The Importance of Follow-Up in Adolescent Patients With a History of Ovarian Dermoid Cysts: A Case Report

Ovarian dermoid cysts (ODCs), also known as mature cystic teratomas, are the most common ovarian neoplasms in children and adolescents. While typically asymptomatic, ODCs can present with a range of symptoms, including neuropsychiatric disturbances due to paraneoplastic encephalitis. The absence of universally accepted guidelines for post-operative surveillance poses a significant challenge in managing these cases, particularly in adolescent patients. We report the case of a previously healthy 12-year-old girl who initially presented with altered mental status and psychosis, leading to the discovery of bilateral ODCs. Despite successful laparoscopic ovarian-sparing resections of the initial lesions, as well as a laparoscopic ovarian-sparing resection of a unilateral recurrence one year later, the patient was lost to follow-up and did not undergo routine surveillance. She eventually presented several years later with severe abdominal distention and frequent seizures, which an abdominal ultrasound revealed were due to recurrent bilateral ODCs that encompassed the entirety of the abdomen. Upon evaluation with MRI, no normal ovarian tissue was identified. After discussion with the patient and her mother, she ultimately underwent a bilateral salpingo-oophorectomy at age 20, resulting in premature menopause. This case underscores the necessity of standardized follow-up protocols for adolescents with ODCs that prioritize regular imaging and clinical monitoring to identify recurrent lesions and prevent adverse outcomes. Additionally, it emphasizes the importance of multidisciplinary care and patient education to ensure adherence to follow-up recommendations. Our findings suggest that a more consistent approach to post-operative surveillance could prevent severe complications and improve long-term outcomes for adolescent patients with ODCs.