Pediatrics 2022

Aseel H S Hraishawi

Stoke-on-Trent, United Kingdom

Title: Giant Cystic Abdominal Mass in an Adolescent Girl


Introduction: Ovarian neoplasms are rare in pediatric population forming only 2.6/100000 cases per year. When the cysts are too large to be assessed by an US scan diagnostic errors are common. The following case report exemplifies the difficulties in initial assessment and management. 
Case description: A 12 year old girl presented with massive abdominal distention causing orthopnea. However, one could not discern any organomegaly. The abdomen appeared fluid filled and was dull on percussion with very minimal dilated veins on the abdominal wall. Despite ultrasonography and CT scan examination, diagnostic difficulties of its organ of origin and the need to give symptomatic relief, necessitated controlled paracentesis of the fluid filled mass. A borderline ovarian tumor of 8.6 KG weight was removed intact, by a fertility preserving right salpingo- oophorectomy, sparing the opposite normal ovary and tube and uterus . Final histology confirmed a Stage 1A Borderline Ovarian Tumor of the Mucinous Cystadenoma type. The case is reported for its rarity in this age group and is the first one reported in this country.
Discussion: Giant ovarian epithelial tumors are rarely seen these days, due to early detection by various imaging modalities. While benign cystadenoma is the second commonest benign cyst in the adolescent, giant cystadenoma is rare in this age group. In general, tapping of an ovarian cyst is not recommended for fear of rupture, fluid leak into the peritoneal cavity, dissemination of malignant cells and upstaging of a tumor. Fertility preservation is the goal of treatment in adolescent age group; and thus the recommendation is for oophorectomy or unilateral salpingo-oopherectomy.