The patient's evolution was favorable, and she was discharged after 1 day. The follow-up at 1 month showed normal clinical, paraclinical, and ultrasound findings.
The PCs are usually encountered in the broad ligament between the ovary and the fallopian tube, and they may be either nonneoplastic simple cysts or neoplastic ones. The histologic variants of PCs include mesonephric, mesothelial, and paramesonephric origins.[1,2] The most frequent reported type was paramesonephric variant. In our case, the giant PC was also located within the broad ligament and the histologic examination revealed no signs of neoplasia. Even though retrospective studies showed a low incidence of neoplastic PCs, a more recent prospective study showed a higher incidence of these lesions, of approximately 25%. In these cases, the preoperative ultrasonography is the single tool that may suggest a neoplastic origin of these cysts revealing papillary projections or gross papillary excrescences on their internal wall. Contrariwise, in our case, the abdominal ultrasound did not show any abnormal findings. Moreover, the sizes do not influence the neoplastic character of PCs. Usually these cysts grow slowly, and they are discovered incidentally during the third or fourth decade of life, being rare during childhood or adolescence.[5,6] Nevertheless, Torres and Íñiguez reported the case of a 13-year-old female presenting with intermittent abdominal pain and increase in abdominal volume who was diagnosed with a giant simple PC of 23/20/8.7 cm diameter. Additionally, Felipe et al. reported a giant PC, but smaller than ours and that of Torres and Íñiguez, of 14 cm length in a 15-year-old patient, who also complained by abdominal pain and increase in abdominal volume. Our patient was incidentally diagnosed with a pelvic cystic lesion because she did not express any symptoms, most likely due to the smaller sizes (170/140/85 mm) of the PC in comparison to the case previously mentioned. Another particularity worth mentioning is that in our patient, it was associated with another 2 smaller PCs. MRI is superior to ultrasound regarding the delineation between the ipsilateral ovary and the PC. Thus, a MRI usually shows a clear delineation between the pelvic cystic lesion and the normal shape of the affected-side ovary. Moreover, according to the Society of Radiologists in Ultrasound, cysts larger than 7 cm require MRI assessment irrespective of the patient's age. Nevertheless, in our case as in the case reported by Torres and Íñiguez, the MRI misdiagnosed the cystic lesion as originating from the left ovary. Therefore, the preoperative diagnosis of PCs is very difficult to be certainly established despite proper imagistic assessments. Giant PCs larger than 10 cm are extremely rare even in adults, but especially in children, and anecdotal in the literature,[27,28,30–32] resulting in a supplementary burden on the diagnosis. Most of the times, these cystic lesions are asymptomatic, like in our case, but their complication rate seems to be higher in children than in adults, and the most frequent complication in pediatric ages is the torsion of adjacent organs such as Fallopian tube of ovary. Thus, Gupta et al reported 2 cases of PC torsion in an 11-year-old and 9-year-old girls complaining of intermittent abdominal pain, strongly recommending laparoscopy to prevent potentially devastating complication, particularly in children.
Giant PCs are extremely uncommon during childhood. The preoperative diagnosis of PCs is very difficult despite the use of proper imagistic diagnostic tools. The surgical removal of PCs through laparoscopic approach is the gold standard treatment for children to prevent potentially devastating complication.
Dr Mărginean Cristina Oana, Dr Mărginean Claudiu and Dr Meliţ Lorena Elena conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
Dr. Mihai Poruţiu, Dr Vlăduţ Ştefan Săsăran and Stud. Cristian Dan Mărginean designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript.
Dr Mărginean Claudiu and Dr Vlăduţ Ştefan Săsăran were involved in the surgical management, designed the data collection instruments, coordinated and supervised data collection, and critically reviewed the manuscript.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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