What kind of ovarian masses occur in children?

Ovarian cysts and solid ovarian tumors occur in children as well as adults. In very young infants ovarian cysts can form because of the influence of maternal hormones. In adolescent girls (as in adults) cysts can form as a result of the normal monthly hormone cycle. Solid tumors, both benign and malignant, also occur in children. The most common ovarian masses are usually benign, either a teratoma or a dermoid cyst.

Which ovarian masses require surgery?

 Large cysts and solid masses are usually removed surgically because:

1. Pain and risk of infection associated with ovarian torsion 
2. Cysts may leak, with the leaked fluid causing pain, so large cysts with demonstrable leaked fluid in the abdomen may require surgery
3. Solid masses are never normal and require surgical exploration

A large ovarian mass will pull on pelvic ligaments and make it likely that the ovary will become twisted (called "torsion") -- which is very painful. Reports of extreme pain by the patient are an important indicator of a torsed ovary -- the diagnosis can be confirmed by observing a lack of blood flow to the ovary on a pelvic ultrasound exam. Frequently these cases are treated with an emergency surgery. Ovaries that have torsed can only rarely be salvaged.

How is surgery done?

Surgery to remove an ovarian mass can be done either open or laparoscopically. Open surgery is usually done through a “bikini” incision low in the abdomen, splitting rather than cutting the abdominal muscles. Laparoscopic surgery is done through small incisions in the umbilicus and lower abdomen. After placing ports in these incisions, a viewing scope and operating instruments are inserted. Some ovarian cysts can be removed while leaving the rest of the ovary intact, but other cysts may require removing the entire ovary and fallopian tube on the affected side. In all cases surgeons take great care to inspect the opposite ovary and protect it from torsion in the future. Incisions are usually closed with absorbable sutures and skin sutures are buried so stitches do not need to be removed.

What are the effects of removing a cyst or removing the ovary?

Other than the normal process of recovering from surgery, removing a cyst while leaving the ovary intact should cause no noticeable effect. Removing one ovary will not affect the normal function of the other ovary, so hormone effects (pubertal change, menstruation) and reproductive capacity of the other ovary should be unaffected.

What is recovery like?

Recovery from ovarian surgery is usually rapid. Most patients treated by the Division of Pediatric Surgery at Johns Hopkins All Children's Hospital are discharged the day following surgery. Patients are usually allowed fluids and food as soon as they recover from anesthesia, and are switched from IV to oral pain medicine. Physical activity is restricted for a few weeks after surgery, but patients may return to school within a few days, once the pain subsides.