Catch me early, treat me promptly: a systematic review on the clinical presentation of ovarian masses in pediatric and adolescent gynecology

BackgroundOvarian lesions are the most common abdominal masses in the pediatric population yet have varied presentation. They are often missed or misdiagnosed causing delay in management and complications. Knowledge gained in managing ovarian lesions in one age group cannot be extrapolated to another group. This paper reviews the common and uncommon clinical presentations of ovarian lesions according to age aiming at timely diagnosis and appropriate management.MethodsThe review was done according to the PRISMA 2020 guidelines. PubMed and Scopus were systematically searched using the key words clinical characteristics or clinical features of ovarian masses, cysts, tumors and torsion in neonates, premenarchal and adolescent girls from 2008 to 2022. The inclusion criteria were full text articles in English, female and human species. Articles with incomplete data, that were non-specific for age, with no sample size and without open access were excluded. The study is approved.ResultsSeventy-eight studies were included. 57 from PubMed, 21 from Scopus. Neonates numbered 24. All presented with ovarian cysts which were discovered antenatally on routine ultrasound. Postnatally, none had symptoms, except one who presented with lethargy and emesis. Abdominal fullness and mass were common signs. Uncommon findings were intestinal obstruction, hydronephrosis, breast budding and pubic hair. 33% of the neonates developed ovarian torsion. The premenarchal group had 112 participants. Abdominal pain, nausea, vomiting, anorexia and fever were common symptoms. Breast budding, pubic hair development, vaginal bleeding and growth spurts were also commonly noted. Less commonly were symptoms of urinary retention, constipation and intestinal obstruction. The adolescent group had 836 participants – the largest of the three groups. The ovarian lesions in this group comprised of tumors with symptoms of abnormal uterine bleeding, abdominal pain, nausea and fever. Less commonly were symptoms of precocious puberty and hydronephrosis.DiscussionNeonates uncommonly present with symptoms of ovarian lesions. Therefore, a high index of suspicion is needed when one encounters a neonate with an abdominal mass. Those discovered antenatally should have routine ultrasound follow up postnatally to reduce the incidence of ovarian torsion. Ovarian lesions in the premenarchal group were largely misdiagnosed causing delayed treatment and torsion, making ovarian sparing surgery difficult. Those presenting with precocious puberty should be evaluated for functional ovarian masses. Adolescent girls with menstrual irregularities and elevated tumour markers should also be assessed for ovarian masses.ConclusionTimely diagnosis of ovarian masses in children leads to early and appropriate management with fewer complications and fertility sparing surgery. Ovarian lesions are the most common abdominal masses in the pediatric population yet have varied presentation. They are often missed or misdiagnosed causing delay in management and complications. Knowledge gained in managing ovarian lesions in one age group cannot be extrapolated to another group. This paper reviews the common and uncommon clinical presentations of ovarian lesions according to age aiming at timely diagnosis and appropriate management. The review was done according to the PRISMA 2020 guidelines. PubMed and Scopus were systematically searched using the key words clinical characteristics or clinical features of ovarian masses, cysts, tumors and torsion in neonates, premenarchal and adolescent girls from 2008 to 2022. The inclusion criteria were full text articles in English, female and human species. Articles with incomplete data, that were non-specific for age, with no sample size and without open access were excluded. The study is approved. Seventy-eight studies were included. 57 from PubMed, 21 from Scopus. Neonates numbered 24. All presented with ovarian cysts which were discovered antenatally on routine ultrasound. Postnatally, none had symptoms, except one who presented with lethargy and emesis. Abdominal fullness and mass were common signs. Uncommon findings were intestinal obstruction, hydronephrosis, breast budding and pubic hair. 33% of the neonates developed ovarian torsion. The premenarchal group had 112 participants. Abdominal pain, nausea, vomiting, anorexia and fever were common symptoms. Breast budding, pubic hair development, vaginal bleeding and growth spurts were also commonly noted. Less commonly were symptoms of urinary retention, constipation and intestinal obstruction. The adolescent group had 836 participants – the largest of the three groups. The ovarian lesions in this group comprised of tumors with symptoms of abnormal uterine bleeding, abdominal pain, nausea and fever. Less commonly were symptoms of precocious puberty and hydronephrosis. Neonates uncommonly present with symptoms of ovarian lesions. Therefore, a high index of suspicion is needed when one encounters a neonate with an abdominal mass. Those discovered antenatally should have routine ultrasound follow up postnatally to reduce the incidence of ovarian torsion. Ovarian lesions in the premenarchal group were largely misdiagnosed causing delayed treatment and torsion, making ovarian sparing surgery difficult. Those presenting with precocious puberty should be evaluated for functional ovarian masses. Adolescent girls with menstrual irregularities and elevated tumour markers should also be assessed for ovarian masses. Timely diagnosis of ovarian masses in children leads to early and appropriate management with fewer complications and fertility sparing surgery.