The probable causes of a pelvic mass found on physical examination or through radiologic studies are vastly different in prepubertal children than they are in adolescents or post-menopausal women (Table 14.4). A pelvic mass may be gynecologic in origin, or it may arise from the urinary tract or bowel. The gynecologic causes of a pelvic mass may be uterine, adnexal, or more specifically ovarian. Because of the small pelvic capacity of a prepubertal child, a pelvic mass very quickly becomes abdominal in location as it enlarges and may be palpable on abdominal examination. Ovarian masses in this age group may be asymptomatic, associated with chronic pressure-related bowel or bladder symptoms, or may present with acute pain caused by rupture or torsion. Abdominal or pelvic pain is one of the most frequent initial symptoms. The diagnosis of ovarian masses in prepubertal girls is difficult because the condition is rare in this age group and, consequently, there is a low index of suspicion. Many symptoms are nonspecific, and acute symptoms are more likely to be attributed to more common entities such as appendicitis. Abdominal palpation and bimanual rectoabdominal examination are important in any child who has nonspecific abdominal or pelvic symptoms. An ovarian mass that is abdominal in location can be confused with other abdominal masses occurring in children, such as Wilms’ tumor or neuroblastoma. Acute pain is often associated with torsion. The ovarian ligament becomes elongated as a result of the abdominal location of ovarian tumors, thus creating a predisposition to torsion. Adnexal torsion is more likely to occur with an ovarian mass than with a normal size ovary. While torsion of a normal ovary is rare in adolescents and adults, it is more likely to occur in prepubertal girls.
Diagnosis of Prepubertal Ultrasonography is the most valuable tool for diagnosing ovarian masses. The characteristics
Pelvic Masses of a pelvic mass can be determined. Whereas both unilocular and multilocular cysts frequently resolve with observation, the finding of a solid component mandates surgical assessment because of the high risk of a germ cell tumor (20). Additional imaging studies, such as CT scanning, MRI, or Doppler ﬂow studies, may be helpful in establishing the diagnosis (21).