Neonatal Ovarian Cyst

  • Etiology: In utero maternal stimulation by estrogen
  • Imaging US:
    — Large ovarian cyst
    — Prominent endometrial stripe in the uterus
  • DDX:
  • Complications: Ovarian torsion
  • Treatment: If greater than 4 centimeters intervention required to prevent ovarian torsion, otherwise can be followed conservatively as they decrease in size as maternal estrogen stimulation decreases
  • Clinical:

Radiology Cases of Neonatal Ovarian Cyst

US of neonatal ovarian cyst and a uterus under maternal stimulation of estrogen
Transverse US of the pelvis shows the fluid-filled bladder on the anterior right side of the image with a uterus with a thickened myometrium and prominent central endometrial stripe located just posterior to it. A large anechoic structure without septations is seen in the left side of the image and was felt to be associated with the right ovary.

Radiology Cases of Neonatal Ovarian Cyst Causing Ovarian Torsion

MRI of ovarian torsion
T1 coronal (left) and T1 sagittal (right) and T2 axial (below) MRI images show a heterogeneous intraperitoneal mass that appears to have hemorrhagic and calcified components. In the operating room this mass was found to be torsed.
US of ovarian torsion due to neonatal ovarian cyst
Transverse US of the fetus (above) shows an anechoic mass in the left side of the abdomen anteriorly. Post natal sagittal US images of the mass (below) show the mass to have mixed cystic and solid components.

Surgery Cases of Neonatal Ovarian Cyst Causing Ovarian Torsion

Surgical image of ovarian torsion
Surgical image shows a large circular and soft mass that was adherent to, but not invading, the hepatic flexure, omentum, and distal ileum and which was no longer connected to any pelvic structures. There was no ovarian tissue in the right adnexa. The left ovary was normal.

Gross Pathology Cases of Neonatal Ovarian Cyst Causing Ovarian Torsion

Gross pathology image of in-utero ovarian torsion
Gross pathological image (above) shows the mass to be circular and cystic. Upon sectioning, the thin-walled cyst was filled with hemorrhagic, fibrinous material (below). Solid areas were not present.
Gross pathology image of in-utero ovarian torsion
Gross pathological image shows the mass to be circular and cystic (above). Upon sectioning, the thin-walled cyst was filled with hemorrhagic and fibrinous material (below).

Histopathology Cases of Neonatal Ovarian Cyst Causing Ovarian Torsion

Histopathology image of ovarian torsion
Histopathological image H&E stained section shows a fibrous-walled cyst with few inflammatory cells and blood vessels filled with acellular fibrin; residual ovarian tissue was not identified.