A 9-year-old girl was in good health until presenting at a local emergency room with nausea, vomiting, constipation, and vague abdominal pain. A large abdominal mass was noted on physical examination, and an abdominal computed tomographic scan revealed a large intraperitoneal, multiloculated mass. She was taken to the operating room, where torsion of an enlarged left ovary was discovered and the intraperitoneal mass removed. On gross inspection, the ovary appeared polycystic, measured 14× 11.5×7.5 cm, and weighed 570 g. The other ovary was also noted to be polycystic but was smaller. After surgery, she was noted to be short and to have early breast development. She was referred for endocrine evaluation. Before a workup could be performed, however, her abdominal pain recurred, and she was readmitted to the hospital.
Her medical history was significant only for birth by emergency cesarean section owing to fetal bradycardia secondary to a tight nuchal