Frequency and treatment of ovarian cysts in adolescence

2-D and 3-D ultrasonographic characteristics of the ovary in women with PCOS and multifollicular ovaries

In this prospective study, seventy-six patients (PCOS group; n = 36, multifollicular ovary group; n = 40) were evaluated by 2-D and 3-D ultrasonography. VOCAL programme, echogenicity, number of follicles and blood flow parameters were evaluated. The patients with PCOS had a higher total ovarian volume, mean stromal volume and stromal echogenicity (18.6 ± 4.75 to 10.2 ± 3.4 p < .01; 12.23 ± 2.53 to 5.02 ± 2.44 p = .02; score 1:28 to 10 p < .01, respectively). There was no statistically significant difference in terms of mean RI and PI values between the groups (p > .05). 3 D power Doppler parameters included VI, FI, and VFI values of the patients with PCOS were higher when compared to those of the patients with multifollicular ovary (3.82 ± 2.65 to 1.78 ± 1.2, p < .01; 50.76 ± 4.45 to 40.6 ± 3.64, p = .03; and 2.34 ± 1.02 to 1.12 ± 0.65, p = .02, respectively). Our results revealed that total ovarian volume, stromal volume and echogenicity; VFI, VI, and FI could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.Impact statementWhat is already known on this subject? Ultrasonography is considered the new diagnostic tool for PCOS. Enlarged ovaries with multiple small follicles peripherally located around increased ovarian stroma with increased stromal echogenicity are the sonographic features of polycystic ovaries.What do the results of this study add? 3-D Doppler ultrasonography may be more specific in the determination of multifollicular and polycystic ovaries when compared to RI and PI in 2-D Doppler ultrasonography. Moreover, 3-D power Doppler ultrasonography could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.What are the implications of these findings for clinical practice and/or further research? In clinical practice, the differentiation of multifollicular ovaries and polycystic ovaries (PCO) is difficult with the use of 2-D sonography alone. Therefore, 3-D ultrasound and power Doppler may also be used in addition to 2-D ultrasound for the differentiation of multifollicular ovaries and PCO.

Physiologic Ovarian Cysts versus Other Ovarian and Adnexal Pathologic Changes in the Preadolescent and Adolescent Population: US and Surgical Follow-up

Background Ovarian and adnexal cysts are frequently encountered at US examinations performed in preadolescent and adolescent patients, yet there are few published studies regarding the outcomes of cysts in this population. Purpose To identify characteristics at US that help to distinguish physiologic ovarian cysts from nonphysiologic entities. Materials and Methods Female patients who underwent pelvic US with or without Doppler from January 2009 through December 2013 were identified by using a centralized imaging database. Patients older than 7 years and younger than 18 years with ovarian or adnexal cysts at least 2.5 cm were included. Demographic characteristics, date of surgery, surgical notes, and pathologic reports were extracted from the electronic medical record. Initial and follow-up dates of US, cyst size and complexity, imaging diagnosis, and change on subsequent US images were recorded. Statistical analysis was performed with the Wilcoxon rank sum and Kruskal-Wallis tests for continuous variables and the Fisher exact test for categorical variables. Results Of 754 patients who met inclusion criteria (age, 8-18 years; mean age, 14.6 years ± 1.9 [standard deviation]; mean cyst size, 5 cm ± 3.3), 409 patients underwent complete follow-up that included resolution at imaging (n = 250) or surgery (n = 159). In the patients with complete imaging follow-up, mean time to US documentation of resolution was 194 days ± 321; 59.6% (149 of 250) patients had nonsimple cyst characteristics. One-hundred fifty-nine patients underwent surgical intervention (mean cyst size, 8.5 cm ± 5.3), and 69.8% (111 of 159) of the cysts had simple characteristics. Of the 159 cysts, 100 (62.8%) were defined in the pathologic report as paratubal cysts. Of 409 patients, no malignancies were encountered in this study population with surgical or imaging resolution. Conclusion No malignancies were encountered in the study population and the majority of cysts resolved at follow-up imaging. Large size, persistence, and separability from the ovary were most helpful for identification of nonphysiologic paratubal cysts. © RSNA, 2019.

Age-Specific Frequencies and Characteristics of Ovarian Cysts in Children and Adolescents

OBJECTIVE

The aim of the present study was to document ovarian cyst frequency and characteristics as well as distribution of these parameters with respect to age in children and adolescents.

METHODS

We retrospectively analyzed the medical records of 1009 girls between the ages of 5-18 years who presented to our pediatric emergency department (PED) with pelvic pain and therefore underwent pelvic ultrasound examination between June 2011 and May 2014.

RESULTS

In total, 132 of 1009 girls (13.1%) were identified as having ovarian cysts ≥1 cm in diameter. The frequency of ovarian cysts was found to be 1.8% (6/337) in children aged 5-9 years and 18.8% (126/672) in those aged 10-18 years. All the cysts detected in children aged 5-9 years were small (<3 cm) and simple with age-specific frequencies ranging between 1.5-2.7%. With the onset of adolescence, ovarian cyst frequency started to increase with age and ranged between 3.8-31.3% throughout adolescence. Age of peak ovarian cyst frequency was 15 years with a rate of 31.3%. Large ovarian cysts (>5 cm) were identified in 19 adolescents (15.1%) with most occurring during middle adolescence. Of the 19 adolescents, five were found to have cyst-related significant ovarian pathologies including cystadenoma (n=3) and ovarian torsion (n=2).

CONCLUSION

In children aged 5-9 years, ovarian cysts were infrequent and small (<3 cm). Peak ovarian cyst frequency was detected at the age of 15 years. All patients diagnosed with cyst-related significant ovarian pathologies were adolescents having a cyst >5 cm in diameter with a complex appearance in most.

[Epidemiology of presumed benign ovarian tumors]

Ovarian cysts presumed benign can be organic or functional. Their prevalence is estimated between 14 and 18% in postmenopausal women and around 7% in asymptomatic women of childbearing age. Their incidence during pregnancy is between 0.2 and 5% and varies within the term of pregnancy. Ovarian cysts presumed benign have caused nearly 45,000 hospitalizations in France in 2012, bringing the annual risk of hospitalization for a woman residing in France to 1.3‰. Among the risk factors studied in the literature, tamoxifen increases the incidence of ovarian cysts in premenopausal patients and immunosuppressive treatments are associated with a high prevalence of benign ovarian cysts while estrogen contraception reduces the risk of developing functional cysts.

Laparoscopic management of chemical peritonitis caused by dermoid cyst spillage

BACKGROUND

Dermoid cyst is the most frequent benign ovarian tumor. Spillage of cyst contents during surgery is common and can rarely lead to chemical peritonitis.

CASE REPORT

A patient presented 3 days after attempted laparoscopic removal of bilateral dermoid cysts. On examination, she had a low-grade fever, rebound tenderness with guarding, and a markedly elevated white blood cell count. A decision was made to proceed with laparoscopy with the presumptive diagnosis of chemical peritonitis. Laparoscopic findings included residual dermoid cyst contents and extensive filmy adhesions of the bowel and omentum to the peritoneal surface. The chemical peritonitis resolved after laparoscopic removal of residual dermoid cyst content including bilateral salpingo-oophorectomy and copious irrigation.

CONCLUSION

Early recognition and prompt treatment by repeat laparoscopic surgery with removal of the remaining cyst contents and peritoneal lavage can be a successful method for treating chemical peritonitis.

Adolescent chronic pelvic pain

The presentation of chronic pelvic pain in the adolescent can at times be quite daunting. A careful and insightful approach to obtaining the history and physical examination must be implemented while maintaining an appreciation of the various stages of adolescent development. The etiologies can range from gynecologic to nongynecologic causes. The ability to render an early diagnosis and appropriate treatment in this population of patients can significantly improve future reproductive health outcomes. The following minireview will outline a systematic approach to the adolescent with chronic pelvic pain.

Ovarian cysts in neonates, children and adolescents

PURPOSE OF REVIEW

This review is intended to increase the understanding of normal ovarian physiology in neonates, prepubescent girls and adolescents and to outline management guidelines for ovarian cysts at each age.

RECENT FINDINGS

Ultrasound has increased the level of understanding regarding the development of ovarian cysts. With ultrasound, ovarian cysts are recognized as a consequence of follicular growth and atresia that can be a normal developmental occurrence at all ages. Clinical experience has taught us that ovarian cysts are common, frequently regress without treatment and are seldom associated with malignancy. New management schemes are developing which rely on increased recognition of torsion and prompt intervention to untwist the adnexa and leave it in situ. In addition, new operative techniques are being developed that are less invasive and morbid, as well as being more conservative of ovarian tissue.

SUMMARY

With the understanding of normal ovarian follicular growth in girls prior to full maturity, the normal development of ovarian cysts can be appreciated. Conservative therapies with observation can often replace surgical management. When treatment is necessary, knowledge of less invasive and morbid techniques can improve ovarian preservation rates.

The effects of monophasic and triphasic oral contraceptives on ovarian function and endometrial thickness

OBJECTIVE

To analyze and compare the effects of seven low-dose oral contraceptives (OCs) on ovarian function and endometrial thickness.

METHODS

Cross-sectional study of users of one of five monophasic OCs, one of two triphasic OCs and a control group of non-users. Ovarian function, endometrial thickness and serum hormone levels were monitored during days 10-12 and 16-18 of the cycle.

RESULTS

Serum estradiol was suppressed in OC users to a greater degree during days 16-18 than during days 10-12, whereas serum progesterone during 16-18 was in the anovulatory range with each preparation. Ovarian activity as measured by follicular size was lowest with desogestrel-containing OCs, whereas greater activity was seen with triphasic levonorgestrel/ethinylestradiol and triphasic norgestimate/ethinylestradiol. Endometrial thickness in OC users was significantly smaller than in controls.

CONCLUSIONS

All preparations demonstrated profound suppression of ovarian activity and effectively prevented ovulation. Ovarian suppression with desogestrel/ethinylestradiol 150/20 did not differ from that of other OCs despite its lower ethinylestradiol content. The use of both triphasic OCs, having a relatively low progestogenic activity, was associated with a higher ovarian activity than that of the monophasic OCs.