When an adnexal mass is 2 cm or larger in a premenarchal female, or 8 cm or larger in other premenopausal females, surgical exploration is frequently required. In young patients, blood tests should include serum hCG and AFP levels, a complete blood count, and liver function tests. A chest radiograph should be performed because germ cell tumors can metastasize to the lung or mediastinum. A karyotype should be obtained preoperatively on all premenarchal females, because of the propensity for these tumors to arise in dysgenetic gonads. A preoperative CT scan may document the presence and extent of retroperitoneal lymphadenopathy or liver metastases, but because these patients require surgical exploration, a more extensive and time-consuming preoperative evaluation is unnecessary. If postmenarchal patients have predominantly cystic lesions up to 8 cm in diameter, they may undergo a trial of hormonal suppression for two menstrual cycles.