Management of ovarian lesions diagnosed during infancy

Purpose: Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively. Methods: A retrospective study was performed of ovarian lesions in children < 1 year-old from 2000 to 2014. Results: Forty patients were identified. Twenty-eight (70%)underwent operative management, while 12 (30%)were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%)had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid–fluid or fluid–debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm)and were followed for an average of 153 days until resolution. Conclusions: The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed. Level of evidence: IIC.