With the use of gynecology microscopes, physicians can diagnose whether a mass is benign or malignant. The type of mass can be differentiated based on its location and characteristics when these masses are examined using gynecology microscopes.

Ovarian tumors occur in both children and adolescents and are usually biopsied using a microscope to check for malignancy. The gynecologist’s response to a pelvic or abdominal mass varies in relation to the patient’s pubertal status, because the likelihood of functional masses in¬creases after menarche. The risk of malignant neoplasms is lower among adolescents than among younger children. Epithelial neoplasms occur with increasing fre¬quency with age. Germ cell tumors are the most common tumors of the first decade of life but occur less frequently during adolescence. Mature cystic teratoma is the most frequent neoplastic tumor of children and adolescents, account¬ing for more than one-half of ovarian neoplasms in women younger than 20 years of age.

It is well established, with the use of gynecology microscopes, that neoplasia can arise in dysgenetic gonads. Malignant tumors have been found in about 25% of dysgenetic gonads of patiellts with a Y chromosome. Go¬nadectomy is recommended for patients with XY gonadal dysgenesis or its mosaic varia¬tions.

Functional ovarian cysts occur frequently in adolescence and are a common gynecology problem. They may be an incidental finding on examination or may present with pain caused by torsion, leakage, or rupture. Endometriosis is less common during adolescence than in adulthood, although it can oc¬cur during adolescence. In series of adolescents referred with chronic pain, 50-65% has been found to have endometriosis. Although endometriosis can occur in young women with obstructive genital anomalies (presumably as a result of retrograde menstru¬ation), one review of pelvic pain and dysmenorrhea found that most adolescents with en¬dometriosis did not have associated obstructive anomalies. Endometriosis occurring in young women may have an atypical appearance, with nonpigmented or vesicular lesions, peritoneal windows, and puckering, when tissue samples are viewed under a microscope.

Uterine Masses

Other causes of pelvic masses, such as uterine abnormalities, are rare in adolescence. Uter¬ine leiomyomas are not commonly seen in this age group. Obstructive uterovaginal anom¬alies present during adolescence, at the time of menarche or shortly thereafter. The diag¬nosis is frequently neither suspected nor delayed, particularly when the patient is seen by a general surgeon. A wide range of anomalies can be seen, from imperforate hymen to transverse vaginal septa, to vaginal agenesis with a normal uterus and functional en¬dometrium, vaginal duplication and obstructing longitudinal septa, and obstructed uter¬ine horns. Patients may present with cyclic pain, amenorrhea, vaginal discharge, or an ab¬dominal, pelvic, or vaginal mass. A hematocolpos, hematometra, or both will frequently be present, and the resulting mass can be quite large.

Inflammatory Masses

Adolescents have the highest rates of pelvic inflammatory disease (PID) of any age group, if one considers only indi¬viduals at risk for STDs (i.e., those who have had sexual intercourse). Thus, an ado¬lescent presenting with pelvic pain may be found to have an inflammatory mass. The diag¬nosis of pelvic inflammatory disease is primarily a clinical diagnosis based on the presence of the lower abdominal, pelvic, and adnexal tenderness; ceryical motion tenderness; a mucopu¬rulent discharge; and the signs of elevated temperature, white blood cell count, or sedimen¬tation rate. PID is clearly associated with the rIsks of acquiring sexually trans¬missible infections, and methods of contraception may decrease the risk (spermicides, oral contraceptives, male latex condoms) or increase the risk (the intrauterine device). Inflamma¬tory masses may consist of a tubo-ovarian complex (a mass consisting of matted bowel, tube; and ovary), tubo-ovarian abscess (a mass consisting primarily of an abscess cavity within an anatomically defined structure such as the ovary), pyosalpinx, or, chronically, hydrosalpinx.