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Symptomatic congenital ovarian cyst in a monochorionic twin
  1. N Thanawala,
  2. A O Akuma
  1. Leicester Royal Infirmary, Leicester, UK


Background and aims Congenital ovarian cysts is increasing being diagnosed because of advances in imaging technology. Most are primarily of follicular origin and can result in pelvic discomfort and pain, feeding intolerance and abdominal distension. Prognosis is favourable in the majority of cases but the risk of complications like torsion or rupture of cyst always remains.

Methods We present the first reported case of congenital ovarian cyst in only one twin of a monochorionic diamniotic (MCDA) pair.

Results This female was born at 33 weeks gestation to a healthy primigravida mother. Pregnancy was uneventful and antenatal scans were normal. She developed abdominal distension and bilious aspirates on day 4 of life following introduction of feeds. Abdominal ultrasonogram revealed a unilocular cyst in the pelvis measuring 5.0 cm at its widest diameter. On laparoscopy, a left-sided congenital ovarian cyst was confirmed and oopherectomy performed. Histology revealed a closed cyst measuring 45 mm×35 mm×20 mm and microscopically the cyst featured a loose fibrous wall derived from the ovarian cortex and lined by an incomplete flattened layer formed by regular cuboidal cells. Immuno-histochemistry showed features consistent with a large ovarian follicular cyst. Her twin remained well with no symptoms or signs suggestive of any intra-abdominal pathology.

Conclusion This case shows that congenital ovarian cyst can present in one infant of a MCDA twin despite genetic similarity and exposure to similar hormonal environment in-utero. It is advisable to examine the other twin for the presence of any small cyst that may require surveillance.

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