Diagnostic Dilemma of a Pelvic-Abdominal Mass in a Teenage Girl

The differential diagnosis of an abdominal mass in young teenage girls include pelvic inflammatory disease, pelvic abdominal Koch’s, endometriosis, pedunculated uterine leiomyomata, colonic mass, and germ cell tumour. There is a strong possibility of benign, borderline, or malignant ovarian carcinoma to be diagnosed in young girls with abdominal mass. Preoperative diagnosis depends on age, menopausal status, serum cancer antigen (CA) level of 125, ultrasound and radiological imaging of the mass. For better diagnosis of benign borderline serous tumours, borderline ovarian tumours (BOTs) and invasive cancers, magnetic resonance imaging (MRI) and positron emission tomography has to be done. However, among patients with benign cysts, BOTs and invasive cancers, CA-125 levels can be same. Likewise, the imaging results are not unique to BOTs. The diagnosis of BOTs can therefore be not established before surgery and intraoperative decisions regarding the extent of surgical management are based on the results of frozen section examination. In BOTs, an effective frozen section diagnosis is of considerable significance. Women of reproductive age always want traditional fertility-sparing surgery. Benign cysts should be distinguished from BOTs. Inadequate surgical staging of BOT may result in misdiagnosis of BOT as a benign tumour, leading to more vigorous treatment and possible tumour spread.1