Ovarian cysts in children
Ovarian cysts in children are rare and make up one third of all ovarian lesions. Almost 90% of ovarian cysts are benign with malignancy suspected in the 10% with complex, large cysts showing a solid component and presenting mainly in post menarchal girls. Children younger than 8 years of age are noted to have a benign lesion in 97% of cases compared to 33% in the older children. Ten percent of ovarian cysts are bilateral. This manuscript is limited to ovarian cysts only. It does not cover ovarian non cystic tumours or lesions. Ovarian cysts are known to arise from mature ovarian follicles and are distinguished from physiological follicles by exceeding 2cm in diameter. Follicular cysts are the most common type of ovarian cysts. Others include corpus luteal cysts, parovarian cysts, teratomas and polycystic ovarian cyst as part of a syndrome. Routine prenatal ultrasound scans detects most ovarian cysts in the fetus. One third of these fetal cysts are greater than 1mm in size. Their aetiology is implicated by maternal and placental hormonal stimulation. Over 50% of prenatal diagnosis of abdominal cysts is ovarian. The fetal incidence of ovarian cysts is disproportionately high when considering that the neonatal incidence classically was only 1 per 100,000 births. This strongly suggests that fetal ovarian cysts undergo spontaneous involution or silent torsion and resorption either late in pregnancy or shortly after birth (this is the aetiology of most cases of unilateral absent ovary diagnosed later in life).Puncturing of prenatal cysts are discouraged due to the risk/benefit mismatch. Prenatal ovarian cysts are thus managed conservatively with regular scans except for huge cysts that could lead to abdominal dystocia during vaginal delivery. Postnatal, ovarian cysts usually present as a palpable mobile mass. The mass is rarely symptomatic and has almost no risk of malignancy .Management include regular follow up with ultrasound scan due to the natural history of resolution. The current indications for intervention after birth include simple cysts greater than 5 cm and complex cysts of any size. Large simple cysts ( > 5cm) are associated with an increased risk of torsion of the ovary. The safest management of large simple cysts after birth is probably aspiration or deroofing under laparoscopic guidance, although some authors recommend observation alone. Complex cysts are often ovarian cysts that have undergone torsion, causing bleeding within the cyst, but may represent duplications or other types of cysts Laparoscopy is indicated to establish the diagnosis. Beyond the neonatal period ovarian cysts in prepubertal children are unusual. A benign cystic teratoma may be discovered during ultrasound examination obtained for complaints of abdominal pain or as an incidental finding. A palpable ovarian mass in this age group should be carefully evaluated and treated as a potentially malignant lesion. Occasionally, precocious puberty may be observed as a result of a follicle cyst that produces a significant excess of estrogenic hormones. Unilocular cysts less than 5 cm may be observed with serial ultrasound scanning. For large ( > 5cm) unilocular cysts that do not regress on repeat ultrasound examinations, careful excision or deroofing of the cyst with retention of the remaining normal ovary is advised. In postmenarchal girls the presence of a cyst is not uncommon. The management is as above. Corpus luteum cysts are seen in teenagers and develop after ovulation occurs. They may present with signs of peritoneal irritation and can be confused with acute appendicitis. The diagnosis is made on ultrasound or at the time of laparoscopy or laparotomy. They do not require treatment and have usually resolved on follow-up ultrasound 6 weeks later. Teratomas make up 40% of all ovarian tumours. These lesions are diagnosed on scanning and with tumour markers. Calcification is noted in more than 50% of lesions. Benign lesions are successfully managed with surgical excision alone and lesions with malignant components may require further adjuvant therapy. © 2010 Nova Science Publishers, Inc. All rights reserved.