ABSTRACT
Ovarian cysts are extremely common and should be regarded as a separate entity from cystic neoplasms when considering surgical management. Follicular cysts are not neoplastic and are sensitive to hormonal stimulation. They are detected most often after puberty, but are also seen prenatally and in newborn girls due to maternal estrogen stimulation. The majority of neonatal cysts are asymptomatic and spontaneously decrease in size by 3-4 months of age. Torsion may occur antenatally and produce a complex appearance to the cyst. Large cysts may occasionally cause respiratory distress or visceral compression impairing feedings. Symptomatic neonatal cysts require surgical intervention, but techniques designed to preserve normal ovarian parenchyma should be used whenever possible. Simple aspiration is occasionally successful, but high recurrence rates are seen, and cyst fenestration by open or laparoscopic technique is preferred. Cysts in the prepubertal child associated with precocious puberty should be evaluated by the pediatric endocrinologist. Postpubertal cysts may be asymptomatic or may present with
pain due to large size, hemorrhage, or torsion. Most simple cysts will resolve spontaneously within three to four menstrual cycles. Indications for surgical intervention include persistent symptoms, pain, or evidence of torsion.
