Specific Ultrasound Pattern of Perinatal Torsioned Ovarian Cysts: Sonographic-pathologic Correlation

Document Type : Original Article

Authors

1 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Radiology, Faculty of medicine, North khorasan University of Medical Sciences, Bojnurd, Iran

Abstract

Background: The accurate differentiation of perinatal torsioned ovarian cysts (PTOCs) in neonates is of utmost importance. This importance is due to the fact that if PTOCs are diagnosed properly, minimally invasive or conservative management approaches can be offered. The present study aimed to describe the ultrasound findings of PTOCs and compare the results with pathological findings.
Methods: This prospective cross-sectional study was conducted in Mashhad University of Medical Sciences, Mashhad, Iran, within 2014-2019. All infants with an intra-peritoneal cyst underwent meticulous ultrasound examination. Patients were followed up until reaching the final diagnosis. In surgically approved PTOCs, the correlation between sonographic and pathologic findings was examined.
Results: Twenty two cases (aged 2 days to 6 months, mean age = 6 weeks) with PTOC were diagnosed during this time. Cysts were mainly on the right side (86%) with mean diameter of 51 mm (27-73mm). The ultrasonogrphic signs of fluid debris level, triple-layer wall and wrinkled inner layer were observed in almost all of patients.
The pathologic triple-layer of perinatal torsioned ovarian cysts included necrotic content with granulation, stroma, and epithelium layers was observed by ultrasound as a uni-locular cyst containing fluid debris level with an echogenic wrinkled inner layer, a hypoechoic uneven non-uniform middle layer and echogenic outer epithelial surface.
Conclusion: Sonographically detected triple-layered pattern for PTOCs was completely in agreement with pathologic results. Then, this specific ultrasound pattern is pathognomonic for PTOC.

Keywords


1. Luis JD, Ricardo PÃ, Pomares A, Bravo C, Francisco GÃ, Aguar Ã, et al. Congenital ovarian cyst: diagnosis and perinatal management. J Gynecol Neonatal Biol. 2015; 1(1):1-5.
2. Spence JE, Domingo M, Pike C, Wenning J. The resolution of fetal and neonatal ovarian cysts. Adolesc Pediatr Gynecol. 1992; 5(1):27-31.
3. Akın MA, Akın L, Özbek S, Tireli G, Kavuncuoğlu S, Sander S, et al. Fetal-neonatal ovarian cysts--their monitoring and management: retrospective evaluation of 20 cases and review of the literature. J Clin Res Pediatr Endocrinol. 2010; 2(1):28-33. 4. Catania VD, Briganti V, Di Giacomo V, Miele V, Signore F, de Waure C, et al. Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound. J Matern Fetal Neonatal Med. 2016; 29(10):1691-9.
5. Bagolan P, Giorlandino C, Nahom A, Bilancioni E, Trucchi A, Gatti C, et al. The management of fetal ovarian cysts. J Pediatr Surg. 2002; 37(1):25-30.
6. Mostofian E, Ornvold K, Latchaw L, Harris RD. Prenatal sonographic diagnosis of abdominal
mesenteric lymphangioma. J Ultrasound Med. 2004; 23(1):129-32.
7. Tseng D, Curran TJ, Silen ML. Minimally invasive management of the prenatally torsed ovarian cyst. J Pediatr Surg. 2002; 37(10):1467-9.
8. Aziz D, Davis V, Allen L, Langer JC. Ovarian torsion in children: is oophorectomy necessary? J Pediatr Surg. 2004; 39(5):750-3.
9. Foley PT, Ford WD, McEwing R, Furness M. Is conservative management of prenatal and neonatal ovarian cysts justifiable? Fetal Diagn Ther. 2005; 20(5):454-8. 10. Nussbaum AR, Sanders RC, Hartman DS, Dudgeon DL, Parmley TH. Neonatal ovarian cysts: sonographic-pathologic correlation. Radiology. 1988; 168(3): 817-21.
11. Godfrey H, Abernethy L, Boothroyd A. Torsion of an ovarian cyst mimicking enteric duplication cyst on transabdominal ultrasound: two cases. Pediatr Radiol. 1998; 28(3):171-3.
12. Kim HS, Yoo SY, Cha MJ, Kim JH, Jeon TY, Kim WK. Diagnosis of neonatal ovarian torsion: emphasis on prenatal and postnatal sonographic findings. J Clin Ultrasound. 2016; 44(5):290-7.
13. Vitezica I, Czernik C, Rothe K, Hinkson L, Ladendorf B, Henrich W. Prenatal diagnosis and management of a massive fetal ovarian hemorrhagic cyst torsion with secondary fetal anemia. J Clin Ultrasound. 2014; 42(4).219-22.
14. Ozcan HN, Balci S, Ekinci S, Gunes A, Oguz B, Ciftci AO, et al. Imaging findings of fetal-neonatal ovarian cysts complicated with ovarian torsion and auto-amputation. Am J Reontgenol. 2015; 205(1):185-9.
15. Brandt ML, Helmrath MA. Ovarian cysts in infants and children. Semin Pediatr Surg. 2005; 14(2):78-85.
16. Cheng G, Soboleski D, Daneman A, Poenaru D, Hurlbut D. Sonographic pitfalls in the diagnosis of enteric duplication cysts. AJR Am J Roentgenol. 2005; 184(2):521-5.
17. Trinh TW, Kennedy AM. Fetal ovarian cysts: review of imaging spectrum, differential diagnosis, management, and outcome. Radiographics. 2015; 35(2):621-35. 18. Llorens Salvador R, Sangüesa Nebot C, Pacheco Usmayo A, Picó Aliaga S, Garcés Iñigo E. Neonatal ovarian cysts: ultrasound assessment and differential diagnosis. Radiologia. 2017; 59(1):31-9.
19. Giorlandino C, Bilancioni E, Bagolan P, Muzii L, Rivosecchi M, Nahom A. Antenatal ultrasonographic diagnosis and management of fetal ovarian cysts. Int J Gynaecol Obstet. 1994; 44(1):27-31.
20. Monnery-Noché ME, Auber F, Jouannic JM, Bénifla JL, Carbonne B, Dommergues M, et al. Fetal and neonatal ovarian cysts: is surgery indicated? Prenat Diagn. 2008; 28(1):15-20.
21. Chinchure D, Ong CL, Loh AH, Rajadurai VS. Neonatal ovarian cysts: role of sonography in diagnosing torsion. Ann Acad Med Singapore. 2011; 40(6):291-5.
22. Ogul H, Havan N, Pirimoglu B, Guvendi B, Kisaoglu A, Kantarci M. Prenatal and postnatal ultrasonographic findings of the torsioned ovarian cyst: a case report and brief literature review. Int Surg. 2015; 100(3):514-7.
23. McKenzie AS, Dyer RB. The “fishnet” appearance. Abdom Imaging. 2015; 40(6):2058-9.
24. Koike Y, Inoue M, Uchida K, Kawamoto A, Yasuda H, Okugawa Y, et al. Ovarian autoamputation in a neonate: a case report with literature review. Pediatr Surg Int. 2009; 25(7):655-8.