Ovarian Cysts in Infants and Children
What is a Cyst?

A cyst is basically a small sac filled with fluid.

What is an Ovarian Cyst, and How Does it Form?

Ovarian cysts form when germ cells (oocytes) are surrounded by epithelial cells (follicular cells). These cysts are naturally present in the ovaries and are usually very small, but if they grow or merge, they become pathological. Natural cysts form and disappear. If they do not disappear or merge, cystic diseases develop.

 

Are ovarian cysts in children cancerous or do they turn into cancer?

Cysts are not cancerous. They do not have the potential to turn into cancer. However, there are cancers that have a cystic structure in the ovary, and these must be distinguished from cysts. Cysts are not cancerous, but they can cause the ovary to twist around itself (ovarian torsion), rupture, and bleed into the cyst.

At What Ages Are Ovarian Cysts Seen in Children?

Although ovarian cysts are more common during puberty, they can occur at any age, even in newborn babies.

Are Ovarian Cysts Seen in the Neonatal Period and Up to One Year of Age Important?

If a mass is detected in the abdomen after birth and up to one year of age, one of the first diagnoses should definitely be an ovarian cystic structure. The reason for this is the FSH hormone, which is passed from the mother and normally secreted by the pituitary gland, which promotes the development of the egg. The FSH hormone passed from the mother can trigger cystic structures in the ovaries. However, these cysts are benign and do not require intervention. In rare cases, they can cause the ovary to twist around itself, leading to a condition we call “ovarian torsion,” which presents with severe abdominal pain in children.

Are There Different Types of Ovarian Cysts in Children?

Yes, there are, primarily:

1. Follicular Cysts:

• These cysts form when follicles in the ovary do not rupture.
• They are usually thin-walled cysts measuring 3-12 cm in diameter and filled with a clear, yellowish fluid.
• Although they are more commonly seen after puberty, 84% of ovarian cysts in newborns and children under 2 years of age are follicular cysts.
• They are generally asymptomatic and may resolve spontaneously.
• In cases of large cysts (>5 cm), torsion, bleeding, and rupture may occur, and surgery may be planned for patients who do not show improvement after 2-3 months of follow-up.
• In surgical treatment, the cyst should be removed in a way that preserves the ovary as much as possible, or if the ovarian tissue is severely reduced, an oophorectomy (removal of the ovary) may be performed.
• Medroxyprogesterone can be used in hormone-secreting cysts.

2. Simple cysts:

• They can be distinguished histologically from follicular cysts, and treatment options are the same as for follicular cysts.
• Fine needle aspiration under ultrasound guidance can be performed for simple ovarian cysts in newborns, but the likelihood of recurrence is high.

3. Corpus luteum cysts:

• They are not seen before puberty (before menstruation) because ovulation does not occur. They can be bilateral and very large in size.
• They appear yellow on the outside and bloody on the inside.
• They can secrete both estrogen and progesterone and are more symptomatic than follicular cysts.
• The main symptoms include amenorrhea, irregular menstruation, intermenstrual bleeding, rupture, and torsion.
• They have the tendency to resolve spontaneously, so it is appropriate to monitor them for a few menstrual cycles.
• Surgical treatment is preferably performed laparoscopically. The ovarian tissue is resected partially (wedge resection) or completely (oophorectomy) along with the cyst.

4. Paraovarian Cysts:

• They are formed from structures called epooforons, which remain as waste during the development of the genital organs in the intrauterine period.
• They are located between the leaflets called mesosalpinx, which are between the ovary and the uterus.
• They have no connection with the ovary, only a relationship due to their proximity.
• They are generally seen after puberty and are very rare in newborns.
• They cannot be distinguished from follicular cysts by ultrasound.
• Treatment is surgical, and they must be removed without damaging the ovary and fallopian tubes.

How are ovarian cysts diagnosed in infants and children?

Cysts may be visible in prenatal (in utero) ultrasounds, but it is not possible to completely distinguish them from pathologies such as duplication cysts and pure cystic teratomas.

What should be done if a cyst is detected in utero?

No special action is required; a normal delivery is performed, and then follow-up and treatment are carried out as with normal cysts.

Postnatal cysts are generally asymptomatic, meaning they do not cause any clinical symptoms. They are usually detected during an ultrasound performed for another reason, such as abdominal pain. Sometimes ovarian torsion occurs, and the cyst is detected during the examination performed for this reason.

During puberty, if your daughter experiences pain in the groin area and menstrual irregularities, there may be a cyst in her ovary.

How Should Cysts Be Treated in Infants and Children?

Cysts may require surgery or may be monitored. The decision on which cysts require surgery and which should be monitored is made based on the patient's clinical condition, the size and type of the cyst, and the patient's age.

Cysts that meet the following criteria are surgically removed: if the cyst has twisted (torsioned) or ruptured, it should be surgically removed under elective conditions if it is not an emergency. The current surgical approach involves laparoscopic removal of the cyst while preserving the ovary or performing unrousing.

Which cysts should be operated on?

Cysts larger than 4 centimeters in infancy

1. Cysts larger than 5-7 centimeters in adolescence
2. Cysts with multiple chambers (these are called “complex cysts”)
3. If the cyst has twisted around its stalk
4. If the cyst has ruptured
5. If there is bleeding inside the cyst
6. Cysts that do not meet the above criteria are monitored. Monitoring is performed using ultrasound and clinical examination. During monitoring, the following are examined:
7. Whether the cyst is growing
8. Whether its structure has changed
9. Whether it has merged with other cysts
10. Whether the patient has any clinical symptoms (pain and menstrual irregularities in older children).

Cysts that form in the neonatal period due to the effects of hormones passed from the mother are very likely to disappear on their own if they are 4 centimeters or smaller, as the effects of these hormones gradually disappear over time after the baby is born. These patients are monitored regularly with ultrasound.

1. During puberty, cysts that are not large enough to require surgery are usually monitored for two or three menstrual cycles, and if they do not shrink, they may be surgically removed. This is because there is a possibility that the cysts may shrink or disappear after menstruation. No special measures are taken to shrink the cyst.
2. Drug treatment is not very effective for ovarian cysts in children and is not used frequently.
3. During surgery, the contents of the cyst are drained, the cyst wall is removed, and the ovary is carefully preserved; the ovary is not removed.

*** The information provided here is intended to inform visitors, particularly families, about the content of the website. No information should be considered as advice by visitors and should not lead to any decisions or actions. Families should have their child examined by a pediatric surgeon, consult with them, and make decisions based on their individual advice.