Ovarian Cysts with Dr. Roshni Dasgupta

Ovarian pathology, well, it can affect children at all stages of life. But the differential and workup differs, based on age of presentation and the size of the mass. So to start, let's talk about a neonatal diagnosis. You have a six week old infant who had a ultrasound at about 28 weeks gestation that showed a six centimeter pelvic mass. That's Dr. Roshni Dasgupta, a pediatric surgeon at Cincinnati Children's Hospital Medical Center. And today, well, she's going to teach us everything we need to know about both the workup and the management of ovarian pathology. Cysts diagnosed prenatally have a fairly wide differential. The cysts can be related to an ovary. Which it probably is in this case, since we're talking about ovarian pathology today. A mesenteric cyst, a duplication cyst, a complex meconium cyst or a renal cyst. But regardless, there isn't really much to do in utero. Born at 39 weeks, looks pretty good, feeding well, having normal bowel movements. What do you want to do next? You can get an ultrasound to delineate where this cyst is originating from. But as long as it's truly cystic and the baby's thriving, it's okay to follow up with serial imaging in about age 12 weeks if it's a simple cyst, should get smaller in that timeframe. If nothing else abnormal is seen on imaging, then, well, you're in the clear. But if there are abnormal ovaries or no ovaries, then there's a little bit more to explain. So intrauterine torsion, right, can happen. And you can just be left with a free floating cyst. So if I have a prenatal diagnosis of a cyst, wait until birth and if the baby's doing well, then I can get an ultrasound to identify the organ of origin. If it's a simple cyst, then I get serial imaging to see if it's shrinking as expected. But things don't go as expected and at the 12 week interval scan, the cyst is complex, it's grown from three to six centimeters. Then what? These cysts are really common, um, first of all, so they're usually diagnosed around the 28 weeks gestation. They are rarely ever, just like you said, associated with malignancy and most of them go away by themselves. So when we think about what your indications for surgery are is if if they develops any sort of symptoms. They're over five centimeters, um, we think that there's just an increased risk of torsion, so that may be an indication to actually go in and operate. Um, and if the cyst is persistent for greater than six months with no decrease in size, sometimes it may not be part of the ovary, um, and it could be a mesenteric cyst or something else that may want you to to do some further investigation. In adolescence, the same rules apply. If you see a cyst, the main concern is size, due to that increased risk of torsion. So serial imaging can be used here as well. So other kinds of ovarian cysts, right, are usually found in adolescence. They can be pretty large. They're composed of granulosa and thecal cells and they can also cause torsion, right? So when we see these cysts, when we do an, um, appendicitis, very often we just leave them alone and you should just get another ultrasound, um, in about six weeks. Now, if you can have ovarian cysts, then you can probably also have paraovarian cysts, but those are kind of hard to differentiate, especially from follicular cysts on imaging. The big concern here is also torsion, but this time of the fallopian tube itself, not just the ovary. Uh, usually they're in the mesosalpinx. Um, you can't tell exactly where they are. Um, if they're greater than 3 centimeters, you want to actually enucleate them, so you don't actually get um any torsion of the tube. You can actually torse the tube as well. Um, if they're smaller than 3 centimeters, often most people don't do anything, but if you want to, you can just open them up and drain them. Thanks for joining our episode in ovarian pathology with Dr. Dasgupta. Remember, to download the Stay Current App, check us out on YouTube, Facebook, Twitter, leave us a comment wherever you listen to podcasts. But until next time, I'm Brittany and remember, knowledge should be free.