Hydronephrosis due to voluminous adnexial mass in a teenager : management and treatment. Urogynaecologia International Journal VOL. 25 N°2,20-23,2011.

Paratubal or paraovarian cysts represent approximately 10% of all adnexal masses. They are usually derived from the mesothelial covering of the peritoneum or remnants of paramesonephric and mesonephric origin, so histologically they are covered by a single layer of ciliated columnar or flattened cells. (3) A paramesonephric cyst is a closed, fluid-filled sac that grows beside or near the ovary and fallopian tube, but is never attached to them. It is located on the broad connection (ligament) between the uterus and the ovary, and usually it is unilateral. Paramesonephric cysts are in must cases very small (ranging from 2 to 20 mm). These small cysts have little clinical significance, occurring asymptomatically as incidental findings during other pelvic examinations and surgeries. Most often, they are diagnosed as benign ovarian cysts or as fluid-filled distentions of the fallopian tube (hydrosalpinx). Although known for their small size, paramesonephric cysts can sometimes became larger, especially during pregnancies. Unlike the small cysts, the larger ones are usually symptomatic. Depending on their size and location, large adnexial cysts can make compression on the bladder uterus or bowel. The smaller paramesonephric cysts are most commonly found in middle-aged women (in the 30 to 40 years of age group), and are often indistinguishable from simple ovarian cysts. Larger paramesonephric cysts develop in younger women, quite often during a pregnancy, when they have a tendency to grow quickly. The great paramesonephric cysts frequently cause pelvic tenderness, usually on one side (unilateral), irregular periods, abnormal uterine bleeding, and pain during sexual intercourse (dyspareunia). The large paramesonephric cysts may be discovered when the physician presses with the hands (palpation) on the lower abdomen, or during the vaginal bimanual examination. An ultrasound scan is used to make the diagnosis of the mass, and to define the localization. Tomography is useful to clarify diagnosis but the risk of radiation must be considered. In case of diagnostic doubts, N.M.R. is preferable to detect the right diagnosis and avoid radiation damage on the ovary, especially in young girl. Most paramesonephric cysts that remain small and asymptomatic do not require treatment; sometimes they disappear on their own. Surgical removal of the cyst is usually indicated for women when the mass overtakes 5 cm diameter or in presence of symptomatology. When the cyst is larger than 10 cm, is complex, increasing in size, persists after several months, is solid, dense, and irregularly shaped, or is infected, bleeding or ruptured, more invasive surgery may be required. We report a rare case of paramesonephric cyst of huge dimensions in a 14 year old obese girl (104 Kg).