Ovarian masses in pediatric patients constitute a rare clinical entity, representing less than 2% of all tumors in females under 16 years of age. Benign ovarian neoplasms in adolescents may present with diverse clinical manifestations ranging from asymptomatic findings to menstrual disturbances, pelvic discomfort, nausea, vomiting, and febrile episodes. Ultrasonography serves as the primary diagnostic modality for differentiating ovarian cysts from other pelvic pathologies. In cases of diagnostic uncertainty, advanced imaging techniques including computed tomography or magnetic resonance imaging are indicated. The management of ovarian neoplasms in pediatric populations should emphasize minimally invasive, organ-preserving approaches with particular attention to fertility conservation. Clinical case. We describe the case of a 15-year-old female patient who presented with rapid abdominal enlargement and weight gain over a one-month period. Diagnostic evaluation revealed a giant left ovarian cyst causing bilateral hydronephrosis. Ultrasonographic examination demonstrated a thin-walled, bilocular cystic lesion occupying the entire abdominopelvic cavity, extending to the xiphoid process without evidence of vascularization, suggestive of cystadenoma. Pelvic magnetic resonance imaging (MRI) confirmed the presence of a massive cystic structure without contrast enhancement and identified secondary bilateral hydronephrosis. The patient underwent 3D laparoscopic intervention under endotracheal general anesthesia. The surgical procedure included aspiration of approximately 6800 mL of clear serous fluid from the cystic cavity, identification and correction of left ovarian torsion, and subsequent cystectomy with maximal preservation of ovarian parenchyma. The intraoperative and postoperative courses were uncomplicated. Notable clinical parameters demonstrated significant changes following the procedure: preoperative measurements included a body weight of 41.1 kg and abdominal circumference of 81 cm, while postoperative values decreased to 33.3 kg and 68 cm respectively, reflecting a reduction of 7.8 kg in weight and 13 cm in abdominal girth. On the postoperative day 2, the patient was discharged home in a satisfactory condition under the supervision of a pediatrician and a pediatric gynecologist. Histopathological examination confirmed the diagnosis of serous cystadenoma. Follow-up renal ultrasonography performed one month postoperatively showed complete resolution of the previously noted hydronephrosis. Conclusions. Early diagnosis of ovarian cysts in adolescent girls will allow to choose a personalized tactic of patient management and prevent the occurrence of serious gynecological and urological complications. Early diagnosis of ovarian cysts in adolescent patients enables the selection of personalized management strategies and prevents potential gynecological and urological complications. Expert ultrasonography serves as the cornerstone diagnostic modality for this pathology. When evaluating large cysts or cases with diagnostic uncertainty, supplementary imaging with computed tomography or magnetic resonance imaging combined with assessment of ovarian tumor markers is recommended. Optimal management of giant ovarian cysts in adolescent patients requires a specialized multidisciplinary approach involving pediatric gynecologists, pediatric urologists, radiologists with expertise in adolescent ultrasonography, and anesthesiologists experienced with teenage patients. For surgical cases in adolescent girls without malignant features, laparoscopic intervention utilizing three-dimensional visualization technology represents the preferred approach when available, with particular attention to preserving future reproductive potential in this young patient population.
Veresnyuk et al. (Wed,) studied this question.