Ovarian Neoplasms - Etiologies of Ovarian Cysts in Prepubertal Girls

Ovarian Neoplasms

Benign Teratomas
Dermoid cysts are the most frequent neoplasms in childhood, with the mean age of diagnosis being 10 years. These are benign germinal tumors that develop slowly but they may become very large. Ultrasonography shows their heterogeneous appearance with a solid cystic component containing ectodermal tissue (skin, hair, dentin) and calcifications which are also clearly visible on plain radiographs.

Treatment consists of cystectomy and careful examination of the contralateral ovary. Monitoring by ultrasonography is continued for several years.

Juvenile Granulosa Cell Tumors
These tumors, which develop during childhood, derive from granulosa cells and tend to be of low malignity. These neoplasms manifest by precocious pseudopuberty and most of them have mixed components, both solid and liquid. Purely cystic tumors are principally virilizing granulosa cell tumors. They secrete estrogens or androgens, which accounts for the rapid appearance of pubertal signs and metrorrhagia. They are generally benign and treatment is surgical excision. Postoperative follow-up consists of ultrasonography and measurement of anti-Müllerian hormone (AMH) and inhibin, which are specific markers of this type of tumor. Greatly decreased postoperative levels are a criterion of cure, whereas an increased level raises the fear of recurrence.

Other tumors such as sex cord-stromal and mixed germ cell tumors are very rare in childhood. They have been reported in girls with isosexual precocity, but the ultrasonographic appearance is very different with heterogeneous and solid components.