Differentiating congenital ovarian cysts from other abdominal cystic lesions in female infants: A study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS)

J Pediatr Surg. 2022 May;57(5):877-882. doi: 10.1016/j.jpedsurg.2021.12.043. Epub 2022 Jan 14.


Purpose: The origin of congenital abdominal cysts in the female fetus often dictates management. While most arise from the ovary and are often managed non-operatively, some are non-ovarian and are frequently removed. We analyzed a national sample of female infants with congenital abdominal cysts to elucidate prenatal and postnatal factors associated with the diagnosis of a non-ovarian cyst.

Methods: A retrospective cohort study of female infants who were prenatally diagnosed with abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centres was performed. Clinical characteristics, pre- and postnatal sonographic findings, and cyst trajectories were compared between patients with proven ovarian etiology and those with cysts arising from other organs.

Results: Of 185 infants with prenatally diagnosed abdominal cysts, 22 (12%) were non-ovarian, five of which had clear non-ovarian organ of origin on prenatal ultrasound. Comparison of the other 17 cysts with 163 congenital ovarian cysts showed the following factors to be associated with a non-ovarian origin: earlier gestational age at diagnosis (23.5 vs 33.5 weeks, p <0.001), smaller diameter on first prenatal ultrasound (15.8 vs. 39.7 mm, p <0.001), change in sonographic character from simple to complex (87% vs 22%, p <0.001), and postnatal sonographic characteristics of complex cyst (87% vs. 48%, p = 0.004).

Conclusion: Clear organ of origin, diagnosis earlier in gestation, smaller initial prenatal cyst diameter, and sonographic cyst character change differentiate congenital non-ovarian cysts from their ovarian counterparts. These characteristics may be used to guide diagnosis and management.

Keywords: Fetal; Intra-abdominal cyst; Ovarian cyst; Postnatal outcome; Prenatal diagnosis; Prenatal ultrasound.

MeSH terms

  • Canada
  • Child
  • Cysts* / diagnostic imaging
  • Cysts* / surgery
  • Female
  • Fetal Diseases* / diagnosis
  • Humans
  • Infant
  • Neuroblastoma*
  • Ovarian Cysts* / diagnostic imaging
  • Ovarian Cysts* / surgery
  • Pregnancy
  • Retrospective Studies
  • Ultrasonography, Prenatal