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Ovarian cyst in adolescent girls

Ovarian cyst in adolescent girls

Ovarian cyst in adolescent girls

Jul 31, 2024

A, 13 yrs old girl BMI--27 presented in gynae opd with the chief complaint of abdominal swelling and off and on pain .Pain was dull in nature and it was unrelated to food or any physical activity,

Menstrual history; She got her menarche at 11 yrs of age but she has just 3 to 4 periods in 2 years .She got her medication started from December 2023 and an ultrasound was done which reported a parovarian cyst 78mm*69 mm on  the right side .

She was put on hormonal pills for six months by some consultant.

Follow up ultrasound done after six months showed no change in the size of the cyst .The cyst appeared  clear .Owing to the size of the  cyst , the decision of laproscopy was taken.

On laproscopy ,there was a big parovarian cyst adjacent to right ovary .The cyst wall was enucleated and removed Both tubes appeared normal and both ovaries are polycystic .

The plan is to put the patient on diet and life style changes and progesterone withdrawl for regulation of her menstrual periods.

Management of Adolescent ovarian cyst involves understanding the underlying cause.


Understanding Ovarian Lesions and Neoplasms in Children and Adolescents

Ovarian health is a crucial aspect of overall well-being, even in young individuals. Children and adolescents can develop a range of ovarian conditions, both non-neoplastic and neoplastic. Let's delve into the types of ovarian lesions and tumors that can occur in this age group, their clinical manifestations, and the importance of specialized care.

Non-Neoplastic Ovarian Lesions

Non-neoplastic ovarian lesions are relatively common and include:

  • Functional Cysts: These are fluid-filled sacs that often resolve on their own.
  • Endometrioma: These cysts are filled with old blood and can cause pain.
  • Torsion: This occurs when the ovary twists, cutting off its blood supply and causing severe pain.
  • Abscess: A collection of pus due to infection.
  • Lymphangioma: A benign tumor of lymphatic vessels.

 

Types of Ovarian Neoplasms

Ovarian neoplasms are classified into four main categories:

  1. Germ Cell Tumors: The most common type in the pediatric population. These include:
    • Mature Teratoma: The most frequent ovarian neoplasm in children and adolescents.
    • Dysgerminoma: The most common ovarian malignancy in this age group.
  2. Epithelial Tumors: More commonly seen in adults.
  3. Sex-Cord Stromal Tumors: Arise from the ovarian stroma.
  4. Miscellaneous Tumors: Less common and diverse in nature.

Clinical Manifestations

Symptoms of ovarian masses can vary but typically include:

  • Abdominal Pain: Often the first sign prompting medical evaluation.
  • Palpable Mass: Can be detected during a physical examination.
  • Nausea and Vomiting: May occur, especially if torsion is present.
  • Endocrine Alterations: Such as menstrual abnormalities, precocious puberty, and virilization (development of male characteristics).

 

Investigating Ovarian Masses

When evaluating ovarian masses in children and adolescents, the primary goal is to determine the likelihood of malignancy. This is crucial because the management of benign and malignant lesions is very different. Key indicators of malignancy include:

  • Solid Components: Presence of solid areas within the mass.
  • Large Size: Larger masses are more concerning.
  • Heterogeneous Appearance: Mixed textures on imaging studies.

 

Imaging and Tumor Markers

Imaging techniques like transabdominal ultrasonography, magnetic resonance imaging (MRI), and computed tomography (CT) scans are essential tools. They help visualize the mass and assess its characteristics. Additionally, certain tumor markers can raise concern for malignancy:

  • Alpha-Fetoprotein (AFP)
  • Lactate Dehydrogenase (LDH)
  • Beta Subunit of Human Chorionic Gonadotropin (β-hCG)
  • Cancer Antigen 125 (CA-125)
  • Inhibin

However, it's important to note that the serum levels of these markers alone cannot definitively confirm or exclude malignancy.

 

Management and Specialized Care

The management of pediatric ovarian masses should aim to be both curative and function-preserving. Minimally invasive techniques are preferred when feasible. Given the complexity of these cases, it's essential that children and adolescents with ovarian masses are treated in specialized centers. This approach ensures accurate diagnosis, appropriate treatment, and avoids unnecessary procedures like oophorectomies.

Conclusion

Ovarian lesions and neoplasms in children and adolescents require careful evaluation and specialized care. Understanding the types of lesions, their clinical presentations, and the appropriate diagnostic and management strategies is crucial for ensuring the best outcomes for young patients. By prioritizing function-preserving and minimally invasive treatments, healthcare providers can help maintain both the health and future fertility of their young patients.


 

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