Means of Diagnosis - Ovarian Masses in Adolescent Girls

Imaging

Numerous techniques are available and play a fundamental role not only in establishing a positive diagnosis and orienting the etiology, but also in surveillance and the assessment of spread.

The plain abdominal radiograph may reveal a mass syndrome. It shows tonal differences (fat), intratumoral calcification or ossification, the skeleton and surrounding soft tissues.

Ultrasonography by an abdominal approach with a full bladder indicates the nature of the mass (fluid, solid, homogeneous or otherwise), its size and borders, its location and relations with adjacent organs and any possible repercussions on the upper urinary tract. Doppler ultrasonography may help to identify the structure of a mass. Certain signs may be useful in evaluating the probable benign or malignant nature of the ovarian mass. These signs have a varying predictive value, which is increased when several elements are found together (poorly defined borders, a thick irregular wall, thick rigid septations with angulated junctions, growths, mainly solid component, size, local spread). The contribution of ultrasonography, and especially Doppler ultrasonography, in pediatric practice is nevertheless limited by the impossibility of endovaginal investigation.

Sectional Imaging: Computed tomography (CT) or magnetic resonance imaging (MRI) help to locate the mass and above all to identify its nature. MRI is particularly valuable for characterizing the various fluid and tissue structures.

Various modalities identify tissue structure, blood (hemorrhagic complication of a cyst, adnexal torsion), mucus, fat, and the more or less complex association of various components (dermoid cyst, teratoma, endometriosis).

If the tumor is solid, MRI provides arguments as to its malignant or benign nature and its potential in affirming malignancy is considered to be about 86% in the adult. MRI is indispensable at the present time in assessing the spread of malignant tumors.

Laboratory Studies

Laboratory studies are necessary in the first instance and are useful to differentiate other pelvic conditions such as pregnancy and pelvic inflammatory disease (PID). First, a pregnancy test should be routinely performed to exclude an ectopic pregnancy. Leukocytosis, elevated erythrocyte sedimentation rate and C-reactive protein are highly predictive of inflammatory processes such as appendicitis or PID, and screening for sexually transmitted diseases must be done. In this case, medical treatment with broad-spectrum intravenous antibiotics is usually sufficient.

Hormonal Investigations

Endocrine manifestations are due to abnormal secretion of steroid hormones by the tumor: estrogens, androgens or both. Clinical features depend on the abnormal hormonal secretion. Excessive production of sex steroids (estrogens or androgens or both) with suppressed pituitary gonadotropin level (LH and FSH) are in favor of gonad production. High steroid levels are not suppressed by the dexamethasone test and this response can differentiate ovarian origin and adrenal hypersecretion.