PREPUBERTAL PELVIC MASS

An  8-year-old  girl    is  evaluated   in  the emergency   department  for sudden

onset   of  severe  lower   abdominal   pain.   A   general surgery consult is  obtained

and appendicitis    is  ruled   out.    Pelvic  ultrasound  reveals a   7   cm  solid   and

irregular   right   adnexal mass.   Pelvic  examination is  consistent  with    a   7   cm

right   adnexal mass,   and there   is  lower   abdominal   tenderness  but no  rebound

present.

An adnexal mass in the prepubertal age group is abnormal. During the
prepubertal and the postmenopausal years, functional ovarian cysts are not
possible because ovarian follicles are not functioning. Therefore any ovarian
enlargement is suspicious for neoplasm.

Sudden onset of acute abdominal pain is a typical presentation of germ cell
tumors of the ovary. These tumors characteristically grow rapidly and give early
symptomatology, as opposed to the epithelial cancers of the ovary that are
diagnosed in advanced stages. Germ cell tumors of the ovary are most common
in young women and present in early stage disease.

Differential Diagnosis. If sonography shows a complex adnexal mass in a girl
or teenager, the possibility of germ cell tumors of the ovary has to be
considered. The following serum tumor markers should be obtained: lactate
dehydrogenase (LDH) for dysgerminoma, β-hCG for choriocarcinoma, and α-
fetoprotein for endodermal sinus tumor.