Pelvic masses are common clinical findings and may involve the reproductive organs or nongynecologic structures. They may be identified in asymptomatic women during routine pelvic examination or may cause symptoms. Typical complaints include pain, pressure sensations, dysmenorrhea, or abnormal uterine bleeding. Although most pelvic masses are acquired lesions, a few arise as congenital anomalies. In the evaluation of pelvic masses, laboratory tests are typically uninformative, but levels of serum β-human chorionic gonadotropin (hCG) or tumor markers may be helpful. Initially, imaging with sonography is preferred, but computed tomography (CT) or magnetic resonance (MR) imaging may be useful when the nature of the mass is still uncertain. The treatment of pelvic masses varies with patient symptoms, age, and risk factors. Although medical management is possible for many pelvic masses, for others, surgical treatment offers the highest success rates.
Age has the greatest influence in evaluation of a pelvic mass. Pathology varies greatly with age, and neoplasms are more prevalent in older women.
Most gynecologic pelvic masses in this age group involve the ovary. Even during childhood, the ovaries are typically active, and many of these masses are functional cysts (de Silva, 2004; Deligeoroglou, 2004). Neoplastic lesions usually are benign germ cell tumors, and mature cystic teratomas (dermoid cysts) are the most common (Brown, 1993; Islam, 2008). Malignant ovarian tumors in children and adolescents are rare and account for only 0.9 percent of all malignancies in this age group (Young, 1975). As discussed in Chapter 14, asymptomatic simple cysts may initially be considered functional and observed. For those that are complex or persistent, additional surgical evaluation is typically indicated. Laparoscopy and in many cases, ovarian cystectomy, rather than oophorectomy, are appropriate approaches in this population.
For the most part, the incidence and type of ovarian pathology found in adolescents are similar to those in prepubertal girls. In addition to functional ovarian cysts, with the onset of reproductive function, pelvic masses in adolescents may also include endometriomas and the sequelae of pelvic inflammatory disease and pregnancy. Gynecologic masses present a special diagnostic challenge in children and adolescents, because benign neoplasms greatly outnumber malignant ones, and their clinical signs and symptoms are often nonspecific.
A number of genital tract disorders cause pelvic masses in adult women. Uterine enlargement due to pregnancy, functional ovarian cysts, and leiomyoma are among the most common. Endometrioma, mature cystic teratoma, acute or chronic tuboovarian abscess, and ectopic pregnancies are other frequent causes. Most pelvic masses in this age group are benign, but malignancy rates typically increase with age.
With the cessation of ovulation and reproductive function, the causes of pelvic mass also change. Simple ovarian cysts and leiomyomas are still a common source. Although menopause typically results in ...