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Polycystic ovarian syndrome (PCOS) and mature cystic teratomas are among the most common conditions affecting ovaries in young adults, but their association has not been studied to date. The presence of functional endocrine tissue within teratomas raises a question of causality for hyperandrogenism in patients with both teratomas and PCOS. We present a novel study demonstrating an association between PCOS and adnexal pathologies in adolescent girls.
This IRB-approved retrospective case-control study included females ages 12-21 years seen at the Adolescent Gynecology & Endocrinology Clinic (AGEC) at a tertiary children's hospital between 2014-2022. The study group was defined as at risk for PCOS if subjects met at least two modified Rotterdam criteria and had transabdominal pelvic ultrasound revealing adnexal pathology. The control group subjects were evaluated for pelvic pain in the absence of gynecological or hormonal disorders and were diagnosed with an adnexal pathology. Exclusion criteria was menstrual age less than two years. Ultrasound imaging was re-interpreted by two radiologists. Statistical analysis was done using descriptive statistics and Chi-squared test.
We included twenty-three subjects in the at risk for PCOS group and forty-four in the control group. Consistent with published data, the two groups had no difference in ovarian volume. There was an increased prevalence of teratomas (48% vs. 23%, p=0.035) and an increased odds ratio for teratoma (OR 3.12, 95% CI 1.06-9.18) in the group at risk for PCOS (Table 1). There was a decreased prevalence of functional ovarian cysts in the at risk for PCOS group (26% vs. 52%, p=0.039). One patient in the at risk for PCOS group had a Sertoli-Leydig cell tumor; there was no difference in the prevalence of cystadenomas or malignant tumors between the PCOS and control groups (Table 1). In the at risk for PCOS group, testosterone levels were reported for fourteen patients pre-intervention (mean 67.9±76.7 ng/dL) and twelve post-intervention (mean 40.5±31.8 ng/dL).
We demonstrated that adolescents at risk for PCOS are more likely to be diagnosed with a mature cystic teratoma compared to adolescents without PCOS. In addition, patients at risk for PCOS were less likely to have functional cysts compared to their non-PCOS counterparts which aligns with the state of chronic anovulation in PCOS. To allow a window of opportunity for preventive surgery that could minimize risk of torsion and malignancy, clinicians should consider a screening pelvic ultrasound for evaluation of teratoma in adolescents with or at risk for PCOS. Prospective studies are needed to further elucidate association between mature teratomas and PCOS.
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