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Children's Health

Cyst

01/14/2011

Question:

Dear Dr,

My daughter is 45days old. We noticed some abnormality at the inguinal area. We consulted a dr and advised for a scan. The scan report reads as below.

A hypo echoic lesion with multiple,small cysts s/o ovary in the right inguinal region. size: 2.2 & 8 cm.

Now Dr advised to go for a surgery.

I seek your valuable advise on this.

Regards

Answer:

Ovarian cysts in female infants occur in about 30% of female infants. Researchers believe their formation is due to the hormones of pregnancy. Many are diagnosed prenatally.

The two treatment paths are 1) watchful waiting for small, non-echogenic cysts and 2) surgery for larger, cysts that are echogenic. A cyst that is non-echogenic is filled with only fluid that is likely to be reabsorbed over time. An echogenic cyst suggests that there is tissue as well as fluid (which could be blood). In your baby's case, the cyst is hypo-echogenic meaning that there is some degree of solid matter within the cyst placing her in a gray area for management.

Surgery for larger, echogenic cysts is recommended because there is currently no way to tell a non-cancerous cyst from a cancerous cyst using ultrasound or other imaging techniques. Larger cysts also tend to go on to torsion or twisting as well as  hemorrhage, both of which are abdominal surgical emergencies. In both cases the baby's entire ovary would be lost. There is no disagreement among experts that solid, echogenic, and large cysts need to be removed.

In the case of early surgery in the absence of torsion and bleeding, attempts are usually made to remove only the cyst and to preserve as much ovarian tissue as possible. Hopefully this will be the case for your daughter if you agree to proceed with surgery. It would be a very good idea to discuss the exact surgical plan with the surgeon. It is ideal to have the surgery performed by a pediatric surgeon and not a general surgeon and for the surgery to be done in a children's hospital facility where doctors and nurses understand the special physical vulnerabilities of children, especially young babies. You may want a second opinion as well.

The most important thing you can do is to ask lots of questions about the two major alternatives in management and to be clear about the surgical strategy planned and the rationale for it. Make sure the anesthesiologist is experienced in the care of infants as well. If you do prefer watchful waiting, it is important to know the signs of ovarian torsion and hemorrhage and to be faithful in keeping follow-up appointments to evaluate the cyst.

I am sure this is a most worrisome time with a new baby. I hope this information is helpful in assisting you to decide on the best care for your daughter.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University