Women today are health conscious. Numerous information campaigns regarding the detection, diagnosis, and treatment of various gynecological disorders and malignancies have helped in the primary prevention of complications of these gynecological diseases. Gynecology microscopes have helped gynecologists in the diagnosis and treatment of these gynecological problems.

One of the most common gynecological problems is pelvic mass. The probable causes of a pelvic mass found on physical examination or through radiologic studies are vastly different in a prepubertal child than they are during adolescence or dur¬ing the postmenopausal years. 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.

Fewer than 5% of ovarian malignancies occur in children and adolescents. Ovarian tumors account for approximately 1 % of all tumors in these age groups. These tumors are diagnosed with the help of gynecology microscopes. Germ cell tumors make up one half to two-thirds of ovarian neoplasms in individuals younger than 20 years of age. A review of studies conducted from 1940 until 1975 concluded that 35% of all ovarian neoplasms occurring during childhood and adolescence were malignant. In girls younger than 9 years of age, approximately 80% of the ovarian neoplasms were found to be malignant when tissue samples were examined under gynecology microscopes. Germ cell tumors account for approximately 60% of ovar¬ian neoplasms in children and adolescents compared with adult, which is approximately 20%. Epithelial neoplasms are rare in the prepubertal age group.

Because neoplastic tumors are rare, data are usually reported from referral centers. How¬ever, some reports include only neoplastic masses, whereas others include nonneoplastic masses. One community survey of ovarian masses revealed that the frequency of malig¬nancy was much lower than previously reported; of all ovarian masses confirmed surgically in childhood and adolescence, only 6% of masses were malignant neoplasms, and only 10% of neoplasms were malignant. In one series, nonneoplastic masses in young women and girls younger than 20 years of age constituted two-thirds of the total. Even in girls younger than 10 years of age, 60% were of the masses were nonneoplastic, and two-thirds of the neoplastic masses were benign. Functional, follicular cysts can occur in fetuses, new¬borns, and prepubertal children. They may be associated with sexual precocity.

Abdominal or pelvic pain is one of the most frequent presenting symptoms. In a prepuber¬tal child, a pelvic mass very quickly becomes abdominal in location as it enlarges, because of the small size of the pelvic cavity. The diagnosis of ovarian masses in the prepubertal age group is difficult because of the rarity of the diagnosis (and therefore a low index of suspi¬cion), as well as the fact that 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 complaints. An ovarian mass that is abdominal in location can be confused with other abdominal masses occurring in children, such as Wilms’ tumor or neuro¬blastoma. Acute pain is often associated with torsion. The ovarian ligament becomes elon¬gated as a result of the abdominal location of these tumors, thus predisposing to torsion.

Diagnosis and management

In recent years, ultrasonography has become an excellent tool for predicting the pres¬ence of a simple ovarian cyst. Unilocular cysts, when examined under a microscope, are virtually always benign and will regress in 3-6 months; thus, they do not require surgical management with oophorectomy or oophorocystectomy. Close observation is recommended, although there is a risk of ovarian torsion that must be discussed with the child’s parents. Recur¬rence rates after cyst aspiration (either ultrasonographically guided or with laparoscopy) may be as high as 50%. Attention must be paid to long-term effects on endocrine func¬tioning as well as future fertility; preservation of ovarian tissue is a priority for patients with benign tumors.

Additional imaging studies, such as CT scanning, MRl, or Doppler flow studies, may sug¬gest the diagnosis. Because the risk of a germ cell tumor is high, the finding of a solid com¬ponent mandates surgical assessment.