DOI: 10.14260/jemds/2014/1906
CASE REPORT
SPONTANEOUS RESOLUTION OF ANTENATALY DIAGNOSED COMPLEX
OVARIAN CYST - A FOLLOW UP SONOGRAPHIC STUDY
Satyabhuwan Singh Netam1, Vishnu Dutt2, Vivek Patre3, Rajesh Singh4, Sanjay Kumar5
HOW TO CITE THIS ARTICLE:
Satyabhuwan Singh Netam, Vishnu Dutt, Vivek Patre, Rajesh Singh, Sanjay Kumar.“Spontaneous Resolution of
Antenataly Diagnosed Complex Ovarian Cyst - A Follow-up Sonographic Study”. Journal of Evolution of Medical
and Dental Sciences 2014; Vol. 3, Issue 04, January 27; Page: 808-810, DOI: 10.14260/jemds/2014/1906
ABSTRACT: A congenital ovarian cyst in feto-neonatal stage is a rare condition. New advanced
Ultrasonography technique increased the incidences. Though benign, large cyst and complex cysts
may require surgical management. We followed one case of complex feto-neonatal ovarian cyst till
complete resolution.
INTRODUCTION: A congenital ovarian cyst is a rare condition which can be diagnosed during
antenatal ultrasonography. In recent years fetal ovarian cysts are diagnosed more frequently
because of improved prenatal sonographic techniques. Although rare it is the most common cystic
masses in abdomen of female fetus and neonates. These are benign, functional cysts which result
from enlargement of normal follicles during third trimester or early neonatal period. Since most of
them follow a benign course, they have an excellent prognosis especially if the cyst is isolated,
unilateral, and unilocular. However, large cysts and complex cysts may require active management.
Here we report a case of complex feto-neonatal ovarian cyst with spontaneous resolution
CASE REPORT: A 25 year old female 1 p-1 g came for routine antenatal ultrasound in third
trimester. On ultrasound examination there was a complex cystic mass of 4.5 cm x 5.0 cm size, in the
lower abdomen of fetus predominantly on Rt side (Fig no-1).
The cystic lesion shows thick well-defined hyperechoic wall with internal echoes. No
calcification or septation seen in the cyst. On color doppler there was no color flow seen. After one
month she delivered a healthy baby of 2.8 Kg. We performed ultrasound of neonate on 2nd post natal
day and found that the cyst was same in size, shape and echo-texture (fig no-2). Neonate was kept
under close observation USG performed after 1 month and found that the size of cyst was reduced to
3.1 cm x 2.3 cm (Fig no-3). There was no any complaint from the neonate so another USG performed
after three month, there was complete resolution of the cystic mass (Fig no-4).
DISCUSSION: The first case of an ovarian cyst was reported in 1889 in a stillborn premature. 1In
1942, Bulfamonte reported the first case of a successfully treated ovarian cyst during the neonatal
period.2 Fetal ovarian cyst was first described as a prenatal finding by Valenti et al in 1975 and were
believed to be rare findings. 3 The etiology of fetal ovarian cysts is still unknown, but hormonal
stimulation is generally considered to be responsible for the disease. 2It is believed that it results
from fetal exposure to maternal gonadotropins and is observed in newborns whose mothers have
increasing levels of HCG (diabetes mellitus, Rh isoimmunisation, toxaemia).4The majority of the
ovarian cysts are benign cysts of germinal/graafian origin such as follicular, theca-lutein cyst, corpus
luteum cyst, and simple cyst in which lining epithelium is destroyed. Most of the cysts are unilateral
and unilocular. The size may vary from small to giant cystic masses occupying the entire abdomen.
Journal of Evolution of Medical and Dental Sciences/Volume 3/Issue 04/ January 27, 2014
Page 808
DOI: 10.14260/jemds/2014/1906
CASE REPORT
Most of the ovarian cysts are asymptomatic, or the symptoms are nonspecific. A large cyst may cause
urinary tract obstruction, thorax compression with pulmonary hypoplasia, and even sudden death. 5
Large size ovarian cyst may cause intestinal obstruction. 6, 7 Cystic mass in ovary may lead to torsion
during the neonatal period and resulting infertility are very disturbing.8 When an ovarian cyst is
suspected prenatally serial ultrasound should follow till the delivery and after delivery. Prenatal
aspiration of cyst seems to be of no advantage and to be reserved for special cases. 9 Most of these
cysts regress in the first 6 months of life. However, large cysts and resulting infertility complex cysts
may require active management. In the present era of minimally invasive surgery, ovarian cysts are
increasingly being managed laparoscopically.10Prenatal aspiration of cyst appearseffective and safe,
criteria for aspiration should be -4 cm or more is matter of investigation, Cyst with ultrasound
pattern of torsion persisting postnatally require surgery; option for their management, when
sonographically disappearing and asymptomatic, need to be investigated.11 Surgical management of
ovarian cysts should be reserved to complex masses. Simple cysts can be monitored safely by close
US follow-up; surgery is indicated if the cyst fails to regress after several months or becomes
symptomatic.12
In our case there was complete resolution of the complex feto-neonatal cyst by 4 months
after birth so our opinion is that irrespective of the sonographic character of ovarian cyst in fetus
and neonates it should be given sufficient time to resolve under close observation.
BIBLIOGRAPHY:
1. Mudholkar VG, Acharya AS, Kulkarni AM, Hirgude ST.Antenatally diagnosedneonatal ovarian
cyst with torsion. Indian J Pathol Microbiol. 2011; 54:228-9.
2. Carson DH, Griscon NT. Ovarian cyst in newborn. Am Roentgenol RadiumTher Nucl Med.
1972;116: 664-72.
3. Bagolan P, Giorlandino C, Nahom A, Bilancioni E, TrucchiA, Gatti C, Themanagement of fetal
ovarian cyst. J Pediatr Surg. 2002;35-25-30.
4. Chiaramonte C, PiscopoA, Cataliotti F. Ovarian cyst in neoborns. Pediatr SurgInt. 2001;17: 1714.
5. Jedrzewski G, Rechberger BK, Wieczorek P.Ovarian ultrasonography innewborn and infants.
Paediatric Endocrinol. 2008; 3: 65-70.
6. Koc -E, Turkyilmaz C, Atalay Y, Basaklar C, Bideci A. Neonatal ovarian cystassociated with
intestinal obstruction. Indian J Pediatr.1997 Jul-Aug; 64(4): 555-7.
7. Standdke M, Bennek J et al. Ovarian cyst. A predisposing factor for ileus in theneonatal period
and early infancy. Zentralbl Chir. 1991; 116(11):669-77.
8. Karasahin KE, GezgincK, Ulubay M, ErqunA et al. Fetal ovarian cyst diagnosedduring prenatal
ultrasound screening. Taiwan J obstet. Gynecolo -2008Jun; 47(2): 215-7.
9. Heling KS, Chaoui R, Kirchmair F, Stadie S, Bollmann R. Fetal ovarian cysts:prenatal diagnosis,
management and postnatal outcome.Ultrasound Obstet Gynecol. 2002 Jul; 20(1):47-50.
10. Manjula Jain, Menu Pujani, Neha Kawatra Madan, Rajiv chadhaand ArchanaPuri, Congenital
Ovarian Cyst: A Report of two cases. J Lab Physician, 2012Jan-Jun; 4(1): 63-65.
11. Bagolan P, Giorlandino C, Nahom A, Bilancioni E, Trucchi A, Gatti C, Aleandri VSpina V. The
management of fetal ovarian cysts.J Pediatr Surg. 2002 Jan;37(1):25-30.
Journal of Evolution of Medical and Dental Sciences/Volume 3/Issue 04/ January 27, 2014
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DOI: 10.14260/jemds/2014/1906
CASE REPORT
12. Chiaramonte C, Piscopo A, Cataliotti F. Ovarian cyst in newborn.pediatr SurgInt. 2001 Mar;
17(2-3): 17.1-4.
Fig. 1: Antenatal USG- complex cystic
mass in fetal abdomen.
Fig. 2: Complex cystic mass in 2nd Post natal day
neonates shows internal echoes
and irregular thick wall.
Fig. 3: Reduced size and clear echogenecity
of cystic mass after 1 month.
AUTHORS:
1. Satyabhuwan Singh Netam
2. Vishnu Dutt
3. Vivek Patre
4. Rajesh Singh
5. Sanjay Kumar
PARTICULARS OF CONTRIBUTORS:
1. Associate Professor, Department of Radiodiagnosis, Pt. JNM Medical College, Raipur,
Chhattishgarh, India.
2. Professor, Department of Radio-diagnosis, Pt.
JNM Medical College, Raipur, Chhattishgarh,
India.
3. Associate Professor, Department of Radiodiagnosis, Pt. JNM Medical College, Raipur,
Chhattishgarh, India.
Fig. 4: Complete resolution of cystic mass
of fetal ovary after 4 month.
4.
5.
Assistant Professor, Department of Radiodiagnosis, Pt. JNM Medical College, Raipur,
Chhattishgarh, India.
Assistant Professor, Department of Radiodiagnosis, Pt. JNM Medical College, Raipur,
Chhattishgarh, India.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr.Satyabhuwan Singh Netam,
D-20, Avanivihar, Daldalseoni Road,
Mova, Raipur, Chhattishgarh,
India, Pin – 492001.
E-mail: sbsnetam@yahoo.com
Date of Submission: 15/12/2013.
Date of Peer Review: 16/12/2013.
Date of Acceptance: 27/12/2013.
Date of Publishing: 21/01/2014
Journal of Evolution of Medical and Dental Sciences/Volume 3/Issue 04/ January 27, 2014
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