USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

Diagnosis. In a prepubertal patient who is symptomatic and has U/S evidence of
an adnexal mass, a surgical evaluation is recommended.

Table II-5-1. Prepubertal   Pelvic  Mass

Definition  of  abbreviations:  S&O,    Salpingo-oophorectomy.

Surgical    diagnosis Simple    cyst Laparoscopy

Complex mass Laparotomy

Management Benign Cystectomy

Annual  follow-up

Malignant Unilateral    S&O

Staging,    chemotherapy

Prognosis 95%   survival    with    chemotherapy

Management.

Simple  mass:   If  the U/S shows   the consistency of  the mass    to  be  simple  (no

septations  or  solid   components),    this    mass    can be  evaluated   through a

laparoscopic    approach.

Complex mass: If    the mass    has septations  or  solid   components, a   laparoscopy

or  laparotomy  should  be  performed,  depending   on  the experience  of  the

surgeon.

Benign  histology.  A   cystectomy  should  be  performed   instead of  a   salpingo-

oophorectomy.   Because of  the patient’s   age the surgical    goal    should  be  toward

conservation    of  both    ovaries.    If  the frozen  section pathology   analysis    is

benign, no  further surgery is  needed. Follow-up   is  on  an  annual  basis.

Germ    cell    tumor.  A   unilateral  salpingo-oophorectomy   and surgical    staging

(peritoneal and diaphragmatic   biopsies,   peritoneal  cytology,   pelvic  and para-

aortic  lymphadenectomy,    and omentectomy)    should  be  done.   All patients    with