Ovarian Cysts with Dr. Roshni Dasgupta

Cysts diagnosed prenatally have a differential including ovarian cyst, mesenteric cyst, duplication cyst, complex meconium cyst, or renal cyst.

There is not much to do in utero for prenatally diagnosed pelvic cysts.

For a thriving neonate with a truly cystic mass, serial imaging at about 12 weeks is appropriate if it is a simple cyst, which should get smaller in that timeframe.

If abnormal ovaries or no ovaries are seen on imaging, intrauterine torsion may have occurred, leaving a free floating cyst.

Prenatal ovarian cysts are really common and usually diagnosed around 28 weeks gestation.

Prenatal ovarian cysts are rarely associated with malignancy and most go away by themselves.

Indications for surgery include development of symptoms, cysts over 5 centimeters (increased risk of torsion), or persistence for greater than 6 months with no decrease in size.

If a cyst persists for greater than 6 months with no decrease in size, it may not be part of the ovary and could be a mesenteric cyst or something else requiring further investigation.

In adolescence, the same rules apply for ovarian cysts, with main concern being size due to increased risk of torsion, and serial imaging can be used.

Other kinds of ovarian cysts found in adolescence can be pretty large, composed of granulosa and thecal cells, and can cause torsion.

When ovarian cysts are seen incidentally during appendicitis workup, they should be left alone and followed with ultrasound in about 6 weeks.

Paraovarian cysts are hard to differentiate from follicular cysts on imaging.

The big concern with paraovarian cysts is torsion of the fallopian tube itself, not just the ovary.

Paraovarian cysts are usually in the mesosalpinx.

If paraovarian cysts are greater than 3 centimeters, enucleation is recommended to prevent torsion of the tube.

If paraovarian cysts are smaller than 3 centimeters, most people do not intervene, but they can be opened and drained if desired.