Evaluation of ovarian masses in children and adolescents without acute severe abdominal pain

History and examination findings
Patient group	Potential significance
All patients
Ovarian mass that is bilateral, solid, fixed, or irregular	Associated with malignant tumors
Abdominal distension or ascites	Associated with malignant tumors
Neonates and infants:
Cyst noted on antenatal ultrasonography	Fetal/neonatal cysts usually resolve spontaneously by 6 months of age
Prepubertal children
Increased height velocity	Onset of puberty (associated with increased incidence of physiologic cysts); rarely may indicate hormone-producing tumors
Early puberty	Ovarian tumor Central or peripheral precocious puberty
Virilization	Sertoli-Leydig cell tumor
Adolescents
Menstrual history	May increase/decrease suspicion for: Physiologic cysts Endometrioma Congenital anomaly of the vagina or uterus
Sexual history	May increase/decrease suspicion for: Pregnancy-associated cysts Tubo-ovarian abscess (associated with STI)
Imaging for all patients
Imaging modality	Findings associated with malignant tumors
Transabdominal ultrasonography	Size ≥8 to 10 cm Multiple lesions Bilateral masses Solid or heterogeneous (solid components >2 cm, thick septations, papillary projections), compared with cystic and homogeneous Invasive or metastatic compared with well-circumscribed Calcifications Ascites
Doppler flow	Increased blood flow (compared with minimal or no blood flow)
Laboratory testing for select patient groups
Patient group	Laboratory tests
Postmenarchal adolescents	Urine beta-hCG
Signs or symptoms of STI	Testing for STI
Increased suspicion for ovarian tumor (eg, based on ultrasonography or associated symptoms)	Panel of ovarian tumor markers (AFP, beta-hCG, LDH, inhibin A and B, CA-125)
Increased suspicion for hormonally active tumor	Estradiol Testosterone
Patients with ascites	Cytology of ascitic fluid (if fluid is obtained)
Ovarian mass with torsion	Platelet count (thrombocytosis is a nonspecific marker of ovarian malignancy)

This table is meant for use with UpToDate content related to the evaluation of ovarian masses in children and adolescents. Refer to UpToDate content for additional details.

STI: sexually transmitted infection; beta-hCG: beta-human chorionic gonadotropin; AFP: alpha-fetoprotein; LDH: lactate dehydrogenase; CA-125: cancer antigen 125.

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خرید پکیج

Evaluation of ovarian masses in children and adolescents without acute severe abdominal pain