Adnexal Masses in Children

Differential diagnosis for adnexal masses in children based on ultrasound appearance:

• Cystic:
  • Simple cyst: Most common adnexal lesion.
  • Teratoma
  • Cystadenoma: Serous: Large anechoic, thin-walled cyst with posterior acoustic enhancement. Mucinous: Multiloculated cyst, each component of which may show low-level echoes and differing echogenicity (echogenic locule may mimic solid component). Papillary projections less common than in serous cystadenoma.
  • Cystadenofibroma: Large cystic lesion that may have septations, solid nodules, and/or papillary projections
  • Hydrosalpinx:
• Complex:
  • Complex cyst
  • Teratoma
  • Tuboovarian abscess
  • Granulosa cell tumor: Large solid and cystic adnexal mass with a thickened endometrial stripe (hormonally active). Atypical hyperplasia or endometrial carcinoma can be seen in 5% of cases.
  • Dysgerminoma: Germ cell tumor. Ovarian analog of seminoma of the testis. Pure form of dysgerminoma is not associated with endocrine hormone secretion, but 5% of cases contain cells that produce HCG. Ultrasound shows a multilobulated solid ovarian mass with heterogeneous echogenicity. Speckled calcification may be present. Anechoic areas represent necrotic portions. Prominent flow in fibrovascular septae may be seen on color Doppler.
• Solid:
  • Hemorrhagic cyst
  • Torsion
  • Teratoma
  • Dysgerminoma: See above

References

Wu A, Siegel MJ. Sonography of pelvic masses in children: diagnostic predictability. AJR Am J Roentgenol. 1987 Jun;148(6):1199-202.