The Various Ovarian Masses

Non-Neoplastic Functional Disorders: Functional Cysts
The development of simple cysts is quite common in adolescents, and the risk of malignancy is close to zero. In the pubertal period, ovaries may contain multiple follicles in different stages of development, and most simple cysts result from the failure of maturing follicles to ovulate and involute. This cystic transformation may be due to either inadequate or excessive ovarian stimulation, as indicated by increased frequency in the pubertal or perimenopausal periods, after treatment to induce ovulation or during treatment with certain microdose progestative contraceptive pills.

The frequency of functional cysts is most certainly underestimated as asymptomatic and spontaneously regressive forms go unrecognized. In a series of 139 observations of adolescent girls who had undergone routine ultrasonography, 12% of the girls had cysts that resolved spontaneously within 3 months. Management depends on clinical symptoms and the diameter and appearance of the cyst. Mere surveillance is only decided if the cyst is a simple one and, inversely, surgery is called for if lesions are suspect and their histological nature must be determined.

When the cyst is unilateral and purely fluid on ultrasonography, surveillance for 3 months with a monthly ultrasound check-up is indicated. Treatment with progestogens or a combined oral contraceptive reduces the time the cyst takes to resolve and decreases the risk of recurrence. In a series of 144 patients, cysts resolved in 3 weeks with estroprogestative treatment compared with 4.5 weeks without treatment. The adolescent should be informed that ultrasonography must be done if acute pain develops, because of the risk of adnexal torsion. If the cyst persists after 3 months or if it rapidly increases in volume, surgery by laparoscopy or laparotomy may be necessary to remove the cyst for histopathological study. This makes it possible to differentiate a simple cyst from a paraovarian or paratubal cyst, a hydrosalpinx or certain epithelial tumors such as serous cystadenomas. These simple cystic processes are not neoplasms and are considered as physiological variations; they are benign and derived from a follicule (first part of the cycle), a corpus luteus (after ovulation) or the cells of the internal theca.

Epidemiology: Predisposing Factors
In the adolescent girl, risk factors such as early menarche, long menstrual cycles or oligomenorrhea may increase the possibility of ovarian cyst. Inversely, the risk decreases if the first menses appeared after the age of 14 years (odds ratio (OR) 0.4), cycles are short and regular (<26 days), and the patient is obese (OR 0.5). The risk is, however, doubled with irregular menses (OR 1.9).

Risk may be affected by tobacco consumption, with a twofold relative increase of risk in patients who are smokers.