Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 3 ( May-June, 2022 ) > List of Articles


Prospective Observational Study of Adnexal Masses in Adolescent Girls: Their Diagnosis and Management in a Tertiary Center

Meenakshi Charaya, Niranjan Narayanrao Chavan, Shikhanshi Shikhanshi

Keywords : Adnexal masses, Adolescents, Adnexa, Ovarian mass

Citation Information : Charaya M, Chavan NN, Shikhanshi S. Prospective Observational Study of Adnexal Masses in Adolescent Girls: Their Diagnosis and Management in a Tertiary Center. J South Asian Feder Obs Gynae 2022; 14 (3):275-278.

DOI: 10.5005/jp-journals-10006-2068

License: CC BY-NC 4.0

Published Online: 30-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Adnexal mass means any swelling arising from the adnexa which comprises the ovary, fallopian tube, structures in broad ligaments, and other connective tissues in parametrium. Adnexal mass can be an incidental diagnosis, or it may be associated with other symptoms like pain in the abdomen. It is very commonly encountered in our clinical practice. Materials and methods: A single-center prospective observational study involving 60 adolescent girls who came to the OPD or emergency in Lokmanya Tilak Municipal Medical College and Hospital with clinical or radiological findings s/o adnexal mass from the year 2017 to 2019 over a period of 20 months. Results: The maximum number of adnexal masses belonged to the age-group of 14–16 years (56.7%). About 60% of patients had pain in the abdomen. While only 36.7% of patients had regular menses, and 3.3% had not attained menarche. The most common associated complaint was dysmenorrhea (20%) followed by menorrhagia (13.3%). In 86.7% of patients, no mass was palpable per abdomen, while 6.7% had a mass of 12 weeks palpable per abdomen and 6.6% had a mass of more than 12 weeks palpable per abdomen. Almost 35% of patients when followed up, showed a decrease in the size of the mass, while in 6.8% the size of the mass increased. Bilaterality was found in 10% of cases while left-sided masses (48.3%) were seen more commonly than those on the right side (41.7%). In total, 53 masses (88.3%) were non-neoplastic and 7 (11.7%) masses were neoplastic, of which 10% were dermoid and 1.7% were dysgerminoma. In our study, 8.5% of patients had ovarian torsion. Cancer Antigen 125 (CA-125) was raised in around 18.3% of patients. Out of 60 patients, 68.3% were managed conservatively out of which 3.3% underwent medical management, 28.3% underwent laparoscopy, and 3.3% patients underwent laparotomy. Conclusion: Adnexal masses are common among adolescents, they are usually benign and often can be managed expectantly. The evaluation of adolescents with an adnexal mass should include menstrual history and a confidential inquiry regarding sexual activity. Among benign lesions, a simple cyst is the most common pathology of adnexal mass. Germ-cell tumors are the most common ovarian malignancies in children and adolescents. Management of adnexal masses in adolescents should prioritize ovarian conservation to preserve fertility.

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  1. Zolton JR, Maseelall PB. Evaluation of ovarian cysts in adolescents. Open J Obstet Gynecol 2013;03(07):12–16. DOI: 10.4236/ojog.2013.37a1004.
  2. Zhang M, Jiang W, Li G, et al. Ovarian masses in children and adolescents–an analysis of 521 clinical cases. J Pediatr Adolesc Gynecol 2014;27(3):1–6. DOI: 10.1016/j.jpag.2013.07.007.
  3. Spinelli C, Pucci V, Strambi S, et al. Treatment of ovarian lesions in children and adolescents: a retrospective study of 130 cases. Pediatr Hematol Oncol 2015;32(3):199–206. DOI: 10.3109/08880018.2013.856050.
  4. Hermans AJ, Kluivers KB, Wijnen MH, et al. Diagnosis and treatment of adnexal masses in children and adolescents. Obstet Gynecol 2015;125(3):611–615. DOI: 10.1097/AOG.0000000000000665.
  5. Brun JL, Fritel X, Aubard Y, et al. Management of presumed benign ovarian tumors: Updated French guidelines. Eur J Obstet Gynecol Reprod Biol 2014;183:52–58. DOI: 10.1016/j.ejogrb.2014.10.012.
  6. Cass DL. Ovarian torsion. Semin Pediatr Surg 2005;14(2):86–92. DOI: 10.1053/j.sempedsurg.2005.01.003.
  7. Gupta B, Guleria K, Suneja A, et al. Adolescent ovarian masses: a retrospective analysis. J Obstet Gynaecol (Lahore) 2016;36(4): 515–517. DOI: 10.3109/01443615.2015.1103721.
  8. Kocak M, Beydilli G, Dilbaz S, et al. Adnexal masses in adolescent girls with pelvic pain: report on 63 cases. Gynecol Surg 2008;5(3): 203–207. DOI: 10.1007/s10397-007-0358-6.
  9. Yogini KD, Balasubramaniam D, Palanivelu C, et al. Laparoscopic approach to adnexal mass in adolescents: a retrospective analysis. J Datta Meghe Inst Med Sci Univ 2017;12(1):55–60. DOI: 10.4103/jdmimsu.jdmimsu_26_17.
  10. Emeksiz HC, Derinöz O, Akkoyun EB, et al. Age-specific frequencies and characteristics of ovarian cysts in children and adolescents. J Clin Res Pediatr Endocrinol 2017;9(1):58–62. DOI: 10.4274/jcrpe.3781.
  11. Kitawaki J, Ishihara H, Koshiba H, et al. Usefulness and limits of CA-125 in diagnosis of endometriosis without associated ovarian endometriomas. Hum Reprod 2005;20(7):1999–2003. DOI: 10.1093/humrep/deh890.
  12. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology. Practice Bulletin No. 174 Summary: Evaluation and Management of Adnexal Masses. Obstet Gynecol 2016;128(5):e210–e226. DOI: 10.1097/AOG.0000000000001768.
  13. Warner BW, Kuhn JC, Barr LL, et al. Conservative management of large ovarian cysts in children: the value of serial pelvic ultrasonography. Surgery 1992;112(4):749–755. PMID: 1411947.
  14. Medeiros LR, Stein AT, Fachel J, et al. Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer 2008;18(3):387–399. DOI: 10.1111/j.1525-1438.2007.01045.x.
  15. Oue T, Uehara S, Sasaki T, et al. Treatment and ovarian preservation in children with ovarian tumors. J Pediatr Surg 2015;50(12):2116–2118. DOI: 10.1016/j.jpedsurg.2015.08.036.
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