Ovarian masses occur in children and young girls and can be discovered due to symptoms, on physical examination, and/or through imaging studies. The probable histology varies according to the age of the patient. Masses in the pelvis, although usually of gynecologic origin, can also arise from the urinary tract, bowel, or other pelvic structures .
Ovarian masses may represent physiologic cysts, benign neoplasms, or malignant neoplasms. They may be associated with pain or present as an asymptomatic mass. Although relatively rare, they are the most common genital neoplasms occurring in childhood . Historically, all ovarian masses discovered in infants, children, and adolescents were removed surgically. However, the identification of tumor markers and advances in radiologic imaging allow a more conservative approach to the management of these neoplasms, with ovarian preservation as the standard except in cases of cancer.
The World Health Organization classifies ovarian neoplasms based upon histologic cell type and benign versus malignant state (table 1). The majority of ovarian tumors in girls and adolescents are of germ cell origin. By comparison, epithelial tumors account for the largest proportion of ovarian neoplasms in adults. (See "Ovarian germ cell tumors: Pathology, clinical manifestations, and diagnosis" and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis".)
Most childhood ovarian masses are benign. However, it is important for the clinician to establish an early diagnosis to reduce the risk of ovarian torsion with possible loss of adnexa and to improve the prognosis for those lesions that are malignant. (See 'Ovarian cancer' below.)
OVARIAN CYSTS IN THE FETUS
Follicular ovarian cysts in fetuses and neonates are common and increase in frequency with advancing gestational age and some maternal complications, such as diabetes mellitus, preeclampsia, and rhesus isoimmunization [3,4]. In one autopsy series of 332 ovaries from stillbirths and neonatal deaths, one or more follicular cysts lined by granulosa epithelium and having a diameter greater than 1 mm were detected in 113 infants . Among live births, the best estimate of the incidence of clinically significant ovarian cysts is 1 in 2500 .