What is the follow-up for a 17-year-old female with a complex right ovarian cystic lesion measuring over 4 cm and a benign follicular cyst in the left ovary measuring 2.3 cm?

From the Guidelines

For a 17-year-old female with a complex right ovarian cystic lesion measuring approximately 4 cm and a benign follicular cyst in the left ovary measuring 2.3 cm, I recommend close follow-up with repeat ultrasound in 6-8 weeks to monitor for resolution or changes in the cysts. The patient should be referred to a gynecologist or adolescent gynecology specialist for evaluation. While many ovarian cysts in adolescents are physiologic and resolve spontaneously, the complex nature of the right ovarian cyst warrants closer monitoring. Pain management can include over-the-counter NSAIDs like ibuprofen 400-600 mg every 6 hours as needed. If the patient experiences severe pain, increasing cyst size, signs of torsion (sudden severe pain, nausea, vomiting), or rupture, she should seek immediate medical attention. Hormonal contraceptives (combined oral contraceptives) may be considered to prevent new cyst formation, typically starting with a low-dose formulation like 20-30 mcg ethinyl estradiol with a progestin component, taken daily for at least 3 months. This approach is justified because most functional ovarian cysts in adolescents resolve within 1-3 menstrual cycles, but complex cysts require monitoring to rule out neoplastic processes, while hormonal suppression can prevent further cyst development 1.

Key Considerations

• The O-RADS US risk stratification and management system provides a framework for evaluating and managing adnexal lesions, including ovarian cysts 1.
• The system categorizes lesions into different risk categories, including physiologic, almost certainly benign, low risk, intermediate risk, and high risk 1.
• The management of ovarian cysts depends on the risk category, with physiologic and almost certainly benign lesions typically requiring no further management, while higher-risk lesions may require closer monitoring, referral to a specialist, or surgical intervention 1.
• Hormonal contraceptives may be considered to prevent new cyst formation and reduce the risk of ovarian cancer 1.

Management Strategies

• Close follow-up with repeat ultrasound in 6-8 weeks to monitor for resolution or changes in the cysts.
• Referral to a gynecologist or adolescent gynecology specialist for evaluation.
• Pain management with over-the-counter NSAIDs like ibuprofen 400-600 mg every 6 hours as needed.
• Consideration of hormonal contraceptives to prevent new cyst formation and reduce the risk of ovarian cancer.
• Immediate medical attention if the patient experiences severe pain, increasing cyst size, signs of torsion, or rupture.

From the Research

Follow-up for Ovarian Cystic Lesions

The follow-up for a 17-year-old female with a complex right ovarian cystic lesion measuring over 4 cm and a benign follicular cyst in the left ovary measuring 2.3 cm involves careful consideration of the risks and benefits of different management strategies.

• The patient's age and desire to preserve fertility are important factors in determining the best course of action 2, 3, 4.
• Expectant management with serial ultrasounds may be considered for patients with complex ovarian cysts, as the risks of malignancy are low and the alternative can be devastating 2, 3.
• Laparoscopic ovarian cystectomy is a common treatment for ovarian cysts, but it may not be necessary for all patients, especially those who desire to preserve fertility 2, 3, 5.
• Minimally invasive, fertility-preserving surgery should be considered as a standard treatment for borderline paratubal cysts if patients desire future fertility 4.
• The size and characteristics of the cyst, as well as the patient's symptoms and medical history, should be taken into account when determining the best course of action 5, 6.

Key Considerations

• The patient's age and desire to preserve fertility are important factors in determining the best course of action 2, 3, 4.
• The size and characteristics of the cyst, as well as the patient's symptoms and medical history, should be taken into account when determining the best course of action 5, 6.
• Expectant management with serial ultrasounds may be considered for patients with complex ovarian cysts, as the risks of malignancy are low and the alternative can be devastating 2, 3.
• Laparoscopic ovarian cystectomy is a common treatment for ovarian cysts, but it may not be necessary for all patients, especially those who desire to preserve fertility 2, 3, 5.