Friday, May 28, 2010

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


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

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