The pelvic area is the lower area of the abdomen. The pelvic area contains the intestines, lower ureters, and bladder. The female pelvic area also contains the ovaries, fallopian tubes, uterus, and cervix. A pelvic mass may form in any of these organs. Pelvic masses are uncommon in infants and young children, but they sometimes occur.
Internal Female Reproductive Anatomy
Pelvic masses in infants and children are discussed here. See Female Pelvic Mass for a discussion of pelvic masses in adult women.
A pelvic mass may or may not cause symptoms. Some symptoms that may occur in children include
Nausea, vomiting
The most common type of female pelvic mass varies by age group.
Newborns and infants may have a type of pelvic mass called a follicular ovarian cyst that can be caused by hormones passed to the fetus from the mother during pregnancy. A cyst can develop in a fetus and may be detected during an ultrasound of the pregnant woman, or a cyst can form and be detected after birth.
In children, ovarian masses may be follicular ovarian cysts or, rarely, tumors that are noncancerous (benign) or cancerous (malignant).
Follicular ovarian cysts form from the fluid-filled cavities (follicles) in the ovaries.
Benign ovarian masses usually grow slowly and rarely become cancerous.
Germ cell tumors start from the cells that produce eggs and are the most common type of ovarian tumors in children.
Some cysts and tumors release hormones and can cause precocious (early) puberty.
Evaluation of Female Pelvic Mass in Children
History
The doctor asks about a child's symptoms, including symptoms associated with the mass (such as pain, pressure, vaginal bleeding, fever). The doctor also asks about a child's medical history. The medical history is obtained from the parent (or caregiver) and the child, if age appropriate. For infants, the doctor asks whether there were any complications during pregnancy or birth. Family history of cancer is important.
Physical examination
Doctors do a general physical examination.
If a pelvic examination is necessary, the doctor talks to the parent and child about the examination so they know what to expect and to build trust between the child and doctor. The goal of the examination should be to obtain necessary information without causing fear or unnecessary discomfort to the child. An external pelvic examination (of the vulva [labia]) and opening of the vagina may be performed, If an internal pelvic examination is needed, the child is usually given anesthesia so that the examination can be done without causing discomfort.
External Female Reproductive Anatomy
Testing
The information from the history and physical examination often suggests a cause and additional tests that may be needed.
Imaging is usually done to evaluate for a pelvic mass. Pelvic ultrasound is usually the first imaging test done. If ultrasound is inconclusive, another imaging test, such as magnetic resonance imaging (MRI), may be needed.
A complete blood count is done if the doctor suspects a pelvic infection.
If there is a vaginal discharge, the doctor collects a sample using methods appropriate for children. The sample is tested for common vaginal infections. If sexual abuse is suspected, testing for sexually transmitted infections is done with blood tests and urine or vaginal samples.
If there are signs of precocious puberty, hormonal tests are done.
Treatment of Female Pelvic Mass in Children
Some pelvic masses (for example, some benign ovarian cysts) may not need treatment.
If a tumor appears cancerous, surgery is done to evaluate the tumor and remove it.
Surgery may be required to remove a mass that stops or interferes with the normal menstrual flow.
Key Points
A pelvic mass may or may not cause symptoms and may be noncancerous (benign) or cancerous (malignant).
Newborns and infants may develop follicular ovarian cysts due to hormones that passed from the mother during pregnancy.
Germ cell tumors are the most common type of ovarian tumors in children.
Doctors use imaging tests to evaluate the child with a suspected pelvic mass.
