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Management of complex ovarian cysts presenting in the first year of life
D P Croitoru1, L E Aaron, J M Laberge
1Department of Surgery, Montreal Children's Hospital, Quebec, Canada.
Insights
Complex ovarian cysts in infants require surgical removal due to risks of torsion, neoplasm, or other complications. Early surgical intervention is recommended for all complex ovarian cysts, regardless of size, to prevent adverse outcomes.
Area of Science:
- Pediatric Surgery
- Gynecologic Oncology
- Fetal Medicine
Background:
- Management of ovarian cysts in infants is controversial, particularly with increased antenatal and postnatal diagnosis.
- Existing protocols focus on simple ovarian cysts, leaving a gap for complex cases.
- Complex ovarian cysts present unique diagnostic and management challenges in neonates and infants.
Purpose of the Study:
- To establish a management protocol for complex ovarian cysts diagnosed antenatally or within the first year of life.
- To evaluate the outcomes of surgical management for complex ovarian cysts in infants.
- To provide evidence-based recommendations for the surgical treatment of complex ovarian cysts in pediatric patients.
Main Methods:
- Retrospective review of nine infant cases undergoing surgical treatment for ovarian cysts between 1980 and 1989.
- Analysis of antenatal and postnatal ultrasound findings, cyst characteristics, and surgical interventions.
- Correlation of cyst presentation, size, and pathological findings with surgical outcomes.
Main Results:
- Six of nine infants had antenatally diagnosed complex ovarian cysts (3-10 cm) requiring surgical intervention.
- Three infants were diagnosed postnatally with complex cystic intra-abdominal masses (up to 7 cm).
- Surgical procedures included oophorectomy or salpingooophorectomy, with diagnoses including ovarian torsion, tuboovarian torsion, and a juvenile granulosa cell tumor.
Conclusions:
- All complex ovarian cysts in infants, irrespective of size, should be surgically removed.
- Surgical intervention is crucial to address potential complications such as torsion, neoplasm, or other serious diagnoses.
- Early surgical removal of complex ovarian cysts can prevent significant morbidity in infants.
Abstract:
With more frequent antenatal and postnatal diagnosis, the management of ovarian cysts has become somewhat controversial. Management protocols for simple ovarian cysts have been proposed. The purpose of this study was to establish a management protocol for complex ovarian cysts presenting antenatally and in the first year of life. We reviewed the records of nine infants who underwent surgical treatment for ovarian cysts over a 10-year period (1980 through 1989). Antenatal ultrasound performed between 24 and 34 weeks of gestation showed ovarian cysts in six infants. All six infants had complex cysts ranging in size from 3 to 10 cm on postnatal ultrasound. Exploration with oophorectomy or salpingooophorectomy was carried out at 2 days to 3 months of age for ovarian torsion. Ovarian cysts measuring up to 7 cm were diagnosed postnatally in three infants from 1 day to 7 months of age with ultrasound confirmation of complex, cystic intraabdominal masses. All patients underwent salpingooophorectomy, two for tuboovarian torsion and the third patient for a juvenile granulosa cell tumor. We recommend that all complex ovarian cysts, regardless of size, be surgically removed because they represent torsion, neoplasm, or alternate diagnoses, and removal can prevent possible complications.