How should the management of ovarian masses in children?

Yusuf Atakan Baltrak 1 * , Seniha Esin Söğüt 1, Arzu Yavuz 2, Onursal Varlikli 1, Hasan Terzi 2
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1 Department of Pediatric Surgery, University of Health Science, Kocaeli Derince Training and Research Hospital, Derince, Kocaeli, Turkey
2 Department of Obstetrics and Gynecology, University of Health Science, Kocaeli Derince Training and Research Hospital, Derince, Kocaeli, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 6, Issue 60, pp. 88-92. https://doi.org/10.23950/jcmk/9270
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ABSTRACT

Introduction: Prevalence of ovarian masses in children increase due to easy access to imaging techniques. There are conflicting views about evaluation and classification of ovarian masses for neoplasia in such age group in the literature.
Material and methods: The patients who were monitored and treated because of ovarian mass in pediatric surgery and obstetrics and gynaecology clinics were reviewed retrospectively. Demographic data, symptoms, dimensions and lateralization of the mass, serum tumour markers, histopathological evaluation results, and treatment outcomes of the patients enrolled in were recorded. Ovarian masses of the participants were divided into two groups as non-neoplastic group (NNG) and neoplastic group (NG) depending on imaging techniques, serum tumour markers and histopathological analysis results. Results were statistically reviewed.
Results: There was not any statistical difference between NG and NNG for age, body mass index, mass diameter, initial symptoms, and mass lateralization (p>0.05). Review of ovarian masses reported by imaging techniques revealed that pure cystic appearance was statistically significant for NNG (p=0.012). Duration of the surgery and hospitalization were detected shorter in NNG treated laparoscopically (p=0.023).
Conclusion: Surgical treatment of ovarian masses in children should be ovarian protective as much as possible. However, there is not any reliable and proven marker that may differentiate a benign ovarian mass from a malignant ovarian mass in paediatric patients like adult population. A detailed medical history, physical examination, imaging methods, and adequate tumour markers should be used for preoperative evaluation of adnexial masses.
Keywords: child, malignancy, ovarian neoplasms, surgery

CITATION

Baltrak YA, Söğüt SE, Yavuz A, Varlikli O, Terzi H. How should the management of ovarian masses in children?. J Clin Med Kaz. 2020;6(60):88-92. https://doi.org/10.23950/jcmk/9270

REFERENCES

  • Hermans A. Adnexal masses in children, adolescents and women of reproductive age. Adnexal Masses in Children,Adolescents, Women of Reproductive, Age. Part 3 Enschede: Ipskamp Printing. 2018; 7-92.
  • Hermans AJ, Kluivers KB, Janssen LM, et al. Adnexalmasses in children, adolescents and women of reproductive age in the Netherlands: a nationwide population-based cohort study. Gynecol Oncol. 2016; 143:93-7. https://doi.org/10.1016/j.ygyno.2016.07.096
  • Quint EH, Smith YR. Ovarian surgery in premenarchal girls. J Pediatr Adolesc Gynecol. 1999; 12:27-9. https://doi.org/10.1016/S1083-3188(00)86617-6
  • Cass DL, Hawkins E, Brandt ML, et al. Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period. J Pediatr Surg. 2001; 36:693-9. https://doi.org/10.1053/jpsu.2001.22939
  • Eskander RN, Bristow RE. Adnexal masses in pediatric and adolescent females: a review of the literature. Curr Obstet Gynecol Rep. 2012; 1:25-32. https://doi.org/10.1007/s13669-011-0001-4
  • Glorieux I, Chabbart V, Rubie H, Baunin C, Gaspard MH, Guitard J, Duga I, Suc A, Puget C, Robert A. Autoimmune hemolytic anemia associated with a mature ovarian teratoma. Arch Pediatr. 1998; 5(1):41-4. https://doi.org/10.1016/S0929-693X(97)83466-5
  • Nokura K, Yamamoto H, Okawara Y, Koga H, Osawa H, Sakai K. Reversible limbic encephalitis caused by ovarian teratoma. Acta Neurol Scand. 1997; 96:367-73. https://doi.org/10.1111/j.1600-0404.1997.tb00227.x
  • Cartault A, Ponsar C, Menendez M, Pienkowski C. Ovarian tumor and cyst in prepubertal girls: hormonal aspects. Arch Pediatr. 2008; 15(5):778-80. https://doi.org/10.1016/S0929-693X(08)71908-0
  • Morowitz M, Huff D, Von Allmen D. Epithelial ovarian tumors in children: a retrospective analysis. J Pediatr Surg. 2003; 38(3):331-5 https://doi.org/10.1053/jpsu.2003.50103
  • Heo SH, Kim JW, Shin SS, Jeong SI, Lim HS, Choi YD, et al. Review of ovarian tumors in children and adolescents: Radiologic-pathologic correlation. Radio-graphics. 2014; 34:2039-55. https://doi.org/10.1148/rg.347130144
  • Oltmann SC, Garcia N, Barber R, Huang R, Hicks B, Fischer A. Can we preoperatively risk stratify ovarian masses for malignancy? J Pediatr Surg. 2010; 45:130-4. https://doi.org/10.1016/j.jpedsurg.2009.10.022
  • Epelman M, Chikwava KR, Chauvin N, Servaes S. Imaging of pediatric ovarian neoplasms. Pediatr Radiol. 2011; 41(9):1085-99. https://doi.org/10.1007/s00247-011-2128-x
  • Bazot M, Lafont C, Roussel A, Jarboui L, Nassar-Slaba J,Thomassin-Naggara I. Soft tissue characterization of the female pelvis with MRI. J Radiol. 2010; 91(4):453-64 https://doi.org/10.1016/S0221-0363(10)70060-3
  • Marro A, Allen LM, Kives SL, Moineddin R, Chavhan GB. Simulated impact of pelvic MRI in treatment planning for pediatric adnexal masses. Pediatr Radiol. 2016; 46:1249-57. https://doi.org/10.1007/s00247-016-3606-y
  • Papic JC, Finnell SM, Slaven JE, Billmire DF, Rescorla FJ, Leys CM. Predictors of ovarian malignancy in children: Overcoming clinical barriers of ovarian preservation. J Pediatr Surg. 2014; 49:144-7. https://doi.org/10.1016/j.jpedsurg.2013.09.068
  • Abid I, Zouari M, Jallouli M, Sahli S, Bouden A, Ben Abdallah R, et al. Ovarian masses in pediatric patients: A multicenter study of 98 surgical cases in Tunisia. Gynecol Endocrinol. 2018; 34:243-7. https://doi.org/10.1080/09513590.2017.1381839
  • Ayhan A, Guven S, Guven ES, Kucukali T. Is there a correlation between tumor marker panel and tumor size and histopathology in well-staged patients with borderline ovarian tumors? Acta Obstet Gyneco Scand. 2007; 86(4):484-90. https://doi.org/10.1080/00016340701226138
  • Taskinen S, Fagerholm R, Lohi J, Taskinen M. Pediatric ovarian neoplastic tumors: Incidence, age at presentation, tumor markers and outcome. Acta Obstet Gynecol Scand. 2015; 94:425-9. https://doi.org/10.1111/aogs.12598
  • Spinelli C, Buti I, Pucci V, Liserre J, Alberti E, Nencini L, et al. Adnexal torsion in children and adolescents: New trends to conservative surgical approach - our experience and review of literature. Gynecol Endocrinol. 2013; 29:54-8. https://doi.org/10.3109/09513590.2012.705377
  • Bristow RE, Nugent AC, Zahurak ML, Khouzhami V, Fox HE. Impact of surgeon specialty on ovarian-conserving surgery in young females with an adnexal mass. J Adolesc Health. 2006; 39:411-6. https://doi.org/10.1016/j.jadohealth.2005.12.022
  • Nitke S, Goldman GA, Fisch B, Kaplan B, Ovadia J. The management of dermoid cysts a comparative study of laparoscopy and laparotomy. Isr Med Sci. 1996; 32:1177-9.
  • Maja Raicevic, Amulya Kumar Saxena, Review of Laparoscopic Management of Mature Cystic Teratoma of Ovaries in Children. J Indian Assoc Pediatr Surg. 2019; 24(2):92-96. https://doi.org/10.4103/jiaps.JIAPS_246_17
  • Rogers, EM, Casadiego, CG, Lacy J, Gerstle JT, Kives S, Allen L. Preoperative risk stratification of adnexal masses: Can we predict the optimal surgical management? J Pediatr Adolesc Gynecol. 2014; 27:125-8. https://doi.org/10.1016/j.jpag.2013.09.003
  • C Mayer, D M Miller, T G Ehlen, Peritoneal implantation of squamous cell carcinoma following rupture of a dermoid cyst during laparoscopic removal. Gynecol Oncol. 2002; 84(1):180-3. https://doi.org/10.1006/gyno.2001.6484
  • Anthony N. Karnezis and Kathleen R. Cho, Preclinical Models of Ovarian Cancer: Pathogenesis, Problems, and Implications for Prevention. Clin Obstet Gynecol. 2017; 60(4):789-800. https://doi.org/10.1097/GRF.0000000000000312
  • Smail Acimi, Acute ovarian torsion in young girls. Journal of Acute Disease. 2016; 5(1):59-61. https://doi.org/10.1016/j.joad.2015.07.006
  • Nair S, Joy S, Nayar J. Five year retrospective case series of adnexal torsion. J Clin Diagn Res. 2014; 8(12):OC09-13. https://doi.org/10.7860/JCDR/2014/9464.5251
  • Didem Baskin Embleton, Betül Zengin, Ahmet Ali Tuncer, Ahmet Afşin Kundak, Evrim Özkaraca Boyacı, Salih Çetinkurşun. Follow-up of neonatal ovarian cysts. A retrospective cross-sectional study. J Clin Med Kaz. 2019; 3(53):38-41 https://doi.org/10.23950/1812-2892-JCMK-00695
  • Reddy J, Laufer MR. Advantage of conservative surgical management of large ovarian neoplasms in adolescents. Fertil Steril. 2009; 91:1941-4. https://doi.org/10.1016/j.fertnstert.2008.02.116