Massive Ovarian Cyst in a Adolescent Girl

Case Report & Review

Presenter: Dr. T.KiakO & G Registrar

Mendi General HospitalEmail: tanakiak@yahoo.com

Background Ovarian tumours are rare in childhood and account for

approximately 1% of all tumours in children and adoles-cents.Germ cell tumours are the most common type of ovarian tumours in children and adolescents.Epithelial cell tumours are less likely in children,while mature ter-atomas, commonly called dermoid cysts,are the most frequently occurring germ cell tumour of the ovary.Immature teratomas and malignant germ cell tumours on the other hand, are relatively rare.

These cysts can develop in females at any stage of life, from the neonatal period to postmenopause. Most ovarian cysts, however, occur during infancy and adolescence, which are hormonally active periods of development. Most are functional in nature and resolve with minimal treatment.

Abdominal cysts are sacs or lumps surrounded by a thin membrane and consist of fluid or semi-solid material. While most cysts are benign, the development of an abdominal cyst may signal an underlying disease. There are several types of abdominal cysts. One of the most common is an ovarian cyst, which forms on ovarian follicles.

The number of diagnoses of ovarian cysts has increased with the widespread implementation of regular physical examinations and ultra-sonographic technology. The discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, but the vast majority of ovarian cysts are benign.

However, ovarian cysts can herald an underlying malignant process or, possibly, distract the clinician from a more dangerous condition, such as ectopic pregnancy, ovarian torsion, or appendicitis.

Due to the simple fact that some cysts can grow from the size of a pea to a grapefruit over time, they can sometimes present complications. Pain, unexplained bleeding and bowel obstruction, should be investigated without delay.

Case Report

A 16 year old adolescent school girl presented with history of gradual distension of abdomen over 2 years. The distension was painless throughout till 2 weeks back when it started causing breathlessness, early satiety and fullness after meal and pain and nausea.

There was no history of jaundice, haematemesis, melaena or any other constitutional symptoms. She had normal appetite and regular bowel bladder habit. Her menachy was at 14 years old had a normal menstrual history.

On clinical examination, she was of average built slightly pale associated with tachycardia and hypotension. A tense and tender lump was arising out of pelvis and was extending up to umbilicus. The abdominal lump was 36 weeks in size, mobile and tender on palpation and was diffusely distended involving all quadrants. Umbilicus was centrally placed and not stretched and everted

Lump was soft and cystic and fluid thrill was present. We made a differential diagnosis of ovarian vs mesenteric cyst.

Ultrasonogarphy(USG) revealed a huge cyst arising from right ovary, measuring 36 x 20x 10 cm3. No ascites or pleural effusion was seen.

Rest of the laboratory investigations (Hb: 13 gm%, WBC: 8200/ml, Bilirubin: 1.14mg/dl, Albumin: 6.49gm%, ESR: 20mm) were normal.

On laparotomy, a massive twisted cyst (36x20x10 cm3) was arising from right ovary reaching up to the liver and stomach. It was surrounded with omentum. 500mls of brownish cystic fluids removed and the sac was excised along Rt tube and section of diseased ovary preserving as much ovarian tissues as possible .

Left ovary, fallopian tube and uterus were left intact. Specimens was sent for histological examination.(Figures 1-3)

Uterus and left ovary were normal in size and texture. Liver and spleen were normal. Peritoneal deposits, free fluids and lymphadenopathy were absent.

Fig 1.Delivering Deflated Sac & Separating omentum from the cyst

Fig 2.Excising cyst along right tube & diseases ovary

Fig 3. Excised cyst

Post Cystectomy

Her post operative recovery was unremarkablePt was advised on her fertility as surgical

intervention was directed towards preservation of ovarian tissue as much as possible

She is awaiting her Histological examination results

Discussion & Conclusion

Functional ovarian cysts can occur at any age (including in utero) but are much more common in women of reproductive age. They are rare after menopause. Luteal cysts occur after ovulation in reproductive-age women. Most benign neoplastic cysts occur during the reproductive years, but the age range is wide and they may occur in persons of any age.

For benign tumours adhesion prevention strategies should be used. Surgical intervention should as much as possible be directed towards preservation of ovarian tissue. There is scarcity of published literature on this subject.

We need bigger studies to address the issue of how much fertility preservation is safely possible.Irrespective of indication for surgery, it is always preferable to attempt conservative, fertility sparing surgery in adolescents.

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