Adnexal masses in children, adolescents and women of reproductive age in the Netherlands: A nationwide population-based cohort study

• The incidence of adnexal masses increases quickly with age, while the risk of malignancy is highest in premenarchal children.
• The proportions of different histological subgroups vary between children, adolescents and women of reproductive age.
• Ovarian sparing procedures are related to age and are highest in adolescents and young adults.

ObjectiveTo provide an accurate incidence of adnexal masses in children and young women which can significantly improve the performance of current risk prediction models.MethodsWe used the PALGA database, a nationwide network and registry of histopathology and cytopathology, as the primary source of our study. Reports on ovarian histology of girls, years 1991–2014, and women aged 21–39, years 2011–2013, were included. Reports were labeled using the WHO-classification and classified as benign, borderline malignant, or malignant. Surgical procedure was scored separately.ResultsIncluded were 11,595 patients. The incidence of adnexal masses increased exponentially with age, from 0.43 per 100,000 womenyears at age 1 to 152 per 100,000 womenyears at age 35. A (borderline) malignancy was found in 898 (7.7%) patients, ratios between benign and malignant masses varied with age and were lowest in premenarchal children. Histology varied widely with surface epithelial tumors (35.1%), germ cell tumors (29.8%), and other cysts, tumors and tumorlike lesions (32.8%) being evenly distributed while sex cord stromal tumors were rare and only represented 2.3%. The proportion of malignancies was 6.3% in germ cell tumors while the type of malignant germ cell tumor was dependent on age. Oophorectomy was more often performed in the premenarchal age group and in women approaching the end of their reproductive age.ConclusionOur results show that adnexal masses in different age groups do not only differ in histological subgroups but also in malignancy rate which is of high value in presurgical risk evaluation.