Fetal ovarian cysts: diagnostic and therapeutic role for intrauterine aspiration.

Antenatal diagnoses of fetal ovarian cysts have not usually been confirmed until postnatal surgery. We describe 2 cases of hemorrhage into fetal ovarian cysts in which cyst aspiration in utero allowed both confirmation of the diagnosis prenatally and obviated the need for neonatal surgery. In both cases, cytology of the cyst aspirate demonstrated luteinized granulosa cells and biochemistry showed estradiol levels of > 10,000 pmol/l, indicating ovarian etiology. Hemorrhage, which had been suspected on ultrasound, was confirmed by cytology, showing hemosiderin-laden macrophages. There was no evidence of recurrence in either case following aspiration. The described association of fetal hypothyroidism was excluded by testing thyroid function in cord blood and/or cyst aspirate. We suggest that intrauterine aspiration contributes to the management of fetal ovarian cysts by confirming their ovarian origin, demonstrating the presence or absence of hemorrhage and facilitating preservation of ovarian function both by reducing the risk of torsion and the need for neonatal surgery.