If a cyst is totally anechogenic, all teams agree that the patient should be monitored for a period ranging from 4 weeks to 6 months. Control ultrasound studies done 2 weeks after diagnosis and then at monthly intervals enable assessment of any change in volume. If there is any clinical or ultrasonographic change or if the cyst persists for more than a reasonable period of observation, excision must be planned as it may be an organic, fluid cyst such as a serous cystadenoma or a dermoid cyst.
If adnexal torsion is suspected or if the cyst is heterogeneous, emergency surgery should be performed (see chapter: Ovarian masses in adolescent girls).
The presence or recurrence of a secretory cyst suggests McCune-Albright syndrome and every effort must be made (aspiration or surgery) to obtain diagnostic evidence by molecular biological analysis; long-term surveillance is also necessary in this case (bone and other endocrine expression). Granulosa cell tumors are very rare and the initial presentation associates precocious pseudopuberty with a heterogeneous mass. Treatment is surgical.
Cysts in the prepubertal period are rarer than in the neonatal and pubertal periods. When found, small cysts (< 10 mm) without pathological significance are most common. Cancerous cysts are very rare. Radiologic data confirm the presence of calcifications in benign teratoma. Precocious pseudopuberty with recurrent ovarian cysts evokes the diagnosis of McCune-Albright syndrome and it is necessary to analyze the Gs α gene in cystic ovarian tissue.
The finding of this mutation is of importance for long-term follow-up.
Revision date: July 4, 2011
Last revised: by Andrew G. Epstein, M.D.