Adnexal Masses in Adolescent Girls With Pelvic Pain: Report on 63 Cases

Pelvic pain is the most common gynecological symptom in adolescent girls presenting with an adnexal mass and the leading reason for hospital admission. A single center retrospective study, carried out in the years 2005–2006, enrolled 63 girls ranging in age from 15 to 20 years who were hospitalized for pelvic pain associated with an adnexal mass. Their average age was 15 years, and the masses averaged 54.5 mm in diameter. Acute pelvic pain prompted hospitalization in 80% of cases. Forty-nine patients, more than three fourths of the total, were operated on, all but 4 of them laparoscopically. The remaining 14 patients were followed up expectantly for what was presumed to be a functional cyst; none were readmitted for surgical intervention. Two converting laparotomies (4%) were carried out. The most common histopathologic findings, each present in approximately one fourth of patients, were benign epithelial ovarian cyst and mature cystic teratoma. A borderline ovarian tumor was found in 4% of cases. The incidence of acute ovarian torsion was 9.5% and that of true ovarian neoplasia, 55%. None of the tumors were malignant. Comparatively infrequent findings included ruptured endometrioma, embryogenic duct remnant cyst, and luteinized cyst. No patient had to be readmitted for postoperative complications. The median time in hospital was 2.6 days. True ovarian neoplasia remains a common indication for surgery in adolescent girls with pelvic pain. Most cases are benign, and minimal-access surgery should be carried out whenever possible. Comprehensive ultrasound study, along with pelvic examination and estimates of tumor markers, may permit better selection of those patients expected to benefit from surgery.