2021 Volume 57 Issue 7 Pages 1041-1048
Purpose: Fetal and neonatal ovarian cysts are classified into two types on the basis of ultrasonographic findings: simple cysts (SCs) and complex cysts (CCs). CCs are associated with ovarian torsion, which has been considered a surgical indication. Recently, some reports have recommended initial observation. We aimed to clarify the indication of surgery and observation for CCs.
Methods: From 1990 to 2018, 17 CCs in 15 cases were treated. Clinical information was retrospectively collected.
Results: All cysts were diagnosed prenatally. Four were CCs at the initial diagnosis, six became CCs in utero, six became CCs soon after birth and one became CC at 9 months of age. In the surgery group (six cysts in five cases), ovary-preserving surgery was performed in one case with bilateral ovarian torsion. However, primary amenorrhea occurred in adolescence and hormone therapy was required. Two unilateral cysts with autoamputation were removed. The other two cysts with unilateral ovarian torsion required oophorectomy. In the observation group (11 cysts in 10 cases), no complications were found. In all but one case, cysts regressed and disappeared in US. The follow-up was performed until 2.7 (1.0 to 11.6) years of age. Five affected cysts in four cases were confirmed by US. Two cases were followed up for more than 10 years, one of which had menarche.
Conclusions: Initial observation of CCs can be safely undertaken without complications. Surgery may be indicated in cases within several days of onset and those with complications. Cysts remaining for more than 1 year should be followed up with surgery in mind.
