The prognostic significance of minimal intracystic vegetations during operative laparoscopy for adnexal masses in women of reproductive age

Study Objective. To evaluate the prognostic significance of minimal intracystic vegetations in ovarian cysts approached by laparoscopy. Design. Prospective study. Setting. A tertiary care university hospital. Patients. Ten of 208 women with adnexal cysts and minimal intracystic vegetations, under 40 years of age, carefully selected for operative laparoscopy on the basis of a preoperative sonogram suggestive of a unilocular cyst, with no thick septa or solid components in the absence of ascites. Interventions. Adnexal cyst excision at operative laparoscopy. Measurements and Main Results. In all 208 women evaluation of the abdomen, pelvis, and external surface of the cyst was negative. In 10 patients minimal intracystic vegetations, not detected by preoperative sonography, were identified during endocystic evaluation. In all these cases frozen section examination was negative. Definitive histologic diagnosis confirmed the presence of benign cysts. Conclusion. The presence of minimal intracystic vegetations alone when diagnosed in highly selected patients under 40 years of age may not justify immediate midline laparotomy if frozen section is negative.