Clinical Analysis Of 113 Adolescent Women With Adnexal Cysts

Objective: To conclude the clinical features, diagnosis and treatment of adolescent with noninflammatory adnexal cysts.Methods: A retrospective analysis is performed on 113 patients of aged from 10 to 19 with noninflammatory adnexal cysts in our department between January 2001 and December 2010.Enter criterions: according to the fourth edition of qiao zhi lin gynecological oncology, we divide the parents into two groups: non-necoplastic cysts group and necoplastic cyst group, we divide the ovary tumor according to the standard of classification of ovary tumors by WHO in 2003.The condition of two or more types of cysts in one person:①if the patient has both benign cyst and malignant one, we divide her into the malignant group;②if the patient had both non-necoplastic cyst and necoplastic cyst we divide her into the necoplastic group;③if one patient had different kinds of ovary tumor, we divide her into the unusual group.Exclusion standards:①had no pathology result or could't definite pathologic classification;②inflammatory cyst;③ectopic pregnancy.Rescults:1 Age of the patient, every patient in the group was between 10 to 19 years old. The average age was 16.44. In the group 99 (86.84%) had menarche, in which 2 cases had orthopedic procedure. The average age of menarche was 13.28. while 15 cases not menarche, in which 8 patients had an obstructive anomaly of the reproductive tract.2 distribution of disease2.1 The classification of the disease: there were 66 (58.41%) neoplastic cyst cases, 52cases were benign, 10 cases were malignancy tumors and 3 cases of borderline tumors. 90% of malignancy tumors were germ cell tumor. 48 (42.48%) cases were non-necoplastic cysts, including 12 cases of endometriosis: 8 cases of the patients had an obstructive anomaly of the reproductive tract.2.2 The relationship between the classification of the disease and the patient's age: we can't tell the difference about the incidence of neoplastic cysts in the three groups (10-13, 14-16, 17-19).2.3 We can't tell the difference of the incidence of neoplastic cysts from the have't menarche and already menarche group, but the incidence of malignant tumors and borderline tumors in the haven't menarche group was higher than the already menarche group.3 The clinical manifestation3.1 symptoms:①56 cases of abdominal pain: which having a lot of types, in which 22 cases representd as acute pain, all with the concomitant symptom as nausea and vomiting, finally most of the patients were pathology dignosed with the pedicle of benign masses torsion. The clinical manifestation of 8 cases who had an obstructive anomaly of the reproductive tract usually was chronicity pelvic pain. The pathologic diagnosis was endometriosis. One case displayed as metastatic pain in right lower quadrant was diagnosed with acute appendicitis by the surgeon. In the operation, they found teratoma in both ovary, one of the adnexa turned around already;②menstrual disorder: 18 (15.93%) cases came for menstrual disorder, there were 8 cases non-ceroplastic masses, 10 cases of necoplastic masses;③15 cases had no trouble only found the cyst after physical examination, finally 7 cases proved to be mature teratoma;④10 cases came for abdominal distension, any cyst here was larger than 10cm, the largest is 40×30×25cm. 1case of non-necoplastic cysts, 2 cases of malignancy tumors and 1 case of borderline tumors were larger than 30cm.⑤7 cases came for abdomen circumference increased, only one case proved to be a huge parovarian cyst, the rest were all ovarian tumors.3.2complications: 36cases (31.86%) had complications, 26 cases (72.22%) appeaed torsion of cysts, 9 cases (25%) appeard rupture of the cysts, 1 case (2.78%)appeard infection. 96.15% of the torsions were proved to be benign cysts and the the most were in the left hand. The rupture of the cysts only happened in the non-ceroplastic ones.4 Accessory examinations4.1Ultrasound examination: 112 cases took this examination, the highest accuracy rate was cyctic teratoma(75.93%). The sonographic features and CDFI were useful to judge the benign masses from malignancy ones.4.2 Serological examination: we can't tell the difference between ceroplastic cysts and non-ceroplastic cysts by CA125 in serum. but in the malignant and borderline tumors the vaule of the CA125 were higher than the benign ones. The sensibility of malignant and borderline tumor by CA199 in serum was 60%, the sensibility of yolk sac tumor was 100%. The sensibility of malignant and borderline tumor by CA199 and CA125 was a little higher than only using one method, but it didn't have statistically significant.5 Operation method5.1 Benign cysts: 69 cases had oophorocystectomy while 31cases had adnexectomy. Both torsion and the size of the cyst larger than 1ocm could increase the rate of adnexectomy, they had statistically significant.5.2 The most of malignant tumor was germ cell tumor(90%), the majority of the grade of the tumor were betweenⅠa-Ⅰc, 3 cases were gradeⅡ, 1case was gradeⅢ. All cases had conservative surgery at the frist time. 3cases of borderline tumor had the affected side adnexectomy only.6 chemicotherapy: After sugery nobody in 3 cases of borderlin tumors had chemicotherapy. The cases with malignant tumor had chemo-treatment, 9 cases were with PVB or PEB, 1 case was with VAC, 3 cases recurred finally.Conclusion1 For the adolescent have abdominal pains, distension and abdominal girth increased, we must consider the possibility of gynecological disease and peform pelvioscopy.2 Preoperative ultrasonography is useful for the discnimirnant diagnosis of ovarian malignant and borderline tumor. As to non-necoplastic cyst which diameter<5cm, we can continuous observation by ultrasonic for 3 to 4 months, so we can eliminate unnecessary surgrey. Serum index is a good way to tell the malignant from bengin cyst and to indicate recurrce or not.3 patients with malignant and bordlerine tumor should be follow up routinely.