(84) Mature Ovarian Dermoid Cyst Trajectory in Premenarchal Girls

Background: Mature ovarian dermoid cysts (ODCs) are the most common benign ovarian tumor diagnosed in children. However, there is a paucity of data on management of ODCs in premenarchal patients. This study aims to assess characteristics associated with expectant management (EM) vs surgical management (SM) in premenarchal patients, to assess growth rate of ODCs in patients expectantly managed, and to investigate rates of oophorectomy versus cystectomy in patients who had surgery

Methods: A retrospective chart review was performed in premenarchal patients ages 0-14 years diagnosed with an ODC between 2012 and 2023 at a single institution. Inclusion criteria consisted of either post-surgical patients with pathologically-confirmed ODC or patients with a radiologic finding consistent with an ODC. Data collected included demographics, cyst characteristics, imaging findings, presence of symptoms, and surgical procedure performed. Analysis to assess differences was performed using Chi squared and Fisher’s exact tests

Results: Forty-four patients met inclusion criteria. Patient age at diagnosis was similar between groups (8.8 vs 8.0, P<.55). Thirty-six patients (82%) underwent SM and eight (18%) underwent EM. Racial and ethnic distribution was similar between groups, and a majority (70%, n=30) were diagnosed by a transabdominal pelvic ultrasound (Table 1). Twenty-two (50%) had imaging findings of calcifications, and 17 (39%) had fat found within the ODC. There was a significant difference in cyst size between SM and EM groups (8.9 cm vs 3.6 cm, P<.01). Eleven (30%) of patients in the SM group underwent oophorectomy vs cystectomy and there was a significant difference in ODC size between procedures (11.8 cm vs 7.7 cm P<.016). Thirty (83%) of SM patients had symptoms at diagnosis, compared to 2 (25%) EM patients (P <.01). Six of eight EM patients (75%) had at least one follow-up ultrasound performed, at an average time frame of 3.67 months from diagnosis, and the average cyst size was stable(3.63 cm. vs 3.67 cm). Three EM patients had four follow-up ultrasounds, the farthest out of which was 44 months after diagnosis—in this timeframe, the ODC grew from 1.6 cm to 4.5 cm. See Figure 1 for details on trajectory of EM patients, 3 (50%) of whom eventually underwent surgery

Conclusions: Literature on the trajectory and management of ODCs in premenarchal patients is lacking. Cyst size at presentation differs significantly and appears to be a significant determinant in the decision path for SM vs EM. Continued research on EM with a larger cohort would assist in furthering understanding of ODC growth progression and parameters for recommending SM in asymptomatic individuals