Diagnostic Workup

When a patient presents with signs or symptoms suggestive of an ovarian mass, a complete history and physical examination, including abdominal palpation and rectal examination, should be performed. Pelvic examination by a skilled practitioner should be considered, especially in an older adolescent. Laboratory values, including aFP, carcinoembryonic antigen, and P-HCG should be obtained. Other tumor markers, including lactate dehydrogenase (LDH), serum CA-125, estradiol, testosterone, F9 embryoglycan, and inhibin, and Mullerian inhibiting substance may offer further diagnostic or treatment information (Table 13.3) [9, 10].

Imaging studies may include a pelvic ultrasound to delineate the characteristics of the pelvic organs, specifically the ovaries. A computed tomographic (CT) scan of the abdomen and pelvis may be helpful to determine the extent of disease preoperatively. If the ovarian mass is complex or solid, over 8 cm, or has persisted for more than 2 months, surgical exploration is indicated [32].

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