Ovarian Cysts in Young Girls

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Ovarian Cysts in Young Girls

Basically, the types of ovarian cysts in young girls are no different than the ones in adults. The important point here is that the cysts found in ovaries of girls in adolescents are very rarely malign. At this point, I guess it is proper to share the data I shared in girl’s sections: Frequency of adnexial mass in 0-14 age group girls in USA in 2000 was found 1/1.000.000 in 0-10 and 8/1.000.000 in 10-14 (Schultz K.A.P. Clin. Obstet. Gynecol. 2006).

The most important cause is (which would be cancer), please do not let anyone remove ovaries of your girls or yours! If there is a suspicious mass, a pathologist must be present in the operation room and surgery must be conducted as if it is malign anyway. When pathologist applied “Frozen section”, meaning decided whether or not the mass is malign, the surgery should continue in that direction. I told what I should have told at the end, but I think this is the most important point here!

You may see various cystic formations in adolescent patient down below. You may find detailed information about these cysts under various topics but you may have summarized information here. I will also try to share my experience in the subject with the slides belonging to my speeches before.

Prof. Dr. Süleyman Engin Akhan
Ovarian Cysts in Adolescents (Adnex=Ovaries+Tuba)

1.Simple and Functional Cysts in Young Girls:

These cysts are fluid filled cysts that occur due to lack of tear of the follicle that contains the ovum which develops at the end of each cycle, meaning lack of ovulation. In case they grow very large, they may give symptoms such as trouble in urination or pain. It commonly causes irregular menstruation because it contains hormones in the cysts. Paraovarian cysts are the ones that derive from the epithelium of tuba, which are not relevant to the ovaries but considered as ovarian commonly because they are right next to the ovaries.

Here you may see the summarization of symptoms of these cysts and treatment options.

Simple Ovarian Cysts in Young Girls and their features

Prof. Dr. Süleyman Engin Akhan
Genç Kızlarda Basit Yumurtalık Kistleri ve Özellikleri

Simple ovarian cysts in young girls and treatment of paraovarian cysts

Simple ovarian cysts should not be intervened until their size becomes over 8-10 cm (read it carefully, I mean 10 cm). They actually regress in 3-6 months. If they do not and if there are severe symptoms such as pain, they should be removed laparoscopically. Note that ovaries are never removed!!

We all prescribe oral contraceptives in treatment of ovarian cysts as gynecologists but they are scientifically proven ineffective .(Grimes DA ve ark. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD006134. DOI: 10.1002/14651858.CD006134.pub4)

Surgery is a must in treatment of Paraovarian cysts, they do not regress spontaneously. Laparoscopic surgery should be done here. What should be considered is that patient’s tube must not be harmed. Although it seems easy, it may prove to be difficult sometimes.

2.Bloody Ovarian Cyst, Corpus Luteum Hemorajicum

The nightmare of families, these are simple cysts that bleed into the abdomen. They are actually simple cysts I told above but when they get ruptured sometimes their vessels in their walls bleed excessively and patient presents with severe abdominal pain. The important thing is not to rush into surgery. This bleeding commonly limits itself. Young girl should not be operated unnecessarily as any surgery has the potential of causing adhesions. Families commonly ask what this blood in the abdomen will be. The body absorbs and clears this blood. If patient’s blood values are dropping, hematocrit or hemoglobin levels are getting low, laparoscopic surgical intervention may be done in this case. Ovaries are never removed and they should not be over burned in order to stop the bleeding.

Prof. Dr. Süleyman Engin Akhan

3. Endometrioma in Young Girls

Endometrioma of young girls is a common condition of which management may vary widely. Endometrioma/endometriosis is the condition in which uterine tissue is located outside the uterus, sometimes in the ovaries. Let’s underline some important points here as the subject is very wide. The aim in a case of young girl who has endometriosis or endometrioma is to regulate complaint focused treatment with the least possible surgery. Endometriosis is a chronic disease. Aggressive surgery should be done without hesitation when necessary, but it is the best to delay coming to that point. Besides, any surgery will have negative effect on fertility of patient in the future. In order to manage the patien without any surgery, oral contraceptives and nonsteroid anti-inflammatory drugs may be used.

If surgery is necessary, a well operation, curative surgery is a must! Surgery must not be repeated. A thorough operation is necessary if surgery will be done.

Prof. Dr. Süleyman Engin Akhan
Endometrioma in a young girl 15 years old

4. Ovarian Torsion

The incidence and ethiology of ovarian torsion is unknown. It is very rare for normal adnexes to develop ovarian torsion. On the other hand, torsion due to cysts below the sizes of 5cm is also very rare. Adnexial torsion results from each two pedicle being mobile. First the veins, and the arteries are obstructed and death of certain amount of cells in the ovaries occur which we call necrosis.

Prof. Dr. Süleyman Engin Akhan
Ovarian Torsion (check the color!)

In the past, we directly removed the ovaries that had dark colors. Today, the basic rule is that ovaries that develop torsion must never be removed. This is very important. Only the torsion part of the ovaries are corrected and it is let to stay as it is afterwards. This whole operation can be done laparoscopically. Then why do you leave it there when you removed it before, if you ask, there has been a study in 2009. In this study, it was shown that the ovarian reserves are protected even in prolonged ischemia, fully obstruction of veins is very rare and necrotic black look do not result from necrosis but the stasis in the vein/lymph flow.

Adnexial torsion has the indication to emergent laparoscopy if there is a suspicion for ovarian torsion. Although the results of colored Doppler usg helps, they do not put a diagnosis or lead the treatment. This point is important, as people say let’s remove the ovaries because Doppler shows no blood flow, this is very wrong. The color, edema and size of the ovaries do not objectively reflect the damage in the ovarian tissue.

Prof. Dr. Süleyman Engin Akhan
Ovarian Torsion in a 40 days old baby

The cyst may be removed when the ovaries are brought back to normal. The ovaries get back to normal after 1 month!

Prof. Dr. Süleyman Engin Akhan