Characteristics and management of adnexal masses in a canadian pediatric and adolescent population.

OBJECTIVE

To determine whether there were differences in presentation, imaging, and tumour markers between pediatric and adolescent gynaecology patients with adnexal masses managed expectantly and those managed surgically.

METHODS

We conducted a retrospective review of patients who presented to the pediatric and adolescent gynaecology service with adnexal masses between January 2003 and January 2006 at Toronto's Hospital for Sick Children. We used t tests, chi-square, and Pearson correlation tests for analysis.

RESULTS

We identified 114 patients with an adnexal mass. Fifty-nine percent had surgery (laparotomy 41.8%, laparoscopy 58.2%) and 41% were managed conservatively. The mean age of patients was 12.7 years (range 7 days to 18 years) and there was no difference in age between management groups (P = 0.59). The most common presenting symptom was abdominal pain (72.8%). Increased abdominal girth was found only in the surgical group (P < 0.01). Size of the mass was the only feature on imaging that differed between groups (11.1 cm surgical vs. 5.3 cm observed, P < 0.001). CT scans were performed in 35 patients, 94.3% of whom had surgery (P < 0.001). Tumour markers were drawn in 41.2% of patients, more often in surgical patients (P < 0.001), and 27% were abnormal, all in the surgical group. Surgical approaches included cystectomy, oophorectomy, or detorsion. Twelve percent of surgeries were for malignancies, representing 7.0% of all adnexal masses, and malignant masses were larger than benign masses (16.1 cm vs. 10.5 cm, P < 0.05). In cases that required only expectant management with serial ultrasound, both simple and complex masses resolved, with or without hormonal suppression.

CONCLUSION

Larger masses and masses associated with increased abdominal girth or abnormal tumour markers were more likely to be managed by surgical intervention. Surgically managed patients had more investigations. Forty-one percent of masses in patients referred to pediatric and adolescent gynaecology specialists resolved with expectant management.