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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 228-229
Antenatally diagnosed neonatal ovarian cyst with torsion


1 Department of Pathology, RCSM Government Medical College and CPR Hospital, Kolhapur - 416 002, Maharashtra, India
2 Department of Surgery, RCSM Government Medical College and CPR Hospital, Kolhapur - 416 002, Maharashtra, India

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Mudholkar VG, Acharya AS, Kulkarni AM, Hirgude ST. Antenatally diagnosed neonatal ovarian cyst with torsion. Indian J Pathol Microbiol 2011;54:228-9

How to cite this URL:
Mudholkar VG, Acharya AS, Kulkarni AM, Hirgude ST. Antenatally diagnosed neonatal ovarian cyst with torsion. Indian J Pathol Microbiol [serial online] 2011 [cited 2017 Sep 25];54:228-9. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/228/77426


Sir,

A congenital ovarian cyst is a rare entity which can be diagnosed antenatally by ultrasonography (USG). It is the most common intra-abdominal cyst in female neonates which has good prognosis. However, it may undergo complications such as torsion or rupture in intrapartum or postnatal period causing risk to the fetus or it may cause dystocia or intestinal obstruction. The first case of an ovarian cyst was reported in 1889 in a stillborn premature. In 1942, Bulfamonte [1] reported the first case of an ovarian cyst successfully treated during the newborn period. The etiology of an fetal ovarian cyst has not been entirely clarified.[2] An ovarian cyst arise from mature follicles which are usually <2 cm in diameter. The cysts larger than this size are considered to be pathological which can be diagnosed beyond 28 weeks.

A 25 year female, IIIrd gravida, with a past history of two missed abortions had delivered a female baby with caesarian section at full term. Antenatal USG at 35 weeks showed an abdominal thin walled cyst measuring 5.5 × 4.3 cm in right side of pelvis of the fetus. At the 12th day of postnatal life, baby presented with distension of abdomen. A soft mass was palpated in the right iliac and hypochondriac region. USG revealed an increase in the size of an ovarian cyst which had undergone torsion. A computed tomographic (CT) scan of the neonate showed a large well-defined hypodense lesion measuring 6 × 6 × 4.5 cm in pelvis showing multiple septations [Figure 1] suggesting a diagnosis of a right ovarian cyst with torsion. All the routine hematological and biochemical investigations were within normal limits. The baby was taken for laparotomy. Intra-operatively, a large dark brown colored cyst was noted in pelvis, which was adhered to the right  Fallopian tube More Details [Figure 2]. The left ovary appeared to be normal. The cyst was excised and sent for histopathology. On gross examination, a dark brown unilocular cyst measuring 7 × 6 × 4.5 cm containing hemorrhagic fluid along with peripheral focal solid ovarian tissue was noted. Multiple sections studied showed a cyst wall with hemorrhagic necrosis and foci of dystrophic calcification with partly viable ovarian stroma [Figure 3]. With these features, a diagnosis of a congenital ovarian cyst with torsion was given.
Figure 1: Computed tomographic scan image of 12 days old neonate showing huge ovarian cyst with multiple septations within it.

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Figure 2: Intra-operative photograph of an ovarian cyst with torsion (dark brown colored) attached to the right fallopian tube.

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Figure 3: Microscopic photograph of cyst showing hemorrhegic necrosis of the wall with foci of dystrophic calcification (H and E, ×400).

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The genesis of an ovarian cyst is controversial. It results from fetal exposure to maternal and fetal gonadotrophins and found often in mothers having increased levels of beta-HCG (DM, Rh isoimmunization, toxemia). [3] Other suspected hypotheses include a precocious FSH peak between the 20-30th weeks of gestation and an abnormal HCG peak due to disorders of theca interna. It has also been suggested that prematurity and fetal hypothyroidism are associated with the development of ovarian cysts. [4] Nussbaum's [5] classification of neonatal cysts divided into simple or uncomplicated and complex or complicated cyst suggesting torsion. Torsion is the most common (50-78%) complication as the newborn ovary has a long pedicle. [4] Symptomatic and complex cysts should be removed by surgery to avoid complications. An ovarian cyst can also be excised by laparoscopy which would be diagnostic as well as therapeutic.

 
   References Top

1.Carlson DH, Griscon T. Ovarian cysts in the newborns. Am J Roentgenol Radium Ther Nucl Med 1972;116:664-72.  Back to cited text no. 1
    
2.Bagolan P, Giorlandino C, Nahom A, Bilanciani E, Trucchi A, Gatti C, et al. The management of fetal ovarian cysts. J Pediatr Surg 2002;37:25-30.  Back to cited text no. 2
    
3.Chiaramonte C, Piscopa A, Cataliotti F. Ovarian cysts in newborns. Pediatr Surg Int 2001;17:171-4.  Back to cited text no. 3
    
4.Jaferi SZ, Bree RL, Silver TM, Quimette M. Fetal ovarian cysts: Sonographic detection and association and hypothyroidism. Radiology 1984;150:809-12.  Back to cited text no. 4
    
5.Nussbaum AR, Sanders RC, Hartman JS, Dudgeon DL, Parmley TH. Neonatal ovarian cysts. Sonographic pathologic correlation. Radiology 1988;168:817-21.  Back to cited text no. 5
    

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Correspondence Address:
Vishal G Mudholkar
"Aadarsh sadan" ND-42, D-1, 10/2, Sambhaji chowk, CIDCO, New Nanded - 431 603, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77426

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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