Para-Tubal Cysts and Their Associations with Adnexal Torsion and Obesity.

Background: Para-tubal cysts, often misdiagnosed as ovarian cysts, may be androgen-sensitive and are of growing clinical concern in relation to obesity and adnexal torsion in adolescents. However, their associations remain underexplored.

Objective: To investigate the association between para-tubal cysts, adnexal torsion, and obesity in female adolescents.

Methods: Retrospective cohort study of female patients aged 2-18 who underwent surgery for suspected benign adnexal lesions at a tertiary-level pediatric hospital between 2018 and 2024. Data on demographics, body-mass index (BMI), cyst characteristics, surgical outcomes, and androgen profile were collected. Obesity was defined as a BMI or weight >95th percentile, using weight alone when BMI was unavailable.

Results: There were 124 patients included, median age 15 years, of whom 43 (34.7%) had para-tubal cysts. Thirty-seven patients (30%) had obesity. Obesity was significantly associated with para-tubal cysts (P = 0.002), with a relative risk of 2.2 (95% CI 1.4, 3.5). In patients with a para-tubal cyst, a positive correlation was found between para-tubal cyst volume and BMI z-score (rho = 0.46, P = 0.007). Para-tubal cysts were also associated with adnexal torsion (P < 0.001), with a relative risk of 2.4 (95% CI 1.6, 3.6) compared to ovarian cysts, and this association remained significant even when restricting ovarian cysts to those of dermoid subtype, which are traditionally considered to be the primary cause of adnexal torsion in the pediatric literature.

Conclusion: Para-tubal cysts are more common in adolescents with obesity and are strongly associated with adnexal torsion. This highlights the need for heightened awareness and careful evaluation of para-tubal cysts in patients with obesity to prevent complications like adnexal torsion.