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.

1. Massive Ovarian Cyst in a
Adolescent Girl
Case Report & Review
Presenter: Dr. T.Kiak
O & G Registrar
Mendi General Hospital
Email: tanakiak@yahoo.com

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. Fig 1.Delivering Deflated Sac & Separating
omentum from the cyst
Fig 2.Excising cyst along right tube &
diseases ovary
Fig 3. Excised cyst

10. Post Cystectomy
Her post operative recovery was unremarkable
Pt 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

11. 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.

12. 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.

13. REFERENCES
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adolescent gynecology. Philadelphia: Lippincott-Raven; 1998.
2. Warner BW, Kuhn JC, Barr LL. Conservative management of
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14. THE END