and 36.7%, respectively, P >.05), but time to resolution was shorter for unilocular cysts compared with septated cysts (mean 1.89 years vs 2.58 years, respectively, P <.001). Both unilocular and septated cysts smaller than 3 cm resolved faster than cysts larger than 6 cm ( P <.001). Variables associated with percent resolution included being of younger age, premenopausal status (but not for synchronous bilateral cysts), and those reporting a family history of ovarian cancer ( P <.05). Variables associated with a faster cyst resolution rate included being older than age 70 years and not using hormone therapy. Body mass index and family history were not associated with cyst resolution time.

CONCLUSION

Different surveillance times may be appropriate depending on cyst structure and size and patient age and HT use.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov , NCT04473833.

Structural Gynecological Disease: Fibroids, Endometriosis, Ovarian Cysts

Fibroids, endometriosis, and ovarian cysts are common conditions. Fibroids can be asymptomatic or present with heavy menstrual bleeding, pelvic pressure, and pain. Endometriosis is a common cause of cyclical pelvic pain. Ovarian cysts are generally diagnosed incidentally. Transvaginal ultrasound is the performed imaging modality for all structural gynecological disease. Symptomatic management is recommended for each condition. Fibroids can be managed medically or surgically depending on the patient's symptoms and desire for future fertility. Nonsteroidal anti-inflammatory drugs are the first-line therapy for endometriosis followed by oral contraceptives and surgical management. Ovarian cysts can be managed expectantly.

Malignant transformation arising from mature ovarian cystic teratoma: A case series

Malignant transformation arising in mature cystic teratoma (MT-MCT) is a rare neoplasm of the ovary. Herein, we aimed to evaluate the clinicopathological features and treatment outcome of the Han Chinese women with MT-MCT.In this retrospective study, the clinical data of patients who had been surgically treated from January 2000 to November 2019 and in whom the diagnosis of MCT was confirmed based on the pathology were included. Fourteen patients with MT-MCT from a total of 569 cases (2.46% incidence) of MCT were reviewed.The mean age of patients with MT-MCT was 51.3 (range, 31-71) years, while the mean age of patients with MCT was 45.3 (range, 17-62) years. Upon gross examination, the mean size of MT-MCT was 14.0 (range, 11-25) cm, whereas the mean size of MCT was 7.5 (range, 4-10) cm. Primary surgical staging was performed in all cases. Complete cytoreduction and suboptimal surgical resection were performed in 12 (85.7%) and 2 (14.3%) cases, respectively. Thirteen patients with malignant transformation of squamous cell carcinoma (SCC) whose Federation International of Gynecology and Obstetrics stage was >1 received chemotherapy, comprising carboplatin and paclitaxel. Response to the chemotherapy regimen was complete in 12 patients; 1/12 patients died within the median follow-up period of 16.5 months. The 5-year overall survival rate and disease-free survival rates were 31.2% and 31.6%, respectively.From the data generated, we conclude that the rate of MT-MCT increases with age. The MT-MCT was much higher in women of postmenopausal age than in younger women. We described our experience of successfully treating patients with malignant transformation of SCC with primary surgical staging and adjuvant chemotherapy (cisplatin, paclitaxel, bleomycin, and etoposide) that might improve survival in patients with advanced-stage disease.

Long-Term Follow-Up and Treatment of a Female With Complete Estrogen Insensitivity

CONTEXT

We previously reported the first female with a causative ESR1 gene variant, who exhibited absent puberty and high estrogens. At age 15 years, she presented with lower abdominal pain, absent breast development, primary amenorrhea, and multicystic ovaries. The natural history of complete estrogen insensitivity (CEI) in women is unknown.

OBJECTIVE

The purpose of this report is to present the neuroendocrine phenotype of CEI, identify potential ligands, and determine the effect of targeted treatment.

DESIGN

We have characterized gonadotropin pulsatility and followed this patient's endocrine profile and bone density over 8 years. Seventy-five different compounds were tested for transactivation of the variant receptor. A personalized medicine approach was tailored to our patient.

SETTING

Academic medical center.

PATIENT OR OTHER PARTICIPANTS

A 24-year-old adopted white female with CEI.

INTERVENTION(S)

The patient was treated with diethylstilbestrol (DES) for approximately 2.5 years.

MAIN OUTCOME MEASURE(S)

Induction of secondary sexual characteristics.

RESULTS

Luteinizing hormone (LH) pulse studies demonstrated normal pulsatile LH secretion, elevated mean LH, and mildly elevated mean follicle-stimulating hormone (FSH) in the presence of markedly increased estrogens. DES transactivated the variant ESR1 in vitro. However, DES treatment did not induce secondary sexual characteristics in our patient.

CONCLUSIONS

Treatment with DES was not successful in our patient. She remains hypoestrogenic despite the presence of ovarian cysts with a hypoestrogenic vaginal smear, absent breast development, and low bone mineral mass. Findings suggest additional receptor mechanistic actions are required to elicit clinical hormone responses.

Retrospective analysis of transvaginal ultrasound-guided aspiration of simple ovarian cysts

BACKGROUND

The widespread availability of ultrasonography means that transvaginal ultrasonography has become a routine procedure during gynecological examinations, even in asymptomatic patients. Nowadays the imaging technology offered by ultrasonography and tumor biomarkers give us an opportunity to implement transvaginal ultrasound-guided aspiration as a less radical treatment of simple ovarian cysts (SOC).

OBJECTIVES

The aim of the study was a retrospective evaluation of the diagnostic and therapeutic efficacy of transvaginal ultrasound-guided aspiration of SOC in postmenopausal and premenopausal patients.

MATERIAL AND METHODS

A total of 84 women, divided into a premenopausal group (38/84) and a postmenopausal group (46/84), underwent transvaginal ultrasound-guided aspiration of small SOC (40-80 mm in diameter). Simple cysts were defined ultrasonographically according to the International Ovarian Tumor Analysis (IOTA) guidelines as cysts with negative risk of ovarian malignancy algorithm (ROMA) scores and CA125 levels. Simple ovarian cyst-related data was obtained from medical documentation (diagnostic tests, medical reproductive and surgical history, and clinical status during SOC aspiration). Follow-up data was collected by means of a telephone interview and medical database. The survey included questions focused on cyst recurrence during the 24-month period following the aspiration of SOC.

RESULTS

We had 100% compatibility with ultrasound diagnosis and cytological examination of aspirated fluid. The cumulative rate of cyst recurrence among 84 patients was 20.2% (17/84). There was a higher percentage of cyst recurrence in the premenopausal group: 27% (10/38) vs 15.2% (7/46) in the postmenopausal group, but the difference was not statistically significant (hazard ratio (HR) = 1.89, 95% confidence interval (95% CI) = 0.72-4.97; p = 0.19). Recurrent cysts were treated with laparoscopic cystectomy, adnexectomy or a second aspiration in accordance with individual indications.

CONCLUSIONS

Ultrasound-guided aspiration of small (<80 mm) adnexal SOC is a diagnostic and alternative therapeutic procedure, which allows cytological examination and may reduce the need for surgery, which is especially beneficial for women of reproductive age.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary: A challenging question for gynecologic oncologists

Mature cystic teratomas of the ovary have an incidence of 1.2-14.2 cases per 100.000 people per year. Malignant transformation occurs in approximately 2% of the cases, and usually consists of squamous cell carcinoma. The preoperative detection is difficult and the diagnostic accuracy of ultrasound, magnetic resonance imaging, and computed tomography is debated. The diagnosis is frequently made in the operating room or on final histological examination. Standard treatment consists of bilateral salpingo-oophorectomy, total hysterectomy and comprehensive surgical staging in early disease and optimal cytoreductive surgery in advanced disease. Paclitaxel/carboplatin- based chemotherapy is the most used adjuvant treatment, whereas more aggressive regimens can be adopted in patients with high tumor burden or recurrent disease. The efficacy of radiotherapy is still unproven. The prognosis is poor when the tumor has spread beyond the ovary. There are few information to provide commonly accepted guidelines for this malignancy.

Contrast-Enhanced Ultrasonography in Sclerotherapy for Ovarian Endometrial Cyst

We investigated contrast-enhanced ultrasonography (CEUS) characteristics related to the perfusion pattern and parameters of the time-intensity curve of ovarian endometrial cysts (OECs) pre- and post-sclerotherapy. Forty-three patients with one-sided, single, untreated OECs underwent CEUS pre- and post-sclerotherapy. OEC wall thickness was measured by 2-D ultrasonography and CEUS, and CEUS enhancement patterns and time-intensity curve parameters before and after sclerotherapy were compared. OEC wall thickness remained essentially unchanged post-sclerotherapy. Wall thickness was significantly larger on 2-D ultrasonography than on CEUS. The OEC wall exhibited rapid enhancement and slow clearance both pre- and post-sclerotherapy. Wash-in and wash-out times remained unchanged. The wall exhibited iso-enhancement pre-sclerotherapy, but low and partially uneven enhancement post-sclerotherapy. Post-treatment, time to peak was delayed, peak intensity was reduced and perfusion slope was decreased. The contrast agent arrival time and area under the curve remained similar. CEUS enhancement patterns and quantitative parameters were altered post-sclerotherapy; thus, treatments involving sclerosing agent retention can help to improve the efficacy of sclerotherapy for OEC.

In-utero aspiration vs expectant management of anechoic fetal ovarian cysts: open randomized controlled trial

OBJECTIVE

To assess the efficacy and safety of in-utero aspiration (IUA) of anechoic fetal ovarian cysts.

METHODS

This multicenter, prospective, randomized open trial in two parallel groups included women from nine outpatient fetal medicine departments with singleton pregnancy ≥ 28 weeks of gestation and a female fetus with an ultrasound-diagnosed simple ovarian cyst, defined as a single fully anechoic cystic structure measuring ≥ 30 mm. They were allocated randomly to IUA under ultrasound guidance or expectant management. All procedures were performed by trained senior obstetricians. Primary outcome was need for neonatal intervention, by laparoscopy, laparotomy or transabdominal aspiration. Secondary outcomes were in-utero involution of the cyst and oophorectomy at birth. Analyses were conducted according to the intention-to-treat principle.

RESULTS

Of 61 participants, 34 were allocated to IUA and 27 to expectant management. Three IUA procedures (9%) could not be performed (one due to fetal position and two due to aspirations being dry). The remaining 31 IUA procedures were uneventful. The incidence of neonatal intervention did not differ significantly between the IUA and the expectant management groups (20.6% vs 37.0%; relative risk (RR), 0.55; 95% CI, 0.24-1.27). Nonetheless, IUA was associated with increased incidence of in-utero involution of the cyst (47.1% vs 18.5%; RR, 2.54; 95% CI, 1.07-6.05) and reduced rate of oophorectomy (3.0% vs 22.0%; RR, 0.13; 95% CI, 0.02-1.03) compared with expectant management.

CONCLUSION

IUA of anechoic fetal ovarian cysts, compared with expectant management, was not associated with a reduction in overall neonatal interventions but was associated with a reduced oophorectomy rate. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Minimally Invasive Management of Ovarian Cysts During Pregnancy Using Ethanol Sclerosis

Traditionally, the management of symptomatic ovarian cysts in pregnancy has been limited to laparoscopy or laparotomy with the associated morbidity. However, in select patients requiring intervention, the risks of surgery may be minimized with sclerotherapy. We present the first case report, to our knowledge, of ethanol sclerosis of an ovarian cyst during pregnancy. A description of the surgical technique to complete such a procedure is provided as well as a brief review of the current literature with respect to the use of sclerotherapy for the management of ovarian cysts.

Contrast-Enhanced Sonographic Features Before and After Interventional Treatment of Ovarian Endometrial Cysts

OBJECTIVES

The purpose of this study was to assess contrast-enhanced sonography features before and after interventional treatment of ovarian endometrial cysts.

METHODS

We retrospectively analyzed 53 patients with ovarian endometrial cysts who underwent contrast-enhanced sonography before and after interventional treatment to assess the sonographic features of the cysts at these different times. The sonographic features and quantitative parameters for the cysts were compared before and after treatment.

RESULTS

The wash-in mode showed rapid annular enhancement of the cyst wall and slow wash-out with even and uneven enhancement types. Compared to the internal iliac artery, the enhancement intensity was weaker, and the wash-in and wash-out times were longer in the cyst wall; furthermore, all 5 quantitative parameters differed between the cyst wall and internal iliac artery. The wash-in and wash-out characteristics of the cysts before and after interventional treatment were almost identical. The enhancement was primarily even before treatment and uneven after treatment; the enhancement intensity was low in all cases. Although the wash-in time before and after treatment did not differ, the wash-out time for the cysts before treatment was significantly lower than that observed after treatment. Two quantitative parameters differed before and after treatment.

CONCLUSIONS

The contrast-enhanced sonographic features and quantitative parameters for the walls of ovarian endometrial cysts differed before and after ultrasound-guided interventional treatment. These characteristics could be valuable for evaluating the efficacy of interventional treatment of ovarian endometrial cysts.

Investigation and management of an ovarian mass

BACKGROUND

Ovarian masses are very common in pre- and postmenopausal women and are typically an incidental finding.

OBJECTIVE

This article aims to provide a systematic approach to an ovarian mass for general practitioners including investigations, risk of ovarian cancer and referral considerations.

DISCUSSION

Investigation for an ovarian mass includes both transvaginal and transabdominal ultrasound. Simple, anechoic cysts 200. Complications of ovarian cysts include cyst rupture and torsion. Torsion is a gynaecological emergency and requires urgent review.

Ovarian cyst aspiration prior to in vitro fertilization treatment for subfertility

BACKGROUND

Ten per cent to 15% of couples have difficulty in conceiving. A proportion of these couples will ultimately require assisted reproduction. Prior to controlled ovarian hyperstimulation (COH) a baseline ultrasound is performed to detect the presence of ovarian cysts.Previous research has suggested that there is a relationship between the presence of an ovarian cyst prior to COH and poor outcome during IVF.

OBJECTIVES

The aim of this review was to determine the effectiveness and safety of functional ovarian cyst aspiration prior to ovarian stimulation versus a conservative approach in women with an ovarian cyst who were undergoing IVF or ICSI.

SEARCH METHODS

We searched the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, ClinicalTrials.gov, Google Scholar and PubMed. The evidence was current to April 2014 and no language restrictions were applied.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) comparing functional ovarian cyst aspiration versus conservative management of ovarian cysts that have been seen on transvaginal ultrasound (TVS) prior to COH for IVF or ICSI. Ovarian cysts were defined as simple, functional ovarian cysts > 20 mm in diameter. Oocyte donors and women undergoing donor oocyte cycles were excluded.

DATA COLLECTION AND ANALYSIS

Study selection, data extraction and risk of bias assessments were conducted independently by two review authors. The primary outcome measures were live birth rate and adverse events. The overall quality of the evidence for each comparison was rated using GRADE methods.

MAIN RESULTS

Three studies were eligible for inclusion (n = 339), all of which used agonist protocols. Neither live birth rate nor adverse events were reported by any of the included studies. There was no conclusive evidence of a difference between the group who underwent ovarian cyst aspiration and the conservatively managed group in the clinical pregnancy rate (OR 1.40, 95% CI 0.67 to 2.94, 3 studies, 339 women, I(2) = 0%, low quality evidence). This suggested that if the clinical pregnancy rate in women with conservative management was assumed to be 5%, the chance following cyst aspiration would be between 4% and 14%. There was no evidence of a difference between the groups in the mean number of follicles recruited (0.55 follicles, 95% CI -0.48 to 1.59, 2 studies, 159 women, I(2) = 0%, low quality evidence) or mean number of oocytes collected (0.41 oocytes, 95% CI -0.04 to 0.85, 3 studies, 339 women, I(2) = 0%, low quality evidence). Findings for the cancellation rate (two studies) were inconsistent but neither study reported a benefit for the aspiration group. The main limitations of the evidence were imprecision, inconsistency, questionable applicability, and poor reporting of study methods.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether drainage of functional ovarian cysts prior to controlled ovarian hyperstimulation influences live birth rate, clinical pregnancy rate, number of follicles recruited, or oocytes collected in women with a functional ovarian cyst. The findings of this review do not provide supportive evidence for this approach, particularly in view of the requirement for anaesthesia, extra cost, psychological stress and risk of surgical complications.

Ovarian cystic disease in guinea pigs

Ovarian cysts are nonfunctional, fluid-filled cysts that develop spontaneously near the ovaries throughout the female guinea pig's reproductive cycle, reducing fertility in females older than 15 months and causing potentially serious uterine disorders. Permanent treatment requires ovariohysterectomy or ovariectomy. This article reviews the clinical signs, diagnosis, histopathology, treatment (including hormonal therapies), surgery, and postoperative care.

French College of Gynecologists and Obstetricians. [Recommendations for clinical practice: Presumed benign ovarian tumors--short text]

These guidelines from the French College of Gynecologists and Obstetricians on the diagnosis and treatment of presumed benign ovarian tumors (PBOT) concern physicians whether gynecologists, obstetricians, surgeons, radiologists, pediatricians, and general practitioners. Vaginal pelvic ultrasound is the first-line imaging examination in case of PBOT in adult women (grade A). In case of pure fluid unilocular mass less than 7 cm size, ultrasound is sufficient to characterize the mass (grade A). MRI is recommended as second-line to explore indeterminate masses or masses greater than 7 cm (grade B). Serum CA125 assay is not recommended as first-line diagnostic in adult women (grade C). Among women with a pure unilocular liquid cyst, hormonal therapy is ineffective (LE1) and is not recommended (grade A). Ultrasound-guided puncture is not recommended (grade B). In adult women without history of cancer, abstention is possible in case of asymptomatic pure unilocular cyst less than 10 cm (grade B). If symptoms develop, laparoscopy is the reference approach for PBOT surgical treatment (grade A). A conservative surgical treatment (cystectomy) should be preferred to oophorectomy in non-menopausal women without previous history of cancer (grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (grade B). Conservative treatment, untwisting without oophorectomy, is recommended for non-menopausal women whatever the estimated duration of the twist and the macroscopic appearance of the ovary (grade B). During pregnancy, expectation is recommended for asymptomatic unilocular liquid masses less than 6 cm (grade C).

Ovarian cysts in the guinea pig (Cavia porcellus)

This article reviews ovarian cysts in the guinea pig (Cavia porcellus), a disease commonly associated with symmetric, nonpruritic alopecia of the dorsum and flanks. Relevant anatomy is discussed and current theories of pathogenesis are reviewed. Prevalence, predisposing factors, diagnosis, treatment, and prognosis are presented.

Safety of conservative management of ovarian masses during pregnancy

OBJECTIVE

To determine the clinical outcomes and risk factors for persistence of ovarian cysts in pregnant women. With the increased use of ultrasound in pregnancy, the identification of incidental ovarian masses is becoming more common.

STUDY DESIGN

An observational study of women with ovarian masses identified before 24 weeks of pregnancy was performed. Only women who underwent follow-up imaging or surgery were included. Factors associated with persistence and outcomes of women who underwent surgery were analyzed.

RESULTS

Of the 803 women with available follow-up, the cysts resolved in 707 (88.1%) patients. Fifty (6.2%) women underwent surgical intervention. Women with persistent cysts were younger, more often Hispanic, detected at a later gestational age, had larger cysts, and more often had complex or solid components (p < 0.05 for all). Overall, 1 (0.1%) malignancy was diagnosed (a patient with a B-cell lymphoma), while 3 (0.4%) women had borderline epithelial ovarian tumors.

CONCLUSION

Ovarian masses identified during pregnancy have a low risk of malignancy. The majority of women can be serially monitored without intervention.

The vanishing endometrioma: the intriguing impact of pregnancy on small endometriotic ovarian cysts

There is a general belief that pregnancy has a beneficial effect on endometriosis but evidence is scanty. Moreover, some recent warning reports documented progression-growth of ovarian endometriomas during pregnancy. To further elucidate this aspect, we set up a prospective cohort study. We recruited 24 women carrying endometriomas at the time of in vitro fertilization who got pregnant. Selected women were contacted about 12-18 months after oocyte retrieval and invited to refer for ultrasound. The primary aim was to evaluate the modifications of endometriotic cysts after pregnancy. Twenty-four women carrying 40 endometriomas accepted to participate. The number of cysts per patient was significantly reduced following pregnancy (p = 0.003). It was unchanged in eight cases (33%), increased in two cases (8%) and reduced in three cases (13%). In the remaining 11 women (46%), no cyst could be detected. A comparison of the size of the endometrioma could be done in 21 cysts; the mean ± SD diameter before and after pregnancy was 20 ± 9 and 18 ± 7 mm, respectively (p = 0.27). In conclusion, pregnancy has a beneficial effect on endometriomas. A consistent proportion of cysts becomes undetectable after delivery. Further studies are warranted to clarify the mechanisms determining the disappearance of these cysts.

Expectant management of adnexal masses in selected premenopausal women: a prospective observational study

OBJECTIVE

To evaluate the results of expectant management of ovarian cysts with benign ultrasound morphology in selected asymptomatic premenopausal women.

METHODS

This was a prospective cohort study of premenopausal women diagnosed with a persistent adnexal cyst. Patients were selected according to symptoms (asymptomatic), the cyst's appearance on ultrasound (benign) and size (< 8 cm). Patients underwent a follow-up protocol with transvaginal ultrasound examination at 6-monthly intervals for 2 years and then annually for at least 3 years.

RESULTS

The study comprised 166 women (mean age, 40 years) with 192 masses present at inclusion. Twenty-two women (with 29 masses) were lost to follow-up. Seventy-four masses (38.5%) resolved spontaneously (median time from diagnosis to resolution, 40 months). Forty-nine masses (25.5%) persisted without change (median follow-up time, 88 (range, 36-192) months). Forty masses (20.8%) were surgically removed; 12 because of increase in size, four because a second lesion appeared during follow-up, three because of change in appearance and increase in size, five because of surgery for uterine benign or malignant disease, two because of change in appearance without increase in size, one because of clinical suspicion of ovarian torsion and 13 because of the patient's decision in spite of there being no change in the mass. Histology was benign in all but two cases (Stage Ia mucinous ovarian carcinoma and Stage Ia mucinous borderline tumor). During follow-up 40 new masses in 31 women were diagnosed, of which 21 resolved spontaneously, five (all with benign histology) were surgically removed and 14 were still present at the time of writing.

CONCLUSIONS

Expectant management of cysts with benign ultrasound morphology is a management option in selected asymptomatic premenopausal women.

Update on adolescent gynecology

Adolescent gynecology is an important part of clinical care of adolescent females. This discussion provides a basic review of current issues in adolescent gynecology, including consideration of current pubertal concepts with attention also given to delayed and precocious puberty. Causes of breast masses are reviewed, including discussion of the ANDI classification. It is recommended that physicians provide sexuality education to their adolescent patients, in addition to the community, to reduce the high rates of unintended adolescent pregnancy and STIs in teens that continue in the United States. Finally, attention is provided to ovarian masses and their management. Adolescent medicine physicians may have to work with a variety of specialists in their care of adolescents and the many gynecologic conditions that may arise.

Conservative treatment for complex neonatal ovarian cysts: a long-term follow-up analysis

OBJECTIVE

We aimed to investigate safety and effectiveness of a conservative approach for complex neonatal ovarian cysts and its long term impact on fertility.

STUDY DESIGN

Neonates with congenital complex ovarian cysts were conservatively managed and followed from the perinatal period to adolescence. Statistical analysis included Student's t-test, Mann-Whitney U-test, the Kaplan-Meier method, and the receiver operating characteristic curve.

RESULTS

The post-natal progressive dimensional reduction of diagnosed ovarian cyst was statistically significant. The Kaplan-Meier survival curves revealed the probability of persistence of the cyst was up to 5% at the age of 25 months. Long term follow-up revealed both ovaries visible at US in 60% of adolescent patients.

CONCLUSION

Conservative management of asymptomatic complex neonatal ovarian cysts can be safely undertaken. As far as the chances of the ovarian tissue to survive conservative treatment are concerned, the results are not encouraging.

[Fetal ovarian cyst: prenatal diagnosis, perinatal outcome and treatment. Case series and literature review]

BACKGROUND

Ovarian cysts in fetal abdominal tumors are more frequently diagnosed during pregnancy. Most of the time are usually small, asymptomatic and resolve spontaneously during pregnancy or in early neonatal life.

OBJECTIVE

To describe the clinical and ultrasound cases with prenatal diagnosis of ovarian cyst treated in our center between 2002 and 2005.

MATERIAL AND METHODS

Descriptive and observational cases of fetal ovarian cyst diagnosedbefore birth. The variables maternal and perinatal most relevant clinical data obtained at diagnosis and after birth.

RESULTS

We explored 9.198 fetuses, of which there were 10 cases of ovarian cyst diagnosed between the second and third trimesters of pregnancy. All cases were unilateral andsonographic appearance homogeneous. In four cases there was spontaneous disappearance during the remaining gestational period. In the other six cases, four missing in the first 12 months and only two image persisted more than a year.

CONCLUSIONS

Based on our results and in accordance with the literature, the prenatal diagnosis of fetal ovarian cyst is usually associated with a conservative approach with serialultrasound monitoring to rule out rare serious complications. During the neonatal period spontaneous disappearance is often the case and the surgical approach is indicated in cases with suspected persistent or torsion or hemorrhage, with cystectomy as first choice.

Primary ovarian and pararectal hydatid cysts mimicking pelvic endometriosis

We report a case of 48-year-old woman with multiple hydatid cysts in pararectal region and right paraovarian localization with an unusual sonographic and computed tomographic presentation mimicking a pelvic endometriosis. During laparotomy, multiple pararectal and right ovarian cysts resembling endometriosis were resected. Pathologic examination gives the diagnosis of hydatid cysts. Retrospectively, we investigate the primary infection but the patient had no history of hepatic and liver involvement, it is a case of primary infection.

Giant abdominopelvic haematoma arising from ovulation in a Glanzmann's thrombasthenia patient with platelet refractoriness: treatment with surgery and intra-abdominal tranexamic acid

Glanzmann's thrombasthenia (GT) is a very rare autosomal recessive genetic bleeding disorder. Women with coagulation abnormalities are at increased risk of corpus luteum rupture and haemoperitoneum. Here we present a severe case of GT resulting in a haematoma extending from the pelvis to the liver that could only be controlled by surgery and intra-abdominal tranexamic acid.

Ovarian cysts in prepubertal girls

Visualization of follicles is perfectly physiological during childhood, their diameter generally does not exceed 10 mm. Ovarian cyst in childhood is well defined for a fluid image >20 mm. Generally mild and asymptomatic, ovarian cysts are fluid formations usually discovered incidentally by ultrasound. Some are hormonally active and cause the development of sexual characteristics. The natural history of functional cysts is eventual regression, and persistence is suggestive of organic tumor. The onset of pain is a sign of complication, and an abrupt sharp pain with vomiting is suggestive of ovarian torsion, in which case surgical intervention is urgent. In all cases, the diagnosis is based on pelvic ultrasound. MRI and tumor marker assays are required to determine the nature of an organic cyst before proceeding to surgery. These cysts may appear functional from the fetal period onward and will require management from the first days of life. Certain endocrine disorders such as precocious puberty, hypothyroidism, and aromatase deficiency cause functional cysts in girls. Recurrent bleeding is due to hormonally active cysts and suggests McCune-Albright syndrome. Although the persistence of a cyst suggests a neoplasm, a fluid character indicates benignity. Imagery is a useful aid in the diagnosis of epithelial tumors (cystadenomas) or teratoma (dermoid cyst).

Management of ovarian disease in pregnancy

The ovary is a complex structure that is responsible for maintaining the endocrine support for a pregnancy during the first trimester until the placenta is sufficiently developed to assume this role. Most ovarian disorders of pregnancy actually relate to pre-existing ovarian conditions such as polycystic ovary syndrome and premature ovarian insufficiency. Both of these are associated with increased complications in pregnancy and require careful monitoring. Ovarian disorders that are a particular consequence of the hormonal milieu of pregnancy such as pregnancy luteoma (PL) and hyperreactio luteinalis (HL) are rare. However, they have important implications for both the mother and the foetus since they can be confused with ovarian malignancy leading to unnecessary surgery. This review focuses on the salient aspects of management of these ovarian conditions during pregnancy.

Ultrasound-guided interventional therapy for recurrent ovarian chocolate cysts

The aim of this study was to determine the effectiveness of ultrasound-guided interventional therapy in the treatment of postoperative recurrent chocolate cysts. The 198 patients enrolled in this study were divided into three groups. In group 1, the saline washing group, the cavity of the cyst was washed thoroughly with warm saline. In group 2, the ethanol short-time retention group, after washing with saline, the cyst was injected with 95% ethanol with a volume of half of the fluid aspirated from the cyst. Ten minutes later, the rest of the ethanol was aspirated. In group 3, the ethanol retention group, the procedures were the same as with the ethanol short-time retention group, except that 95% of the ethanol was retained in the cyst. An ultrasound examination was performed in the third, sixth and 12th months after therapy. The chocolate cyst cure rate was significantly higher in the ethanol retention group (96%, 66/69) than in the ethanol short-time retention group (82%, 56/68) and no case was cured in the first group (saline washing). We conclude that ultrasound-guided injection and 95% ethanol retention are an effective therapy for the treatment of postoperative recurrent chocolate cysts.

Recurrence of ovarian cyst after sclerotherapy

AIM

The aim of this paper was to evaluate correlation between cyst recurrence and some cyst characteristics after sclerotherapy of non-neoplastic ovarian cyst with alcohol-erythromycin combination.

METHODS

Fifty two cases of simple ovarian cysts were subjected to sclerotherapy with alcohol and erythromycin. Two patients were excluded due to suspicious cytologic result. All patients were followed-up monthly with color Doppler ultrasonography for over 12 months. Failure of procedure was considered if recurrent cyst diameter exceeds 5 centimeters detected by ultrasound. Cyst size, volume and color of aspirate, steroid hormone, and tumor marker levels of the cyst fluid were correlated to the recurrence rate.

RESULTS

The fluid of cyst was serous in 32 cases and dark chocolate-colored in twenty cases. Cytological analyses of thirty cysts were acellular sediment, twenty were suitable with endometrioma and two were reported as suspicious. At 12-month follow-up, 12 cyst recurrences was detected. There was no difference in aspirated cyst volume, cyst size and FSH and LH content of recurrent and resolved cyst. The cyst wall thickness of recurrent cyst was higher than that of resolved cyst (P<0.001). The mean estradiol and progesterone concentrations of resolved cysts were significantly higher than that of recurrent cysts on the other hand, the mean CA125 levels in recurrent cysts (347.9±204.4) was significantly higher as compared to the mean CA125 concentrations of resolved cyst (16.75±22.45).

CONCLUSION

Aspiration and sclerotherapy with alcohol and erythromycin yielded a relatively high recurrence rate in cyst with a bloody aspirate and high CA125 levels in cyst fluid.

Infected tuboovarian hydatid cyst: a rare cause of tuboovarian abcess

Pelvic hydatid cysts, although rare, must be considered when evaluating a pelvic mass in women living in an endemic area. The pelvis may become secondarily involved as a result of a rupture of the cyst in another location or be the only localization of the disease. If the cyst becomes secondarily infected, it may mimic a tuboovarian abscess. A 49-year-old multipara was admitted to the emergency department with the complaint of fever, generalized abdominal pain and distension. Abdominal ultrasound revealed a 4 cm cystic structure in the liver and the gynecological examination was normal. The patient's abdominal pain receded spontaneously, so she was prescribed albendazole and discharged from the hospital. Ten days later, she complained of pelvic pain, pressure and vaginal discharge. The uterus and adnexa were tender on pelvic examination. Ultrasound revealed an 8 cm uniloculated cyst with free floating internal echogenities located between the bladder and the uterus. At surgery a 10 cm right-sided tuboovarian mass was present. A germinative membrane was present inside the abscess and pericystectomy with unilateral salphingo-oophorectomy was performed.

[Ovarian cysts]

Ovarian cysts are found in 7.8% of asymptomatic fertile aged women. Post-menopausal women exhibit a prevalence of 2.5 to 18%. An ovarian cyst is detected either as an incidental finding, in ultrasonography performed for lower abdominal pain, or on the basis of a suspicious finding in pelvic examination. With easy availability of ultrasonography asymptomatic ovarian cysts are detected in an increasing number. Most cysts are benign and often vanish spontaneously. Therefore in the absence of suspected malignancy or harmful symptoms, it is unnecessary to expose the woman to the risks of the operation.

Hemophilia carrier status and counseling the symptomatic and asymptomatic adolescent

Carriers of hemophilia have a 50% chance of giving birth to a hemophilic son. Approximately 35% may have a lower than normal factor VIII or IX and therefore can be diagnosed without genetic testing. These individuals may present with menorrhagia, menometrorrhagia and dysmenorrhoea. The treatment of menorrhagia is similar to girls without bleeding disorders--tranexamic acid, the oral contraceptive pill and, where acceptable, the levonorgestrel-releasing intrauterine device. Genetic diagnosis is possible for potential carriers--50% families with severe hemophilia carry the intron 22 inversion and databases are available which list most of the causative mutations for hemophilia A and B. Ideally the mutation in the index in a family is known. The testing of adolescents for a recessively inherited condition raises ethical issues and guidance may vary within different countries and cultures.

Expression of benign and malignant thyroid tissue in ovarian teratomas and the importance of multimodal management as illustrated by a BRAF-positive follicular variant of papillary thyroid cancer

BACKGROUND

The most common type of ovarian germ cell tumor is the teratoma. Thyroid tissue, both benign and malignant, may be a component of an ovarian teratoma. Here we review this topic and illustrate major features by presenting multimodal management of a patient with BRAF-positive disseminated follicular thyroid cancer arising in an ovarian teratoma.

SUMMARY

Malignant thyroid tissue is often difficult to distinguish from benign thyroid tissue arising in ovarian teratomas. Preoperatively, an elevated thyroglobulin (Tg) level, laboratory or clinical evidence of hyperthyroidism, or ultrasonography appearance of "struma pearl" should prompt referral to oncologist for surgical management of a possibly malignant ovarian teratoma. Postoperatively, tumor tissue should be referred to pathologists experienced with differentiating benign from malignant struma ovarii. Once diagnosed, treatment of this rare condition should be handled by a team of specialists with combined treatment modalities. We cared for woman with disseminated thyroid cancer arising in an ovarian teratoma whose history illustrates the complexity of managing ovarian teratomas with malignant thyroid tissue. At age 33 she had an intraoperative rupture of an ovarian cyst, thought to be struma ovarii. During her next pregnancy, pelvic masses were noted; biopsies revealed well-differentiated papillary thyroid carcinoma, follicular variant. She was euthyroid, but had elevated serum Tg levels. Surgical staging demonstrated widely metastatic intraabdominal dissemination. A thyroidectomy revealed no malignancy. A post-(131)I treatment scan revealed diffuse uptake throughout the abdomen. She then developed abdominal pain and, on computed tomography, was found to have multiple intraabdominal foci of disease. Serum Tg was 264 ng/mL while on L-thyroxine for hypothyroidism and to obtain thyrotropin suppression. A 18 fluorodeoxyglucose positron emission tomography scan showed no pathological uptake. The tumor was found to be BRAF mutation positive (K601E). She underwent extensive secondary debulking and a second course of (131)I with lithium pretreatment. Posttreatment scan revealed diffuse abdominal uptake. Six months posttherapy, the patient is asymptomatic with a serum Tg of 18.1 ng/mL.

CONCLUSIONS

Aggressive multimodal management appears to be the most promising approach for malignant thyroid tissue arising in ovarian teratomas.

Alcohol sclerosing ovarian cystic lesions, 20 years experience

The purpose of the study is to present technique of punction and conservative treatment of cystic ovarian lesions. The following criteria were included: 1) Cyst should be unilocular, sonolucent, with a smooth inner wall of capsule, without septa and without neovasculariation on transvaginal color and power Doppler. 2) Serum CA-125 levels must be lower than 35 U/mL. The capsule of the cyst was punctured with a 18 gauge needle under the control of 5 MHz transvaginal probe. Cyst fluid was sent for cytologic examination. After complete emptying of the cyst, we injected sterile 95% ethanol in the 50-75% of the evacuated liquor amount. The alcohol remain in the cyst from 5 to 20 minutes and was then aspirated completely. We punctured cysts in 366 patients aged from 18 to 65 years, volume of cyst being between 40 and 300 mL. Patients were monitored for 24 hours and follow-up examinations were 3, 6 and 12 months after the procedure. Three cysts were ruptured (0.8%) and alcohol split in the Douglas cavity. Intensive pelvic pain had 8.1% and relapse appeared in 8.2% of the patients. Technique ofpunction is simple and easily performed. Method of treating by 95% alcohol has demonstrated good results. Relapse we treated by laparoscopy or laparotomy.

[Treatment of ovarian cyst after ovulation-induction with sanjie zhentong capsule]

OBJECTIVE

To observe the efficacy of Sanjie Zhentong Capsule (SJC) in treating ovarian cyst after ovulation-induction.

METHODS

Fifty-eight patients with ovarian cyst were randomly assigned to two groups, 33 in the treated group treated with SJC and 25 in the control group treated with temporization for 1 month. Changes of estradiol (E2), luteinizing hormone (LH) and follicle stimulating hormone (FSH) level as well as condition of cyst before and after treatment were observed and compared. And the time for complete disappearance (TCD) of cyst and the pregnant rate within 4 months were followed-up.

RESULTS

Effective rate (no fluid cyst sized over 1.0 cm could be found in bilateral ovary and E2 <280 pmol/L) in the treated group was 81.8% (27/33) and 52.0% (13/25) in the control group, showing significant difference between them (P <0.05). Level of E2 decreased in both groups, but the lowering was more significant in the treated group, after 1 month, it being 220.54 +/- 96.23 pmol/L vs 372.56 +/- 330.62 pmol/L (P <0.05). The changes of LH and FSH levels were of no statistical significance (P >0.05). TCD in the treated group was 1.18 +/- 0.46 months, which was shorter than that in the control group (1.96 +/- 1.34 months, P <0.05). The pregnant rate within 4 months in the two groups was 60.6% (20/ 33) and 32.0% (8/25) respectively, showing significant difference (P < 0.05).

CONCLUSION

SJC has good efficacy in treating ovarian cyst after ovulation-induction.

[Prenatally reported fetal ovarian cysts--treatment and prognosis]

We present 6 case reports of ovarian cysts, diagnosed in the prenatal and postnatal period, as well as treatment. There was no need for invasive prenatal therapy in any of the reported fetuses. Most of the cysts disappeared spontaneously (in one case uncomplicated cyst rupture in fetus have been observed), only in one case laparoscopy was performed after birth.

Massive ascites as a presentation in a young woman with endometriosis: a case report

OBJECTIVE

To report a case of endometriosis associated with massive ascites and an elevated CA-125 level.

DESIGN

Case report.

SETTING

Tertiary care center.

PATIENT(S)

A 26-year-old woman presented with massive ascites and an increased CA-125 level suggestive of ovarian cancer.

INTERVENTION(S)

Ultrasonography, laparotomy, and bilateral ovarian cystectomy and reconstruction. Endometriosis was diagnosed postoperatively on the basis of histopathology. The patient received 6 months of treatment with a GnRH analogue.

MAIN OUTCOME MEASURE(S)

Ultrasound examination 6 months after surgery to evaluate for ascites or recurrent ovarian cysts.

RESULT(S)

Frozen sections obtained at laparotomy and ovarian cystectomy ruled out a malignancy. The final histologic report was compatible with a diagnosis of endometriosis. After 6 months of treatment with the GnRH analogue, the patient experienced a progressive reduction of the ascitic fluid and full remission after 2 years.

CONCLUSION(S)

Endometriosis associated with massive bloody ascites is an unusual occurrence. This report draws attention to this condition as a complication of endometriosis. For this reason, endometriosis should be included in the differential diagnosis of reproductive-age women presenting with an apparent ovarian malignancy.

Sonographic appearance of ruptured ovarian cyst in the neonatal period

Rupture is a rare complication of ovarian cysts diagnosed during the prenatal period. We present a case that focuses on the postnatal sonographic appearance of rupture of an ovarian cyst after vaginal delivery. Histopathologic correlation is provided. The main sonographic features include complicated ascites and a collapsed cystic structure in the abdomen. Ruptured ovarian cyst should be included in the differential diagnosis of unexplained ascites in a newborn girl.

[Management of ovarian cyst associated to pregnancy]

BACKGROUND

The problem of the association of the ovarian cyst and pregnancy is to determine whether the cyst is functional or organic?

AIM

To draw up the epidemiological profile of the patients having a cyst of the ovary, show the peculiarities of this association; and to clarify the therapeutic methods and its effects on the progress of the pregnancy.

METHODS

A retrospective study concerning a period of 5 years and interesting 25 patients.

RESULTS

The average age of the patients was of 34 years, the average parity was of 2. The discovery of the cyst was in 68% of cases in the first 3 months. On the clinical plan the circumstances of discovery were pelvic pains in 48% of cases and complications in 6% of cases; such us twisting of the cyst. 61% of the patients had a laparoscopy, 44% a laparotomy and a case of guided ultrasound punction, 4% of the patients underwent a pregnancy interruption, 17 pregnancies were led till the end, we noted an intrauterine death of the foetus and a case of late abortion at 22SA.

CONCLUSION

problems due to the association of the ovarian cyst and pregnancy are especially of diagnostic and therapeutic order. Obsession was to underestimate a malignant tumour; that's why we should perform a surgical investigation in front of any persevering cyst beyond the first three months of the pregnancy.

Primary hypothyroidism with precocious puberty and bilateral cystic ovaries

It is a general observation that children with hypothyroidism have delayed sexual maturation and delayed puberty. However, longstanding untreated hypothyroidism could be associated with isosexual precocious puberty. Here we report a nine year old girl with longstanding untreated hypothyroidism presenting with precocious puberty and bilateral multicystic ovaries, which promptly responded to thyroid hormone replacement.

The incidental postmenopausal adnexal mass

The postmenopausal ovary continues to produce cysts; the prevalence in an ovarian cancer screening population approaches 18%. Yet 60% to 70% of unilocular cysts resolve spontaneously. Optimal management of an asymptomatic adnexal mass allows surveillance of women at low malignancy risk while triaging intermediate/high-risk women to surgery. Women with unilocular cysts on transvaginal ultrasound (TVS) and a normal CA-125 are monitored with repeat TVS at 3 to 6 months. Those with a complex mass <5 cm and normal CA-125 should have repeat TVS and CA-125 testing in 4 weeks. Surgery is recommended for any women with increasing morphologic complexity or a rising CA-125.

Pedicle torsion of ovarian cyst and acupuncture--a case report

A case history is reported of a patient who presented with acute pedicle torsion in a left ovarian cyst, which had been diagnosed seven months previously. The diagnosis was established by sonography. She declined surgery for personal reasons, and was treated with acupuncture. Her pain was successfully relieved, and she continued to be observed. The acupuncture was repeated daily for 15 days, after which time repeat sonography showed reduction in size of the cyst, and no torsion of the pedicle. No relapse had occurred at 16 months follow up.

[Natural history of fetal/newborn ovarian cyst]

OBJECTIVE

Fetal and neonatal ovarian cysts are detected freguently by ultrasonography. Prenatal ovarian cysts have a follicular or luteal origin. Their natural history is a spontaneous involution. Pre- and postnatal changes in the sonographic aspects allow to choose the appropriate therapeutical indications: conservative approach, surgery, or percutaneous aspiration. MATERIALALS AND METHODS: In retrospective review from 1992-2004 authors present 26 patients with ovarian cysts.

RESULTS

Fifteen patients were diagnosed by prenatal ultrasonography carried out between 33 and 39 weeks of gestation. Postnatally 14 were observed only and their cysts regressed, 10 with cysts larger than 4 cm, had surgical exploration, 2 patients with cysts between 2 to 4 cm were candidates for percutaneous aspiration.

CONCLUSION

1. The conservative treatment and clinical observation using ultrasonography is recommended when the ovari cystic is 40 mm in diameter. 2. When the ovari cystic is bigger then 40 mm in diameter it is recommended to perform puncture and fluid aspiration from the cystis under ultrasonography control. 3. The surgical intervention was planned when the ovari cystis was heterogenous and has been growing for a few months.

Transvaginal aspiration of ovarian cysts: long-term follow-up

BACKGROUND AND PURPOSE

Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy.

METHODS

Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness.

RESULTS

Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy.

CONCLUSION

Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.

Percutaneous drainage as the treatment of choice for neonatal ovarian cysts

BACKGROUND

Involution of neonatal ovarian cysts occurs usually by 12 months. Persisting cysts larger than 4 cm are prone to torsion. Two modes of therapy are advocated: surgery and percutaneous US-guided cyst aspiration.

OBJECTIVE

To compare ovarian preservation following the use of US-guided aspiration or conventional surgery for the treatment of large asymptomatic neonatal ovarian cysts, and to suggest alternative treatment when intrauterine ovarian torsion occurs.

MATERIALS AND METHODS

The study population comprised 25 baby girls with an ovarian cyst, 5 with a simple cyst and 20 with a complex cyst. Of these 25 infants, 8 had surgery and 17 had US-guided cyst aspiration.

RESULTS

In the surgical group of 8, 6 underwent oophorectomy, and in 2 the ovary was saved. In the aspirated group of 17, the ovary was saved in 10, and was lost in 5. At the time of this report one patient was still in the follow-up period, and one was lost to follow-up.

CONCLUSION

US-guided aspiration of large neonatal cysts preserves ovarian tissue in a higher percentage of patients than surgery. It is safe, effective, and repeatable. We recommend US-guided aspiration of asymptomatic large ovarian cysts for salvage or for decompression if intrauterine ovarian torsion occurs. Surgery should be reserved for patients with acute torsion, intestinal obstruction and intestinal volvulus.

Economic Comparison of Timed Artificial Insemination and Exogenous Progesterone as Treatments for Ovarian Cysts

The objective of this study was to compare the economic benefits of timed artificial insemination (AI) and a progesterone insert as therapeutic treatments for cows diagnosed with cystic ovarian disease (COD). A secondary objective was to illustrate the use of a stochastic dynamic simulation model to fully account for all changes in revenues and costs affected by differences in treatments. First, 4 herds of 1,000 cows each were simulated until steady state. These cows were free from COD and inseminated based on estrus only. Herds differed by probability of estrus detection (46 or 70%) and days in milk (DIM) when nonpregnant cows were culled (330 or 400 d). Second, 3 herds were created with 1,000 nonpregnant cows at 90, 170, or 250 DIM. These cows were considered diagnosed with COD at the start of the simulation (d 0); no new cases of COD developed after d 0. Cows spontaneously recovered or were treated. Treatments were either timed AI or intravaginal device containing progesterone followed by PGF(2alpha) and then AI if estrus was detected. Effects of treatments were evaluated in 48 scenarios based on compliance of timed AI (82 or 100%), probability of estrus detection (46 or 70%), and DIM when nonpregnant cows were culled (330 or 400 d). As cows became pregnant or were replaced, the herd evolved into the associated steady-state herd. Seven scenarios resulted in less than 50% of cows conceiving before they were culled. The percentage of cows diagnosed with COD that calved again ranged from 14.0 to 74.4% and was significantly reduced when COD was diagnosed later in lactation. Treatments in all cases were more valuable than waiting for spontaneous recovery. The average values of timed AI (82 or 100% compliance) and the progesterone insert were 83.29 dollars, 86.83 dollars, and 71.89 dollars, respectively, compared with waiting for spontaneous recovery. Treatments were least beneficial at 90 DIM. The benefits of timed AI (82 or 100% compliance) compared with the progesterone insert, adjusted for DIM and days to culling, were 14.98 dollars and 21.53 dollars when the probability of estrus detection was 46%. At 70% probability of estrus detection, the benefits were 7.81 dollars and 8.34 dollars, respectively. Overall benefit of treatment by timed AI was 11.39 dollars greater than by progesterone insert.