Ovarian masses in young adolescents: imaging findings with surgical confirmation

Functional cysts and benign neoplasms are the most common ovarian masses among young adolescents. Ovarian cancer on the other hand, although rare in this age group, is the most common genital tract malignancy. The purpose of this study was to define imaging characteristics of ovarian masses in adolescents between 12 and 21 years old and correlate imaging and surgical findings. Thirty-seven female adolescent patients aged between 12 and 21 years were operated on because of a diagnosed ovarian mass between 1997 and 2002. All patients underwent pelvic ultrasound, five had an abdominal CT scan, two had abdominal MRI, one abdominal X-ray and one intravenous pyelography. Ultrasound was used to define the size of the lesion and to characterize its gross morphologic condition as solid, simple cyst or complex cyst. The records were reviewed for age at presentation, presenting symptoms, diagnostic studies, surgical procedure and pathology findings, which were available for all patients. In our study 32 patients (86.5%) were symptomatic and five asymptomatic (13.5%). The most common presenting symptom was abdominal pain (59.5%). Thirty-four patients (91.1%) had benign lesions, two had malignant tumors (5.4%) and one patient had a borderline lesion (2.7%). The most common ovarian masses detected were germ cell tumors (27.5%) and functional cysts (25%). Twenty patients (54%) underwent operative laparoscopy and 17 patients (46%) exploratory laparotomy. Simple resection of the ovarian mass was achieved in the majority of cases (84%). Bilateral salpingo-oophorectomy was performed in only one case (2.7%).

Ovarian mass; Adolescents; Ultrasound; Magnetic resonance imaging; Computed tomography

[1] Pfeife「S.M., Gosman G.G.: "Evaluation of adnexal masses in adolescents". Pediatr. Clin. No. Am., 1999, 46 (3), 573.

[2] Yakushiji M., Matsukuma T., Abe M. et al.: "Ovarian tumors, in adolescents less than 20 years of age". Acta Ob.stet. Gynecol. Jpn., 1981, 33, 833.

[3] Tepleman C., Fallat M.E., Blinchensky A., Hertweck S.P.: "Noninflammatory ovarian masses in girls and young women". Ob.stet Gynecol., 2000, 96, 229.

[4] Kanizsai B., Orley J., Szigetvari I. et al.: "Ovarian cysts in children and adolescents: Their occurrence, behavior, and management". J. Pediatr. Adolesc. Gynecol., 1998, 11, 85.

[5] Warner B.W., Kuhn J.C., Barr L.L.: "Conservative management of large ovarian cysts in children: The value of serial pelvic ultrasonography". SitrJ:erv, I 992, 112, 749.

[6] Wu A., Siegel M.J.: "Sonography of pelvic masses in children: Diagnostic predictability". Am. J. Roentgenol., 1987, 148, 1199.

[7] Van Winter J.T., Simmons P.S., Podratz K.C.: "Surgically treated adnexal masses in infancy, childhood, and adolescence". Am. J Obstet. Gynecol., 1994, 170, 1780.

[8] Steinkampf M.P., Hammond K.R., Blackwell R.E. et al.: "Hormonal treatment of functional ovarian cysts: A randomized, prospective study". Fertil. Steril., 1990, 54, 775.

[9] Egarter C., Putz M., Strohmer H. et al.: "Ovarian function dunng low-dose oral contraceptive use". Contraception, 1995, 51, 329.

[10] Chatman D.L., Ward A.B.: "Endometriosis in adolescents". J. Reprod. Med., 1982, 27, 156.

[11] Goldstein D.P., deCholnoky C., Emans S.J., Leventhal J.M. "Laparoscopy in the diagnosis and management of pelvic pain in adolescents". J. Reprod. Med., 1980, 24, 251.

[12] Athey P.A., Cooper N.B.: "Sonographic features of paraovanan cysts". Am. J. Roentgenol., l 985, 144, 483.

[13] Nelson L., Ekbom A., Gerdin E.: "Ovarian cancer in young women in Sweden, 1989-1991". Gyneco/. Oncol., 1999, 74, 472.

[14] Thind C.R., Carty H.M., Pilling D.W.: "The role of ultrasound in the management of ovarian masses in children". Clin. Radiol., 1989, 40, 180.

[15] Teele R.L., Share J.C.: "Ultrasonography of the female pelvis in childhood and adolescence". Radio/. Clin. No. Am., 1992, 30, 743.

[16] Deprest J., Moerman P., Corneillie P., Ide P.: "Ovarian borderhne mucinous tumor in a premenarchal girl: Review on ovarian epithelial cancer in young girls". Gynecol. Oncol., 1992, 45, 219.

[17] Gershenson D.M., Del Junco G., Herson J., Rutledge F.N.: "Endodermal sinus tumor of the ovary: The M. D. Anderson experience" Obstet. Gynecol., 1983, 61, 194.

[18] Lack E.E., Young R.H., Scully R.E.: "Pathology of ovanan neoplasms in childhood and adolescence". Pathol. Ann., 1992, 27, 281.