The Clinicopathological Features And Surgical Procedure of Adnexal Mass With Abdominal Pain In Pediatric And Adolescent Patients

Abstract Objective: To investigate the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients.Methods: A total of 212 pediatric and adolescent adnexal masses with abdominal pain who underwent surgery were retrospectively reviewed. The patients were divided into two groups, namely, the emergency surgery (EMS, n=96) group and the elective surgery (ELS, n=116) group, according to whether they had been surgically diagnosed with emergency conditions. EMS group refers to patients who had been surgically diagnosed with emergency conditions including adnexal masses torsion，corpus luteum rupture，and rupture of ectopic pregnancy. ELS group refers to patients with adnexal mass without emergency condition. The differences between the two groups were compared using the chi- squared test.Results: At the surgery evaluation, the median age was 14.5±3.6 years. A total of 175 patients (82.5%, 175/212) had menstruation, and 37 patients (17.5%, 37/212) had not yet begun menstruating. A total of 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. Pelvic abdominal ultrasound was the first imaging modality used in all the patients (n = 212/212; 100%). Tumor markers were abnormally elevated in 26 patients.Compared with the ELS group, the proportion of patients with emergency onset of pain, pain duration less than 3 months, persistent and intense of pain were significantly higher than those in ELS group (P < 0.05). There were significantly more patients without menarche in the EMS group than in the ELS group (p<0.05). The average tumor size in the ELS group was larger than that in the EMS group (p<0.05). In the EMS group, 78 cases（ 81.3%,78/96）had adnexal mass torsion, 16 cases (16.7%，16/96) had mass rupture, and 2 cases (2.1%, 2/96）had ectopic pregnancy. Of the 78 patients with adnexal mass torsion, 49 cases (62.8%, 49/78）underwent ovary-preserving surgery, and 24 cases (30.8%，24/78）underwent adnexectomy. The most common pathologic types of adnexal torsion were mature teratoma cysts and simple cysts, accounting for 29% and 26%, respectively.Conclusions: Adnexal masses combined with abdominal pain in pediatric and adolescent patients, especially for patients presented as acute pain which characterized by emergency pain onset, persistent pain that cannot be relieved or recurrent pain，should be considered due to the possibility of adnexal mass combined with acute complications, and emergency surgery should be performed immediately. For patients with suspected malignant lesions, a comprehensive evaluation of the lesions should be conducted preoperatively to select the appropriate surgical method and strategy. After the discovery of an adnexal mass, evaluation should be performed quickly, and long-term management should be implemented.