Assessment and Management of the Adnexal Mass in the Pediatric Population

Author(s): Joshua W. Monson*, Christina L. Jones.

Journal Name: Current Women`s Health Reviews

Volume 15 , Issue 1 , 2019

Submit Manuscript
Submit Proposal

Graphical Abstract:


It is important for the obstetrician-gynecologist to be able to decipher the diagnostic clues of an adnexal mass and manage it appropriately. This becomes even more of a challenge when faced with adnexal masses in the pediatric population. Adnexal masses can be of gynecological (cervical, vaginal, primary peritoneal, uterine/endometrial, ovarian) or of non-gynecological origin. In order to approach adnexal masses in any age group, a thorough history and physical examination, along with proper laboratory studies and radiological studies need to be obtained. This pertains as much for adults as it does for assessing adnexal masses in children. This article will review the evaluation to include the initial assessment, usefulness of imaging and markers in the diagnosis, and management of adnexal masses in neonates, young children, and adolescents, and the newest recommendations for each, respectively.

Keywords: Pediatrics, adnexa, mass, oncology, gynecology, review.

Balachandran B, Singhi S, Lal S. Emergency management of acute abdomen in children. Indian J Pediatr 2013; 80(3): 226-34.
Janssen LJ, Voorhoeve PG, van den Wildenberg FJ, van den Brand LR. Acute abdominal pain in children caused by pneumonia. Ned Tijdschr Geneeskd 2016; 160(0): D533.
Lobo RA, Gershenson DM, Lentz GM, Valea FA. Comprehensive Gynecology. 7th ed. Philadelphia: Elsevier 2017; p. 733.
Hermans AJ, Kluivers KB, Wijnen MH, Bulten J, Massuger LF, Coppus SF. Diagnosis and treatment of adnexal masses in children and adolescents. Obstet Gynecol 2015; 125(3): 611-5.
Breen JL, Maxson WS. Ovarian tumors in children and adolescents. Clin Obstet Gynecol 1977; 20(3): 607-23.
Eskander RN, Bristow RE. Adnexal masses in pediatric and adolescent females: A review of the literature. Curr Obstet Gynecol Rep 2012; 1(1): 25-32.
Skinner MA, Schlatter MG, Heifetz SA, Grosfeld JL. Ovarian neoplasms in children. Arch Surg 1993; 128(8): 849-53.
Houry D, Abbott JT. Ovarian torsion: A fifteen-year review. Ann Emerg Med 2001; 38(2): 156.
Marin JR, Alpern EF. Abdominal pain in children. Emerg Med Clin North Am 2011; 29(2): 401-28.
Golladay ES, Mollitt DL. Ovarian masses in the child and adolescent. South Med J 1983; 76(8): 954-7.
Ryoo U, Lee DY, Bae DS, Yoon BK, Choi D. Clinical characteristics of adnexal masses in Korean children and adolescents: Retrospective Analysis of 409 cases. J Min Inv Gyn 2010; 17(2): 209-13.
Oelschlager AEA, Gow KW, Morse CB, Lara-Torre E. Management of large ovarian neoplasms in pediatric and adolescent females. J Pediatr Adolesc Gynecol 2016; 29(2): 88-94.
Nakhal RS, Wood D, Creighton SM. The role of examination under anesthesia (EUA) and vaginoscopy in pediatric and adolescent gynecology: A retrospective review. J Pediatr Adolesc Gynecol 2012; 25(1): 64-6.
Billmire ME, Farrell MK, Dine MS. A simplified procedure for pediatric vaginal examination: Use of veterinary otoscope specula. Pediatrics 1980; 65(4): 823-5.
Kelleher CM, Goldstein AM. Adnexal masses in children and adolescents. Clin Obstet Gynecol 2015; 54(1): 76-92.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol 2016; 128(5): 1193-5.
Bellah RD, Rosenberg HK. Transvaginal ultrasound in a children’s hospital: is it worthwhile? Pediatr Radiol 1991; 21(8): 570-4.
Guducu N, Sidar G, Isci H, Yigiter AB, Dunder I. The utility of transrectal ultrasound in adolescents when transabdominal or transvaginal ultrasound is not feasible. J Pediatr Adolesc Gynecol 2013; 26(5): 265-8.
Goyal M, Agarwal VK. Diagnostic accuracy of B-mode USG and doppler scan for ovarian lesions. J Clin Diagn Res 2016; 10(9): TC01-4.
Guerra A, Cunha TM, Felix A. Magnetic resonance evaluation of adnexal masses. Acta Radiol 2008; 49(6): 700-9.
Peroux E, Franchi-Abella S, Sainte-Croix D, et al. Ovarian tumors in children and adolescents: a series of 41 cases. Diagn Interv Imaging 2015; 96(3): 273-82.
Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Roentgenol 2011; 176(2): 289.
Zhang J, Mironov S, Hricak H, et al. Characterization of adnexal masses using feature analysis at contrast-enhanced helical computed tomography. J Comput Assist Tomogr 2008; 32(4): 533-40.
Papic JC, Finnell SM, Slaven JE, Billmire DF, Rescorla FJ, Leys CM. Predictors of ovarian malignancy in children: Overcoming clinical barriers of ovarian preservation. J Pediatr Surg 2014; 49(1): 144-7.
Mizuno M, Kato T, Hebiguchi T, Yoshino H. Surgical indications for neonatal ovarian cysts. Tohoku J Exp Med 1998; 186(1): 27.
Xue-Qiang Y, Nan-Nan Z, Lei Y, et al. Management of ovarian cysts in infants. J Res Med Sci 2015; 20(12): 1186-90.
Sarnacki S, Brisse H. Surgery of ovarian tumors in children. Horm Res Paediatr 2011; 75(3): 220-4.
Baert T, Storme N. Van Nieuwenhuysen, et al Ovarian cancer in children and adolescents: A rare disease that needs more attention. Maturitas 2016; 88: 308.
Choudhary S, Fasih N, Mc Innes M, et al. Imaging of ovarian teratomas: appearances and complications. J Med Imaging Radiat Oncol 2009; 53(5): 480-8.
Jonson AL, Geller MA, Dickson EL. Gonadal dysgenesis and gynecologic cancer. Obstet Gynecol 2010; 116(Suppl. 2): 550-2.
Chaopotong P, Therasakvichya S, Leelapatanadit C, Jaishuen A, Kulfarusnont S. Ovarian cancer in children and adolescents: treatment and reproductive outcomes. Asian Pac J Cancer Prev 2015; 16(11): 4787-90.
Hazard FK, Longacre TA. Ovarian surface epithelial neoplasms in the pediatric population: incidence, histologic subtype, and natural history. Am J Surg Pathol 2013; 37(4): 548-53.
Kerkeni Y, Ksiaa A, Sahnoun L, et al. Management of epithelial ovarian tumors in children. Tunis Med 2014; 92(5): 350-1.
Merras-Salmio L, Vettenranta K, Mottonen M, Heikinheimo M. Ovarian granulosa cell tumors in childhood. Pediatr Hematol Oncol 2002; 19(3): 145-56.
Estel R, Hackethal A, Kalder M, Munstedt K. Small cell carcinoma of the ovary of the hypercalcaemic type: An analysis of clinical and prognostic aspects of a rare disease on the basis of cases published in the literature. Arch Gynecol Obstet 2011; 284(5): 1277-82.
Houry D, Abbott JT. Ovarian torsion: A fifteen-year review. Ann Emerg Med 2001; 38(2): 156-9.
Ashwal E, Hiersch L, Krissi H, et al. Characterisitics and management of ovarian torsion in premenarchal compared with postmenarchal patients. Obstet Gynecol 2015; 126(3): 514-20.
Horwitz JR, Gursoy M, Jaksic T, Lally KP. Important of diarrhea as a presenting symptom of appendicitis in very young children. Am J Surg 1997; 173(2): 80-2.
Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for twisted ischaemic adnexa can preserve ovarian function. Hum Reprod 2003; 18(12): 2599-602.
Bertozzi M, Esposito C, Vella C, et al. Pediatric ovarian torsion and its recurrence: A multicenter study. J Pediatr Adolesc Gynecol 2017; 30(3): 413-7.
Nakayama D. Examination of the acute abdomen in children. J Surg Educ 2016; 73(3): 548-52.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [27 - 31]
Pages: 5
DOI: 10.2174/1573404814666180613094120
Price: $58

Article Metrics

PDF: 6