Ovarian Tumors or Pelvic Masses (Pediatric)

What Are Ovarian Tumors and Pelvic Masses?

Ovarian tumors and pelvic masses in children are uncommon but important conditions that require thorough evaluation. While many pelvic masses in pediatric patients are benign and non-cancerous, some may be tumors—either functional cysts, benign growths, or malignant (cancerous) tumors. These growths can originate from the ovary, fallopian tube, uterus, or surrounding pelvic structures.

In premenarchal girls and adolescents, early identification and treatment help preserve fertility and prevent complications such as torsion or rupture.

Common Causes and Types

Pediatric ovarian or pelvic masses may include:

  • Functional ovarian cysts (most common and typically resolve on their own)
  • Benign tumors such as teratomas (dermoid cysts) or cystadenomas
  • Malignant tumors like germ cell tumors or sex cord-stromal tumors
  • Non-ovarian masses including Müllerian anomalies or abscesses
  • Ovarian torsion where the ovary twists on its blood supply, causing pain and swelling

Symptoms

Many ovarian or pelvic masses are discovered incidentally, but symptoms may include:

  • Lower abdominal or pelvic pain
  • Abdominal distention or a palpable mass
  • Nausea or vomiting (especially with torsion)
  • Changes in urination or bowel habits
  • Hormonal changes like early puberty or irregular menstruation

Diagnosis

Evaluation typically involves:

  • Pelvic ultrasound — the first-line imaging tool
  • MRI or CT scan — if further imaging is needed
  • Blood tests — to check tumor markers (e.g., AFP, beta-HCG, LDH, CA-125)
  • Physical exam and history — to assess symptoms and onset

Treatment

Treatment depends on the type and size of the mass:

  • Observation — for small, asymptomatic cysts
  • Minimally invasive surgery — for larger or symptomatic cysts or benign tumors
  • Oophorectomy or salpingo-oophorectomy — removal of one ovary or ovary + fallopian tube, typically for malignant masses or those at risk of rupture

Preservation of ovarian tissue and fertility is a key consideration in pediatric patients. Oncology consultation may be necessary for malignant tumors.

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Frequently Asked Questions

No, they are relatively rare in pediatric patients, but when they occur, most are benign. Malignant tumors are less common but require prompt treatment.

If untreated, some masses can rupture, twist (torsion), or cause pressure on nearby organs. Early diagnosis and treatment can reduce long-term complications.

Not always. Small, simple cysts may be monitored. Surgery is typically needed for large, persistent, or suspicious masses.

Whenever possible, surgeons aim to preserve healthy ovarian tissue. Even if one ovary is removed, fertility can often be maintained with the remaining ovary.

Persistent abdominal or pelvic pain, a noticeable mass, nausea, or early signs of puberty may warrant evaluation.