Background: Very large pelvic cysts in young adolescents present a challenge in diagnosis and management. When such cysts present shortly after menarche, measure > 20 cm and appear simple on ultrasound or MRI, the diagnosis is likely a benign paraovarian cyst.
Cases: Three young adolescents within 2 years of menarche presented with abdominal distention and masses. On ultrasound and MRI each was confirmed to be a large simple cyst ranging from 20-26 cm in diameter. In each case the simple cyst was drained through a very small incision, allowing the decompressed cyst and adnexa to be externalized and a cystectomy to be performed. The final pathology in each case was consistent with a paraovarian cyst.
Conclusion: The peak incidence of paraovarian cysts is in the fourth and fifth decades of life; however, larger paraovarian cysts are more common in postpubertal teenagers. This is likely due to the fact that smaller asymptomatic cysts go unrecognized until later in life when they are found incidentally. Ultrasound is helpful in making the diagnosis in a young patient. Such cysts are unlikely to be malignant, and the least invasive approach possible in a young patient is preferable.