Ovarian cysts in children and adolescents: their occurrence, behavior, and management.

STUDY OBJECTIVE

To evaluate the characteristics and symptoms of ovarian cysts, their connection with the methods of treatment, and the effectiveness of the therapy.

METHODS

A retrospective analysis of data on girls with ovarian cysts was performed at a university clinic. Participants included 119 girls in whom 144 ovarian cysts were found by ultrasound examination performed either routinely or for a specific purpose. One group of patients received gestogen to facilitate resolution of the cyst and as treatment of menstrual disorder. Others received clomiphene citrate exclusively as therapy for menstrual irregularity. Aside from this, patients were treated by surgical intervention, or only follow-up sonography was performed. The site, number, size, and type of the cysts were examined. The indications for ultrasonography and the effectiveness of the treatment were analyzed.

RESULTS

The ovarian cysts were mostly unilateral, unilocular, and simple, with the size varying between 3 cm and 5 cm in diameter in 90 cases, more than 5 cm in 41 cases, and less than 3 cm in 13 cases. A number of cysts were found incidentally on ultrasound. Girls were scanned most often because of irregular bleeding (80 cases). Hormonal treatment was given in 105 cases, whereas in 35 cases only follow-up sonography was performed. Cysts resolved spontaneously in 4.5 weeks on average, or in 3 weeks after hormonal treatment. Surgical therapy was necessary for nine patients. The indication for surgery was the detection of complex cysts indicative of dermoid type, size of the cysts, severe pelvic pain, or failure of the cyst to resolve or decrease in size spontaneously or in response to treatment as determined by follow-up sonography. All of the cysts were benign on pathological evaluation.

CONCLUSION

Most ovarian cysts in girls could be managed conservatively, even the larger ones greater than 5 cm in diameter. Only exceptional cases required surgical therapy. Hormonal treatment shortened the duration of the cysts somewhat, but not significantly, and thus was useful mainly in the treatment of concomitant menstrual disorders.