Our experience with adnexal masses in the pediatric age group and review of literature

Abstract

Background and objectives: Adnexal masses are rare in the pediatric age group. We present our experience with 20 patients with adnexal masses.

Design and setting: This retrospective observational analysis was performed on 20 children with adnexal masses who were treated at our institute between May 2011 and November 2015.

Patients and methods: Fifteen pediatric patients who were admitted between May 2011 and November 2015 were reviewed and retrospectively analyzed based on their age at the time of admission, their presenting complaints, clinical and radiological findings, tumor markers, management and follow-up.

Results: The patients' age at the time of admission ranged between 3 days and 12 years. Abdominal pain and lump were the most common presenting complaints.Four patients (20%) had antenatally diagnosed cystic ovarian lesions. On postnatal scan, two patients had a simple cyst measuring less than 6 cm, which resolved on follow-up ultrasound at 3 months. One neonate had a simple cyst, larger than 6 cm on postnatal scan, which was managed by marsupialization. One antenatally diagnosed patient had a dermoid cyst that required oophorectomy.Ten patients (50%) had dermoid cyst and underwent complete surgical excision of the mass. Based on histopathologic results, two of these patients had immature teratoma and required adjuvant chemotherapy (Bleomycin, Etoposide, and Cisplatin). The serum AFP levels of these patients were carefully monitored.One patient with bilateral ovarian cysts was diagnosed with Van Wyk-Grumbach syndrome, which resolved significantly after a 3-month regimen of thyroxin supplementation.Five patients presented with torsion and required emergency surgery-three had mature teratoma, one had an immature teratoma and one had large simple cysts.

Conclusion: The majority of ovarian tumors are benign. Accurate staging, complete resection and chemotherapy for the treatment of malignant tumors have contributed to excellent survival rates in these patients.

Keywords: Adnexal masses; Benign; Malignant; Pediatric; Torsion.

Fig. 1

Clinical photograph of an adnexal mass presenting as abdominal lump.

Fig. 2

CT image showing large left adnexal mass.

Fig. 3

Intraoperative image of a left immature teratoma.

Fig. 4

Excised specimen of the left immature teratoma.

Fig. 5

Excised specimen of the left mature teratoma.

Fig. 6

CT image of patient with right paraovarian cyst showing cystic lesion in right adnexa.

Fig. 7

Intraoperative image showing right paraovarian cyst in a patient.