Functional ovarian cysts and the need to remove them

Ovarian tumors in the pediatric population: An update

Research reveals that 1% of neoplasms in females under 17 years of age are ovarian neoplasms and though usually benign, malignant tumors may occur in the pediatric age group. This review considers various current concepts of these tumors including the epidemiology, risk factors, clinical presentations, diagnosis, differential diagnosis, and treatment options including the need to provide fertility-sparing surgery as well as their potential impacts on the psychological well-being of children and adolescents. We gathered data from the published articles ranging from studies, meta-analyses, retrospective studies, and reviews. We focused on the articles published in English between January 1, 2000, and August 31, 2023. Only a few articles published prior to 2000 were included for historical perspective.

Usefulness of repeat pelvic ultrasonography before surgery for benign ovarian mass

OBJECTIVE

To evaluate the results of repeat pelvic ultrasonography before surgery in patients with suspicion of benign ovarian tumor.

METHODS

A retrospective study included premenopausal women who were scheduled to undergo surgery for a benign-appearing ovarian mass and who had repeat ultrasonography on the day before surgery at Samsung Medical Center, Seoul, South Korea, between January 1, 2007, and December 31, 2011, to check for any change in the mass. Ultrasonography findings and final histology were evaluated by medical record review.

RESULTS

Of 1854 women studied, regression of mass was detected before surgery for 27 patients, and 105 patients had histologically proven functional cysts; considered together, 132 patients had functional cysts, and the remaining 1722 women had benign ovarian tumors. Evaluation of the findings of initial ultrasonography revealed that mean size (P=0.008) and proportion of bilateral cysts (P<0.001) were lower in the presence of functional cysts than benign tumors. Additionally, an anechoic pattern was more common among regressed functional cysts than among histologically proven functional cysts (P<0.001). In total, 105 (5.7%) patients required surgery for a functional cyst despite repeat ultrasonography.

CONCLUSION

Repeating ultrasonography prior to surgery may have only a limited ability to prevent unnecessary surgeries for functional cysts.

Hemorrhagic corpus luteum cysts: an unusual problem for pediatric surgeons

STUDY OBJECTIVE

Hemorrhagic corpus luteum cysts (HCLC) constitute a common disorder in pediatric subjects undergoing surgical intervention. HCLCs especially develop in the early period after menarche, and they are commonly associated with dysfunctional ovulation.

DESIGN

Retrospective analysis of surgery outcome of HCLC patients.

SETTING

Pediatric Surgery Unit, S. Chiara University Hospital.

PARTICIPANT

13 girls with HCLC diagnosis.

INTERVENTIONS

Surgical treatment of HCLCs.

MAIN OUTCOME MEASURES

We reviewed the clinical presentation and outcome of 13 post-menarcheal girls surgically treated for HCLCs in the Pediatric Surgical Unit from 2002 to 2006.

RESULTS

Primary presentation was persistent abdominal pain in 84.6% and acute abdominal pain in 15.4% of patients, respectively. Ultrasound examination showed complex ovarian masses in 77.23% cases and simple ovarian masses in 33.7% cases, respectively. Although laparoscopic excision of HCLC was performed in more than 45% cases, laparotomic approach was commonly required. After conservative surgery, ovarian size and viability were normal, as assessed by 6-month ultrasound scan. No recurrences of disease and regular menses were reported at 2 years follow-up.

CONCLUSIONS

In pediatric subjects with HCLC that required surgical intervention, no complications or disorder recurrence were reported. In order to preserve ovarian function, conservative surgery has to be performed whenever feasible.

Functional ovarian lesions in children and adolescents: when to remove them

STUDY OBJECTIVE

Functional ovarian lesions represent 45% of all pediatric adnexal abnormalities. Their surgical management, even if frequent, is not clear, especially in pediatric age.

MATERIALS AND METHODS

We retrospectively reviewed 22 pediatric patients surgically treated for functional ovarian lesions from 2000 to 2006. The following characteristics were analysed: age, size of the lesion, ultrasound (US) aspect and clinical presentation.

RESULTS

The average age was 16.1 years of age (range: 6 months-18 years). Of the 22 functional lesions, 12 (55%) were follicular cysts and 10 (45%) corpus luteum ones. The average size was 6.7 cm (range: 5.1-33 cm). US scan showed simple lesions in 10 cases (45%) and complex ones in 12 cases (55%). In 16 girls (72.8%) the presenting symptom was abdominal pain while 2 patients (9%) presented abdominal distention. In the other 4 patients (16.2%) the lesion was found accidentally during US examination.

CONCLUSION

In pediatric subjects, functional ovarian cysts rarely required surgical intervention, though no complications or disorder recurrence were reported. To preserve ovarian function, conservative surgery has to be performed whenever feasible.

Diagnosis and management of simple ovarian cysts: An audit

Simple ovarian cysts are common. The aim of clinical management is to optimize the treatment of malignant and premalignant cysts while minimizing intervention for cysts likely to resolve spontaneously. In this retrospective study, ovarian cysts over 30 mm in diameter were detected in 90 women. Of this population, 75 were premenopausal, 13 postmenopausal, and two had undergone a hysterectomy. Thirteen women presented acutely. Family history of breast, ovary or colon cancer was not ascertained in any of the women. None had CA125 levels performed. In 22 cases, the cyst was aspirated; only 10 of these had follow-up ultrasound. Laparotomy was performed in 25 premenopausal women, the two perimenopausal women and eight postmenopausal women. Average cyst size was 71 mm (range 40-80 mm) in the laparoscopy group, and 72 mm (range 36-180 mm) in the laparotomy group. After initial diagnosis at ultrasound, a follow-up scan was performed 4-16 weeks later. The final diagnosis was ovarian neoplasm in 13 and hydrosalpinx in two. None had a malignancy. Documentation at ultrasound was often inadequate, and management of the women with an ovarian cyst was haphazard. Guidelines on management of simple ovarian cysts are likely to improve clinical practice.

Diagnosis-related pitfall of a lateral sacral cyst. Case report

Because physical examination typically demonstrates normal findings in cases of low-back pain, diaglosis of the cause can be challenging. Frequent magnetic resonance imaging studies of the lumbosacral spine can typically lead to discovery of benign diseases and thus misinterpretation of these images. The authors report an unusual case in which a functional ovarian cyst was incidentally associated with a perineural cyst and mimicked a lateral sacral meningocele. In light of this, the authors recommend repeated examinations to avoid mistakes.

Ovarian lesions in children and adolescents--an 11-year review

OBJECTIVE

To describe the spectrum of pediatric ovarian pathology, identifying the clinical features and ultrasound characteristics that help in decisions about patient management, and to correlate these with ovarian pathology.

PATIENTS AND METHODS

Retrospective analysis of 134 records of patients admitted with ovarian lesions to Royal Children's Hospital, Melbourne over an 11-year period (1989-99 inclusive).

RESULTS

The age of presentation varied widely from 2 days to 19 years with 63.4% being over 12 years of age. Eighty-one patients (60.4%) had physiological or functional ovarian cysts, 52 of which required surgical intervention. Forty-four patients (32.8%) had neoplastic lesions and a palpable abdominal mass was felt in 53.7% of them. Mature cystic teratoma or dermoid cyst, seen in 27 patients, was the commonest neoplasm, and 77.8% of these children were under 12 years. Six children had malignant ovarian neoplasms, of which five were germ cell in origin. Five patients had epithelial or stromal neoplastic lesions. Endocrine manifestations were seen in seven patients and included early or precocious puberty and virilization. Plain trans-abdominal ultrasonography was useful in identifying ovarian lesions in 94 (81.7%) of the 115 patients in whom it was performed, but was not helpful in determining the nature of the lesion. Neoplastic ovarian lesions were commonly greater than 10 cm in diameter

CONCLUSIONS

Physiological or functional ovarian cysts are the most common ovarian lesions seen in the pediatric age group and malignant neoplasms are rare. A palpable abdominal mass or ovarian lesion >10 cm was significantly associated with the lesion being neoplastic. Lesions <5 cm in post-pubertal girls were significantly more likely to be non-neoplastic. Ultrasonography is useful in localizing ovarian lesions but is not helpful in determining their pathological nature. Endocrine manifestations sometimes occur with either benign or malignant lesions of the ovary.