[Prenatal diagnosis of ovarian cysts]

Abstract

The authors report 10 cases of ante-natally diagnosed ovarian cysts. Ultrasonography greatly contributed to the diagnosis of this condition rarely described before. These cysts are usually follicular cysts. Physiopathological explanation still remain unclear: excessive fetal gonadotrope activity, enzymatic abnormality of the theca interna, abnormal stimulation by the mother's HCG are the main hypothesis. Ultrasonographic prenatal diagnosis is based on the discovery of an intra-abdominal round liquid area in a female fetus with normal kidneys and bladder. Obstetrical management is very simple: observation and vaginal delivery. After birth, diagnosis is assessed by clinical examination and ultrasonography which may be able to recognize a possible torsion (intracystic fluid septation). Treatment is conditioned by two facts: first these cysts are usually follicular benign lesions, second there is a high risk of complications, mainly torsion or rupture. Non-operative treatment and observation can be justified for very small cysts which have low risk of torsion. Laparotomy confirms the diagnosis: regarding non complicated cysts, surgery must be as conservative as possible: cystectomy is often feasible, leaving a laminated but functional ovary. Percutaneous puncture under ultrasonography could be considered.