Prenatal diagnosis of a fetal ovarian cyst

Objective

Fetal ovarian cysts are the most common prenatally diagnosed abdominal tumors. Fetal ovarian cysts are usually unilateral, diagnosed in the third trimester and they are uncommon. In this article, antenatal detection of a fetal ovarian cyst is reported by reviewing the available literature.

Case 

A 20-year-old primigravid patient was referred to our prenatal center at 24 weeks of gestation after detection of a fetal cystic mass in the abdomen by prenatal sonography. Her past medical history was unremarkable and her antenatal course was uneventful. Ultrasound examination confirmed the presence of normal anatomy of the bladder, kidneys, liver and intestine in a female fetus. The cyst measured to be 73×65 mm in diameter had anechoic content and the thin wall of the cyst was located in the lower abdomen of the fetus. These findings are suggestive of a simple ovarian cyst (Figure 1,2). The patient has been informed of her condition and then serial ultrasonographic scans were performed to follow the cyst every 2 weeks until delivery. The diameter of the cyst increased to 58×50 mm, 69×53 mm and 75×60 mm at 34, 37 and 39 weeks of gestation, respectively. Due to breech presentation at term, caesarean section was performed and a healthy female infant was delivered. The baby was weighing 3040 grams with Apgar scores of 8 and 10 respectively). A cystic mass of 80×78 mm in diameter was shown at abdominal ultrasound scanning performed on the first postnatal day. Due to determination of severe abdominal distension and respiratory distress, it was recommended to perform laparotomy on the second postnatal day. A yellow cystic structure arising from the right ovary was seen in the lower right quadrant of the abdomen during the surgical procedure. The pedicle of the cyst was not twisted and the left ovary and adnexal structures were normal in appearance. Laparoscopic right ovarian cystectomy was perfomed. The histopathological examination of the sample demonstrated a large cystic mass with a diameter of 80×80 mm filled with serous fluid. Final pathological report confirmed the diagnosis of a serous cystadenoma of the right ovary. The newborn had an uneventful and uncomplicated postoperative course and she was discharged with her mother on the 5th postoperative day.

Results

While the etiology still remins unknown, it is generally considered that the hormonal stimulation is responsible for the disease (fetal gonadotropins, maternal estrogen and placental human chorionic gonadotropin). Maternal and fetal ovarian cysts may co-exist and they could potentially have a similar hormonal etiology. Neonatal ovarian cysts are almost always benign simple cysts and they are self-limiting, and many of them go unreported.

Conclusion

In general, a fetal ovarian cyst is not a life-threatening condition. These cysts are usually simple cysts and they are small in size. After diagnosis, they have to be followed by serial ultrasonographic examinations.

Keywords

Fetal Ovarian cyst, Ovarian Cyst, Prenatal Diagnosis

	File/Dsecription
	Figure 1 An ovarian cyst with a size of 73x65 mm and fulfilling the fetal abdomen in the ultrasound.
	Figure 2