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Fetal ovarian cyst

Fetal ovarian cysts refer to an ovarian cyst detected antenatally in a female fetus. They are relatively uncommon and are usually diagnosed in the 3rd trimester 5.

Epidemiology

From autopsy studies they are found in up to 30% of fetuses 1.

Pathology

The exact aetiology is not well known at the time of writing but is thought to be related to some form of hormonal stimulation (e.g. fetal gonadotrophins, maternal oestrogen and placental beta-HCG) 6.

A fetal ovarian cyst can be of variable size. It is not thought change significantly in size over the latter course of the pregnancy 2.

Locatio /distribution

They tend to be unilateral although bilateral cysts are also rarely seen.

Associations

Other associated anomalies are considered generally rare 2.

Radiographic features

Antenatal ultrasound

While is often difficult to accurately diagnose a fetal ovarian cyst sonographically due to many other cystic lesions having similar appearances, it is typically seen a well circumscribed unseptated cyst in the fetal pelvis separate from the fetal bladder, stomach and gall bladder. It is often anechoic if simple and uncomplicated. The presence of a small daughter cyst is considered a characteristic feature. Due to the relative laxity of supporting ligaments, the cyst can sometimes rise into the upper abdomen.

If there has a complication there may be fetal ascites (from cyst rupture) on or irregular echogenic intracystic material (from a haemorrhage).

Complications

  • in utero cyst rupture
  • cyst torsion
  • intra-cystic haemorrhage
  • compression of adjacent structures

Treatment and prognosis

They are almost always benign simple cysts. Treatment is usually conservative and in selected cases antenatal or neonatal cyst aspiration, laparoscopic cystectomy and laparotomy have been considered. Some advocate intervention if cysts are complex, wonders about the abdomen on serial scans, are larger than 4-5 cm or demonstrate rapid interval enlargement 4-5,7. Spontaneous remission can commonly occur although on occasion can take up several months 11.

Differential diagnosis

Differential considerations for a cystic lesion in the fetal pelvis include:

See also

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