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Rich BS, McCracken K, Nagel C, Allen L, Aldrink JH. The Shared Ovary: A Multidisciplinary Discussion With Pediatric and Adolescent Gynecology. J Pediatr Surg 2024; 59:1349-1354. [PMID: 38614951 DOI: 10.1016/j.jpedsurg.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
Pediatric and adolescent ovarian lesions are common and are frequently managed by both pediatric surgeons and pediatric and adolescent gynecologists. During the 2023 American Academy of Pediatric Section on Surgery meeting, an educational symposium was delivered focusing on various aspects of management of pediatric and adolescent benign and malignant masses, borderline lesions, and fertility options for children and adolescents undergoing cancer therapies. This article highlights the discussion during this symposium.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Northwell Health, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Kate McCracken
- Section of Pediatric and Adolescent Gynecology, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Christa Nagel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, The James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Lisa Allen
- Division of Pediatric Gynecology, Department of Obstetrics and Gynecology, Sick Kids Hospital, University of Toronto, Toronto, Canada
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
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Sulaniya C, Lakhera KK, Babu A, Patel P, Singh S, Mehta D, Singhal PM. Ovarian Germ Cell Tumors in North-Western India: A Comprehensive 3-Year Retrospective Study of 145 Cases at a Tertiary Cancer Hospital. Indian J Surg Oncol 2024; 15:288-295. [PMID: 38741622 PMCID: PMC11088569 DOI: 10.1007/s13193-024-01889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/03/2024] [Indexed: 05/16/2024] Open
Abstract
Germ cell tumors encompass a broad spectrum of neoplasms arising from germ cell lineage, demonstrating varying histological profiles and clinical presentations. These tumors encompass a range of benign and malignant entities. While global trends provide insights into their prevalence, specific regional variations, such as those within North-Western India, remain less explored. This study seeks to bridge this knowledge gap by examining the prevalence and characteristics of germ cell tumors within a tertiary cancer hospital. In this retrospective analysis, all cases of germ cell tumors diagnosed over a 3-year period in the specified tertiary cancer hospital were included. Cases with incomplete records or inadequate pathological data were excluded. Data encompassing histological subtypes, patient age distribution, clinical presentations, and histopathological features were collected and analyzed. The study comprised 145 cases of germ cell tumors. Teratomas were the most prevalent subtype, with mature teratomas accounting for the majority. The highest incidence occurred within the 21-30-year age group with a mean age of 24.77 years. Abdominal mass (56%) and abdominal pain (34%) were the prominent clinical presentations. Benign cases constituted the majority 85.5%. Solid tumors (p < 0.00001) and tumors more than 10 cm (p .029028) were found to have a high propensity to be malignant, which was proven to be statistically significant. This study comprehensively explains germ cell tumors' prevalence, clinical features, and histopathological subtypes in a tertiary cancer hospital in North-Western India. The predominance of teratomas, particularly mature ones, aligns with global trends. The age distribution and clinical presentations reflect common patterns. The diverse histopathological appearances underscore the heterogeneous nature of germ cell tumors. This study offers valuable insights for clinical management and further regional research.
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Affiliation(s)
- Chandrakanta Sulaniya
- Department of Surgical Oncology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Kamal Kishor Lakhera
- Department of Surgical Oncology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Agil Babu
- Department of Surgical Oncology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Pinakin Patel
- Department of Surgical Oncology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Deeksha Mehta
- Department of Surgical Oncology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Pranav Mohan Singhal
- Department of Surgical Oncology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan 302004 India
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Ergun-Longmire B, Greydanus DE. Ovarian tumors in the pediatric population: An update. Dis Mon 2024; 70:101691. [PMID: 38281826 DOI: 10.1016/j.disamonth.2024.101691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Research reveals that 1% of neoplasms in females under 17 years of age are ovarian neoplasms and though usually benign, malignant tumors may occur in the pediatric age group. This review considers various current concepts of these tumors including the epidemiology, risk factors, clinical presentations, diagnosis, differential diagnosis, and treatment options including the need to provide fertility-sparing surgery as well as their potential impacts on the psychological well-being of children and adolescents. We gathered data from the published articles ranging from studies, meta-analyses, retrospective studies, and reviews. We focused on the articles published in English between January 1, 2000, and August 31, 2023. Only a few articles published prior to 2000 were included for historical perspective.
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Affiliation(s)
- Berrin Ergun-Longmire
- Department of Pediatric and Adolescent Medicine, Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.
| | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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Chicoine N, Hafezi N, Sanchez V, Elliott V, Gray B. Treating Benign Ovarian Lesions in the Pediatric Population: A Single Institution's Retrospective Investigation of Laparoscopy Versus Open Repair. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38686518 DOI: 10.1089/lap.2023.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background: Benign ovarian lesions in the pediatric population have variable risk of recurrence or development of metachronous lesions, leading to variations in operative approach. Our study compares outcomes with differing surgical approaches to better elucidate risk of recurrent or metachronous lesions, time to development of these lesions, and hospital length of stay to determine if one operative approach has superior outcomes. Methods: We retrospectively examined data from Indiana University Health facilities from 2002 to 2020. Patients ≤18 years old who underwent surgical management of a benign ovarian lesion were included. Patients were categorized as undergoing oophorectomy versus ovarian sparing surgery (OSS), with open and laparoscopic approaches. Significance was defined as P < .05. Results: We identified 127 patients who underwent an open (n = 65) versus laparoscopic (n = 55) surgical approach. Patients undergoing open surgery had a greater mean size of lesion (P = .05) and longer length of stay (P < .01). Complication rates (P = .1), rates of developing a metachronous or recurrent lesion postoperatively (P = .47), and time to formation of additional lesions were similar between groups (P = .25). The incidence of identifying an additional lesion after surgery was 14.2% (n = 18) in the mean time of 29.5 ± 31.6 months [SEM 7.5]. Risk of developing a metachronous lesion was similar regardless of the operative approach. Surgery for recurrent ovarian lesions was rare and occurred in only 1 case. Conclusions: Laparoscopic surgery was performed for smaller lesions and was associated with a shorter length of hospital stay. Laparoscopic and OSS was found to have no increased risk of developing metachronous lesions nor increased reoperative risk compared with traditional open and oophorectomy techniques.
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Affiliation(s)
- Nicole Chicoine
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Ascension St. Vincent General Surgery Residency, Indianapolis, Indiana, USA
| | - Niloufar Hafezi
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Victoria Sanchez
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Victoria Elliott
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brian Gray
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Minneci PC, Bergus KC, Lutz C, Aldrink J, Bence C, Breech L, Dillon PA, Downard C, Ehrlich PF, Fallat M, Fraser JD, Grabowski J, Helmrath M, Hertweck P, Hewitt G, Hirschl RB, Kabre R, Lal DR, Landman M, Leys C, Mak G, Markel T, Pressey J, Raiji M, Rymeski B, Saito J, Sato TT, St Peter SD, Cooper J, Deans K. Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients. JAMA 2023; 330:1247-1254. [PMID: 37787794 PMCID: PMC10548301 DOI: 10.1001/jama.2023.17183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023]
Abstract
Importance Although most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health. Objective To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies. Design, Setting, and Participants Pre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children's hospitals in the United States between August 2018 and January 2021, with 1-year follow-up. Intervention Implementation of a consensus-based, preoperative risk stratification algorithm with 6 months of preintervention assessment, 6 months of intervention adoption, and 18 months of intervention. The intervention adoption cohort was excluded from statistical comparisons. Main Outcomes and Measures Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution. Results A total of 519 patients with a median age of 15.1 (IQR, 13.0-16.8) years were included in 3 phases: 96 in the preintervention phase (median age, 15.4 [IQR, 13.4-17.2] years; 11.5% non-Hispanic Black; 68.8% non-Hispanic White); 105 in the adoption phase; and 318 in the intervention phase (median age, 15.0 [IQR, 12.9-16.6)] years; 13.8% non-Hispanic Black; 53.5% non-Hispanic White). Benign disease was present in 93 (96.9%) in the preintervention cohort and 298 (93.7%) in the intervention cohort. The percentage of unnecessary oophorectomies decreased from 16.1% (15/93) preintervention to 8.4% (25/298) during the intervention (absolute reduction, 7.7% [95% CI, 0.4%-15.9%]; P = .03). Algorithm test performance for identifying benign lesions in the intervention cohort resulted in a sensitivity of 91.6% (95% CI, 88.5%-94.8%), a specificity of 90.0% (95% CI, 76.9%-100%), a positive predictive value of 99.3% (95% CI, 98.3%-100%), and a negative predictive value of 41.9% (95% CI, 27.1%-56.6%). The proportion of misclassification in the intervention phase (malignant disease treated with ovary-sparing surgery) was 0.7%. Algorithm adherence during the intervention phase was 95.0%, with fidelity of 81.8%. Conclusions and Relevance Unnecessary oophorectomies decreased with use of a preoperative risk stratification algorithm to identify lesions with a high likelihood of benign pathology that are appropriate for ovary-sparing surgery. Adoption of this algorithm might prevent unnecessary oophorectomy during adolescence and its lifelong consequences. Further studies are needed to determine barriers to algorithm adherence.
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Affiliation(s)
- Peter C. Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
- Now with Department of Surgery, Nemours Children’s Hospital–Delaware Valley, Nemours Children’s Health, Wilmington, Delaware
| | - Katherine C. Bergus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Carley Lutz
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Jennifer Aldrink
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Christina Bence
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Lesley Breech
- Division of Pediatric Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Patrick A. Dillon
- Division of Pediatric Surgery, Department of Surgery, St Louis Children’s Hospital, Washington University School of Medicine in Saint Louis, St Louis, Missouri
| | - Cynthia Downard
- Division of Pediatric Surgery, Norton Children’s Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, Department of Surgery, C. S. Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor
| | - Mary Fallat
- Division of Pediatric Surgery, Norton Children’s Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jason D. Fraser
- Division of Pediatric Surgery, Department of Surgery, Children’s Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City
| | - Julia Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Helmrath
- Division of Pediatric Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paige Hertweck
- Division of Pediatric Surgery, Norton Children’s Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Geri Hewitt
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Ronald B. Hirschl
- Section of Pediatric Surgery, Department of Surgery, C. S. Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dave R. Lal
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Matthew Landman
- Division of Pediatric Surgery, Department of Surgery, Riley Hospital for Children, Indiana University Health, Indianapolis
| | - Charles Leys
- Division of Pediatric Surgery, Department of Surgery, American Family Children’s Hospital, University of Wisconsin School of Medicine and Public Health, Madison
| | - Grace Mak
- Section of Pediatric Surgery, Department of Surgery, Comer Children’s Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Troy Markel
- Division of Pediatric Surgery, Department of Surgery, Riley Hospital for Children, Indiana University Health, Indianapolis
| | - Joseph Pressey
- Division of Pediatric Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Manish Raiji
- Section of Pediatric Surgery, Department of Surgery, Comer Children’s Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Beth Rymeski
- Division of Pediatric Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jacqueline Saito
- Division of Pediatric Surgery, Department of Surgery, St Louis Children’s Hospital, Washington University School of Medicine in Saint Louis, St Louis, Missouri
| | - Thomas T. Sato
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Shawn D. St Peter
- Division of Pediatric Surgery, Department of Surgery, Children’s Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City
| | - Jennifer Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Katherine Deans
- Department of Surgery, Nemours Children’s Hospital–Delaware Valley, Nemours Children’s Health, Wilmington, Delaware
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Weil BR, Rich BS, Madenci AL, Stambough KC, Schmoke N, Peace A, Bruny JL, Rescorla FJ, Dicken BJ, Dietrich JE, Billmire DF. Critical elements in the operative management of pediatric malignant ovarian germ cell tumors. Semin Pediatr Surg 2023; 32:151342. [PMID: 38039829 DOI: 10.1016/j.sempedsurg.2023.151342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Performance of the appropriate operation is highly important to ensure that any patient with a suspected ovarian germ cell tumor receives optimal therapy that prioritizes cure while simultaneoulsy minimizing risk of short and long-term toxicities of treatment. The following critical elements of any operative procedure performed for a suspected pediatric or adolescent ovarian germ cell tumor are reviewed: 1. Complete resection of the tumor via ipsilateral oophorectomy while avoiding tumor rupture and spillage, and 2. Performance of complete intraperitoneal staging at the time of initial tumor resection.
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Affiliation(s)
- Brent R Weil
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard University, Boston, United State; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, United States.
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, NY, United States
| | - Arin L Madenci
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard University, Boston, United State
| | - Kathryn C Stambough
- Division of Pediatric and Adolescent Gynecology, Arkansas Children's Hospital, University of Arkansas School for Medical Sciences, Little Rock, United States
| | - Nicholas Schmoke
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Alyssa Peace
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Jennifer L Bruny
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Frederick J Rescorla
- Division of Pediatric Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, United States
| | - Bryan J Dicken
- Division of Pediatric Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Baylor College of Medicine, United States
| | - Deborah F Billmire
- Division of Pediatric Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, United States
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Hao J, Sun Z, Song G. Laparoscopy for Ovary-Sparing Tumorectomy in Children with Ovarian Tumors: A Clinical Retrospective Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:296-302. [PMID: 36716193 DOI: 10.1089/lap.2022.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective: The aim of this study is to analyze the characteristics of pediatric ovarian tumors (OTs) and evaluate treatment strategies for ovary-sparing tumorectomy (OST). Materials and Methods: Medical records of children from October 2011 to December 2021 were reviewed. Data regarding clinical characteristics, pathological type, and management of OST were analyzed. Results: In total, 61 patients with OTs were screened. The median age was 14.8 ± 3.0 years. The median length and volume of borderline and malignant OTs were larger than those of benign OTs (P < .001 and P = .05, respectively). There was a significant difference in the median OT volume between torsion and nontorsion OTs (P = .04). The overall OST rate was 91.8% (67/73). A total of 53.4% (39/73) lesions were treated with laparoscopic OST. The OT volume was smaller in patients who underwent laparoscopy than in those who underwent laparotomy (P = .04). The probability of intraoperative tumor rupture or spillage was higher during laparoscopy than during laparotomy (P = .02). No significant differences were observed in OT recurrence. Seven patients had borderline and malignant tumors, 3 of whom had stage IA tumors and underwent OST. None of the patients experienced relapse. Conclusions: OT size is a useful reference factor for differential diagnosis and choosing laparoscopic surgery. Intraoperative tumor rupture and spillage of benign tumors during laparoscopy and laparotomy did not seem to be associated with recurrence, and laparoscopic OST was considered safe. Further prospective studies are required to confirm these conclusions.
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Affiliation(s)
- Jing Hao
- Department of Gynaecology, Weihai Municipal Hospital, Shandong, China
| | - Zhihuan Sun
- Department of Pediatric Surgery, Weihai Municipal Hospital, Shandong, China
| | - Guoxin Song
- Department of Pediatric Surgery, Weihai Municipal Hospital, Shandong, China
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Wang H, Wang L, An S, Ma Q, Tu Y, Shang N, Pan Y. American college of radiology ovarian-adnexal reporting and data system ultrasound (O-RADS): Diagnostic performance and inter-reviewer agreement for ovarian masses in children. Front Pediatr 2023; 11:1091735. [PMID: 36969276 PMCID: PMC10030612 DOI: 10.3389/fped.2023.1091735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Objective To evaluate the diagnostic performance and inter-observer agreement of the American College of Radiology Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS) in the diagnosis of ovarian masses in children. Methods From June 2012 to December 2021, 163 ovarian masses in 159 patients with pathologic results were retrospectively analyzed. Each mass was classified into an O-RADS category according to the criteria. The diagnostic performance of O-RADS for detecting malignant ovarian masses was assessed using histopathology as the reference standard. Kappa (k) statistic was used to assess inter-observer agreement between a less-experienced and a well-experienced radiologist. Results Out of 163 ovarian masses, 18 (11.0%) were malignant and 145 (89.0%) were benign. The malignancy rates of O-RADS 5, O-RADS 4, and O-RADS 3 masses were 72.7%, 34.6%, and 4.8%, respectively. The area under the receiver operating characteristic curve was 0.944 (95% CI, 0.908-0.981). The optimal cutoff value for predicting malignant ovarian masses was > O-RADS 3 with a sensitivity, specificity, and accuracy of 94.4%, 86.2% and 86.2% respectively. The inter-observer agreement of the O-RADS category was good (k = 0.777). Conclusions O-RADS has a high diagnostic performance for children with ovarian masses. It provides an effective malignant risk classification for ovarian masses in children, which shows high consistency between radiologists with different levels of experience.
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Toker Kurtmen B, Dokumcu Z, Divarci E, Ergun O, Ozok G, Celik A. Long-term surgical outcomes in pediatric ovarian neoplasms: 20-year single-center experience. Pediatr Surg Int 2022; 38:2035-2044. [PMID: 36169670 DOI: 10.1007/s00383-022-05256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON. METHODS A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence. RESULTS Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7 years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1 years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group. CONCLUSION The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue.
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Affiliation(s)
- Bade Toker Kurtmen
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Zafer Dokumcu
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey.
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AlDakhil L, Aljuhaimi A, AlKhattabi M, Alobaid S, Mattar RE, Alobaid A. Ovarian neoplasia in adolescence: a retrospective chart review of girls with neoplastic ovarian tumors in Saudi Arabia. J Ovarian Res 2022; 15:105. [PMID: 36114569 PMCID: PMC9482250 DOI: 10.1186/s13048-022-01033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ovarian neoplasia in children and adolescents is a rare tumor. The diagnosis and management of such tumors is often difficult and delayed due to non-specific symptoms and low suspicion. Surgical management that preserves fertility and ovarian function should be the goal. Objective This study aimed to review the clinical presentation, tumor characteristics, and management of Saudi Arabian adolescents. Methods A retrospective chart review was conducted on adolescent girls aged 19 or less admitted to tow referral hospital in Riyadh, Saudi Arabia, diagnosed with adnexal mass over an 8 years’ period; patients who were older than 19 were excluded. The data collected from patients’ charts included age, presenting symptoms, radiologic findings, type of surgery, specialist who performed the surgery, and histopathology of the tumors. We classified patients according to age using the three WHO developmental stages: early adolescence (10–13 years old), middle adolescence (14–16 years old), and late adolescence (16–17 years old). The statistical study used SPSS version 18.0 to determine the data’s frequency, distributions, and means (SPSS Inc., Chicago, IL). Results We analyzed 164 patients, between 10 and 19 years old, admitted to two hospitals between 2009 and 2017. We found that 85% of these patients underwent surgery for adnexal mass removal, and 90.2% were symptomatic or emergency cases. The majority of our patients were post-menarche (96.95%), and were between the ages of 14 and 19. The most common surgical procedure for tumor removal was laparoscopic cystectomy (74.4%). An adnexal mass with a solid component on ultrasound is the most commonly found indicator of malignancy. The majority of tumors were benign (32.3%). Germ cell tumors were the most common (68.7%) malignant tumor, and yolk sac tumors were the most common subgroup of germ cell tumors. When managed by a gynecologist, surgical intervention can be a successful method of preserving fertility. Conclusions Our results confirm that the majority of neoplastic ovarian tumors in children and adolescents are benign, and surgical intervention can be used to maintain fertility, especially when managed by a gynecologist. This is one of the largest reported series and the first from our area.
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Tarca E, Trandafir LM, Cojocaru E, Costea CF, Rosu ST, Butnariu LI, Iordache AC, Munteanu V, Luca AC. Diagnosis Difficulties and Minimally Invasive Treatment for Ovarian Masses in Adolescents. Int J Womens Health 2022; 14:1047-1057. [PMID: 35971543 PMCID: PMC9375555 DOI: 10.2147/ijwh.s374444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
About 1% of childhood tumors can be malignant ovarian tumors and differential diagnosis with benign ones is sometimes difficult before surgery. Concerning the management of such tumors in adolescents for which future fertility is a concern, there is specific interest in their malignant potential and the possible use of ovarian-sparing operative techniques, as well the suitability of chemotherapy. To exemplify the difficulties of preoperative differential diagnosis, personalized approach and the difficulties of deciding to preserve the affected ovary, we report a rare case of a 14-year-old female adolescent with a growing abdominal painless mass and without any other chronic diseases. After physical examination and imaging investigations, laparoscopic surgical procedure is performed, the peritoneal cavity is explored and the well-delimited gigantic tumor is removed. Considering the normally looking pelvis and absence of adenopathy, as well as the patient's age and wish to have children, both ovaries are preserved. Laparoscopy has become the gold standard in the management of this condition, although there are few studies that report this approach in children; the differential diagnosis between a benign and a malignant tumor cannot be established exactly until after the histological examination, which revealed in our case a cystic teratoma with mature tissues. A better understanding of clinical features and evolution of giant ovarian masses in adolescents could help clinicians better diagnose and treat such lesions.
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Affiliation(s)
- Elena Tarca
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Laura Mihaela Trandafir
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I-Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Claudia Florida Costea
- Department of Surgery II-Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Solange Tamara Rosu
- Department of Nursing, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Lacramioara Ionela Butnariu
- Department of Mother and Child Medicine-Genetics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Alin Constantin Iordache
- Department of Surgery II-Neurosurgery, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Valentin Munteanu
- Department of Biomedical Sciences, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Alina Costina Luca
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
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12
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Braungart S, Williams C, Arul SG, Bambang K, Craigie RJ, Cross KM, Dick A, Hammond P, Okoye B, Rogers T, Losty PD, Glaser A, Powis M. Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement. Pediatr Blood Cancer 2022; 69:e29589. [PMID: 35118808 DOI: 10.1002/pbc.29589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/19/2022]
Abstract
AIM No widely agreed consensus protocols exist for the management of benign ovarian tumors (BOT) in children. This presents a substantial risk for suboptimal management. We aimed to generate multispecialty consensus guidance to standardize surgical management and provide a clear follow-up protocol for children with BOTs. METHODS Prospective two-round confidential e-Delphi consensus survey distributed among multispecialty expert panel; concluded by two semistructured videoconferences. MAIN RESULTS Consensus was generated on these core outcome sets: preoperative/intraoperative management; follow-up; adolescent gynecology referral. (1) Children with BOTs should receive the same management as other patients with potentially neoplastic lesions: Preoperative discussion at a pediatric oncology multidisciplinary meeting to risk stratify tumors, and management by health professionals with expertise in ovarian-sparing surgery and laparoscopy. (2) Ovarian-sparing surgery for BOTs should be performed wherever possible to maximize fertility preservation. (3) Ovarian masses detected during emergency laparoscopy/laparotomy should be left in situ wherever feasible and investigated appropriately (imaging/tumor markers) before resection. (4) Follow-up should be undertaken for all patients after BOT resection. Patients should be offered referral to adolescent gynecology to discuss fertility implications. CONCLUSION This best practice Delphi consensus statement emphasizes the importance of managing children with BOTs through a well-defined oncological MDT strategy, in order to optimize risk stratification and allow fertility preservation by ovarian-sparing surgery wherever possible.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.,Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Cara Williams
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - Suren G Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Katerina Bambang
- Department of Reproductive Medicine, Liverpool Women's Hospital, Liverpool, UK
| | - Ross James Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Kate Mary Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alistair Dick
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Philip Hammond
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Bruce Okoye
- Department of Paediatric Surgery, St George's Hospital London, London, UK
| | - Timothy Rogers
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Paul Damian Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Adam Glaser
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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13
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Watson L, Gavens E, Pachl M, Singh M, Soccorso G, McCarthy L, Arul GS. Controlled aspiration of large paediatric ovarian cystic tumours. J Pediatr Surg 2022; 57:711-714. [PMID: 34348845 DOI: 10.1016/j.jpedsurg.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 01/27/2023]
Abstract
AIM Cystic ovarian masses in children may be physiological or neoplastic. It is mandatory that suspected neoplastic lesions are resected without tumour spillage. However, a large midline incision is cosmetically unappealing incision to young women. Here we describe our experience of using controlled drainage without spillage that allows a cosmetic pfannenstiel approach without compromising oncological principles. METHOD All girls treated with large ovarian cystic masses since 2008 in our centre were identified and data was collected prospectively. A small pfannenstiel incision was performed followed by peritoneal washings; tissue glue was used to stick an Opsite™ dressing to the cyst surface and fluid drained so there was no leakage back into the patient. Once aspirated the cyst was delivered and an ovarian preserving cystectomy was performed where possible. RESULTS Twenty-three girls (median age 14.5 years (8.1 to 16.5 years) were included. Pre-operative MRI scan showed a complex lesions with median volume of 1169 ml (range 252-7077 ml). At surgery 22/23 cysts were intact and removed without spillage. HISTOLOGY mature teratoma (11), serous cyst (3), mucinous cyst adenocarcinoma (2), mucinous cystadenoma (5), Sertoli-Leydig tumour, sclerosing stromal tumour. One girl with pre-operative rupture of a mucinous adenocarcinoma subsequently died. Ovarian sparing cystectomy was performed in 17/23 girls. All other patients are well without evidence of recurrence. CONCLUSION This is the largest series in children and adolescents using controlled drainage of cystic ovarian tumours. Though there were a range of diagnoses we have shown that these can be removed safely with a cosmetic pfannenstiel approach while following oncological principles.
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Affiliation(s)
- Lucy Watson
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Elizabeth Gavens
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Max Pachl
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Mike Singh
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Giampiero Soccorso
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Liam McCarthy
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - G Suren Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
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14
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Kang GG, So KA, Hwang JY, Kim NR, Yang EJ, Shim SH, Lee SJ, Kim TJ. Ultrasonographic diagnosis and surgical outcomes of adnexal masses in children and adolescents. Sci Rep 2022; 12:3949. [PMID: 35273292 PMCID: PMC8913732 DOI: 10.1038/s41598-022-08015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 02/23/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the incidence, clinical diagnosis, surgical treatment, and histopathological findings of adnexal masses in children and adolescents. This retrospective study included patients aged < 20 years who were diagnosed with adnexal masses between January 2005 and December 2018 at the Konkuk University Medical Center. Adnexal masses were diagnosed in 406 patients. The mean age of patients was 17.3 years at the time of diagnosis. The primary presenting symptoms and signs were abdominal pain (81.4%), mass per abdomen (13.7%), dysmenorrhea (3.4%), incidental finding (2%), and abdominal distention (0.5%). In total, 204 patients underwent surgery for adnexal masses, and 202 patients were observed without surgery. Histopathological examination revealed 110 benign neoplasms, 72 non-neoplastic lesions, 3 ectopic pregnancies, 3 tubo-ovarian abscesses, 7 borderline malignant tumors, and 9 non-epithelial ovarian malignant tumors. Abdominal pain was the most common reason for hospital visits and surgery in adolescents and young women with adnexal masses. The ultrasonographic diagnosis was consistent with the histopathological diagnosis. In recent years, the use of minimally invasive surgery such as laparoscopy and robotic, has increased in young patients with adnexal masses.
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Affiliation(s)
- Gun Gu Kang
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Kyeong A So
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
| | - Ji Young Hwang
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Nae Ri Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Eun Jung Yang
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Seung Hyuk Shim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Sun Joo Lee
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
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15
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What Should Be the Topics of a Prospective Study on Ovarian Masses in Children?—Results of a Multicenter Retrospective Study and a Scoping Literature Review. Curr Oncol 2022; 29:1488-1500. [PMID: 35323325 PMCID: PMC8946882 DOI: 10.3390/curroncol29030125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: to determine management problems of ovarian masses in girls in order to form a baseline for prospective randomized studies of the established topics and quality improvement of our management. Materials and Methods: We performed a national analysis of clinical aspects of ovarian masses in girls operated on in Poland, analyzed retrospectively medical files of all consecutive patients aged 0–18 who underwent surgeries for ovarian lesions between 2012 and 2017 at 17 pediatric surgical departments and complemented the analysis with a scoping review of a recent primary research related to ovarian masses in children. Results: The study group comprised 595 patients. Forty-four (7.39%) girls were diagnosed with malignant tumors. The overall preservation rate was 64.54%. The analysis revealed that positive tumor markers (OR = 10.3), lesions larger than 6 cm (OR = 4.17) and solid mass on ultrasound examination (OR = 5.34) are interdependent variables differentiating malignant tumors from non-malignant lesions (X42 = 79.1; p = 0.00000). Our scoping review revealed 10 major branches of research within the topic of ovarian masses in pediatric population. Conclusions: We have developed an overview of the field with the emphasis on the local environment. Our next step is a multi-institutional prospective study of a quality improvement project implementation based on the obtained knowledge.
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16
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Chui CH, Aung L. Peritoneal metastases after laparoscopic ovarian cystectomy for ovarian teratoma with unexpected somatic-type malignancy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Arthur F, Hennessey I, Pizer B, Losty PD. Surgical management and outcomes of paediatric ovarian tumours-a 25-year UK single centre experience. Pediatr Surg Int 2021; 37:1355-1359. [PMID: 34170394 DOI: 10.1007/s00383-021-04950-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ovarian neoplasms in children are rare heterogeneous lesions with variable biological behaviour and outcome. We herein report a 25-year experience from a UK specialist centre managing paediatric ovarian tumours. METHODS All female patients requiring operation for ovarian tumours were identified during the study period 1990-2018. Patient demographics, clinical presentation, and management are highlighted. RESULTS Eighty-eight females with 101 ovarian tumours including cases with synchronous and metachronous neoplasms were documented. Mean age at diagnosis was 11.8 years. Tumours were equally distributed in left and right ovary(s). Bilateral disease occurred in 11 (10.8%) patients. Eighty-six (85%) neoplasms were benign and 15 (15%) malignant requiring in addition to surgery chemotherapy and/or radiation. There were no significant difference(s) observed in maximum tumour diameter in benign vs malignant lesions. Only half of malignant tumours had positive tumour markers. Fifteen patients (15%) had ovarian lesions that were metastatic at primary presentation including a rare case of disseminated peritoneal gliomatosis. Surgical management included salpingo-oopherectomy n = 21 (21%), ovary excision n = 33 (33%), 'ovary sparing' tumourectomy n = 34 (34%), and cyto-reductive extirpation in 2 cases (2%). Lymphadenectomy was performed in 9 patients (9%) together with peritoneal fluid cytology in 18 cases (18%) who had abdominal ascites. Omentectomy was required in 14 patients (14%), multiple peritoneal biopsy(s)-in 11 cases (11%) and biopsy of other suspicious involved organs notably bowel, gut mesentery and contralateral ovary in 7 (7%) further patients. Recurrent and metachronous lesions occurred in 10 (10%) cases in those with teratoma (n = 9) and adenocarcinoma(s) (n = 1). Overall patient survival was 97% with only 3 deaths-mucinous cystadenocarcinoma (n = 1), desmoplastic small round cell tumour of ovarian origin (n = 1), and a small cell carcinoma of ovary with hypercalcaemia (n = 1). CONCLUSIONS Findings from this study show an excellent survival (97%) for paediatric ovarian neoplasms. Rare malignant neoplasms though do carry a poor prognosis. In the modern era of care, all efforts should be made to preserve future hormonal health and fertility with 'ovarian sparing' operation(s) where appropriate.
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Affiliation(s)
- Felicity Arthur
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Iain Hennessey
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,School of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK. .,School of Health and Life Sciences, University of Liverpool, Liverpool, UK.
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18
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Xac MC, Jetelina KK, Jarin J, Wilson E. Benign, Borderline, and Malignant Pediatric Adnexal Masses: A 10-Year Review. J Pediatr Adolesc Gynecol 2021; 34:454-461. [PMID: 33453397 DOI: 10.1016/j.jpag.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/30/2020] [Accepted: 01/01/2021] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To investigate the incidence, clinical features, tumor markers, radiologic findings, types of surgeries, and histologies for adnexal masses in female pediatric and adolescent patients. DESIGN Retrospective chart review. SETTING Children's Health in Dallas and Plano, Texas from 2009 to 2018. PARTICIPANTS Female patients younger than 19 years old who underwent surgical management of an adnexal mass. INTERVENTIONS None. MAIN OUTCOME MEASURES Imaging characteristics, tumor markers, surgical procedures, and histopathology. RESULTS In total, 752 patients (mean age, 13.7 years) underwent 756 surgical procedures for 781 adnexal masses. Of these, 732/781 (93.7%) were benign, 7/781 (0.9%) were borderline, and 42/781 (5.4%) were malignant. Of all 781 masses, 520/781 (66.6%) were ovarian and 261/781 (33.4%) were paratubal or tubal. Benign masses were associated with Hispanic race, pain, simple or cystic characteristics on imaging, and negative tumor markers. Borderline and malignant masses were associated with white race, pain, mass or distension, larger size, and heterogeneous appearance on imaging. Borderline masses were associated with negative tumor markers. Malignant masses were associated with elevated alpha fetoprotein, beta human chorionic gonadotropin, cancer antigen 125, and lactate dehydrogenase. CONCLUSION Most adnexal masses in the pediatric and adolescent population are benign. Benign masses were significantly smaller, more likely to have negative tumor markers, and appear simple or cystic. There is little standardization with respect to preoperative tumor markers for adnexal masses. High-yield tumor markers for malignancy include alpha fetoprotein, beta human chorionic gonadotropin, cancer antigen 125, and lactate dehydrogenase. Low-yield tumor markers include inhibin A and B. Gynecologists performed more fertility-preserving surgeries including mini-laparotomies and fewer laparotomies for benign masses than pediatric surgeons.
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Affiliation(s)
- May C Xac
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Katelyn K Jetelina
- Children's Health, Dallas, Plano, Texas; Department of Epidemiology, University of Texas Health Science Center, Human Genetics, and Environmental Sciences, Houston, Texas; Department of Data and Population Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jason Jarin
- Children's Health, Dallas, Plano, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ellen Wilson
- Children's Health, Dallas, Plano, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
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19
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Billmire D, Dicken B, Rescorla F, Ross J, Piao J, Huang L, Krailo M, Pashankar F, Frazier L. Imaging Appearance of Nongerminoma Pediatric Ovarian Germ Cell Tumors Does Not Discriminate Benign from Malignant Histology. J Pediatr Adolesc Gynecol 2021; 34:383-386. [PMID: 33316416 PMCID: PMC8096645 DOI: 10.1016/j.jpag.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE Pediatric ovarian neoplasms with imaging appearance suggestive of teratoma are often presumed to have low risk of malignancy. We assessed the pre-operative imaging appearance of pediatric malignant ovarian germ cell tumors (MOGCT) and the presence of associated teratoma in a series of MOGCT. DESIGN Retrospective review of clinical and pathology data. SETTING Multicenter trial for extracranial malignant germ cell tumors in young female individuals by the Children's Oncology Group (COG study AGCT0132) that included yolk sac tumor, embryonal carcinoma and choriocarcinoma. PARTICIPANTS Female individuals 0-20 years of age at enrollment with ovarian primary nonseminomatous malignant germ cell tumors. INTERVENTIONS Review of data forms, including prospectively collected surgical checklist documenting imaging characteristics of the tumor, and review of pathology reports. MAIN OUTCOME MEASURES Description of imaging appearance and frequency of mixed histology with benign teratoma elements. RESULTS A total of 138 female individuals (11 months to 20 years of age) had primary ovarian tumors. Imaging appearance and pathology information were available for 133 patients. Among the 133 patients, tumor appearance was solid (10.5%), solid with calcification (3.0%), mixed cystic and solid (58.7%), mixed cystic and solid with calcification (24.8%), and unknown (3.0%). In all, 54% had elements of teratoma in addition to malignant histology. CONCLUSION Mixed cystic and solid appearance with or without calcification was seen in 83.5% of pediatric ovarian malignant germ cell tumors. Associated benign teratoma was common. The presence of a mixed cystic and solid appearance on preoperative imaging should not dissuade the surgeon from obtaining preoperative serum markers and undertaking complete surgical staging.
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Affiliation(s)
- Deborah Billmire
- Division of Pediatric Surgery, Indiana University, Indianapolis, Indiana.
| | - Bryan Dicken
- Division of Pediatric Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Frederick Rescorla
- Division of Pediatric Surgery, Indiana University, Indianapolis, Indiana
| | - Jonathan Ross
- Department of Urology, Rush University, Chicago, Illinois
| | - Jin Piao
- Children's Oncology Group, Monrovia, California
| | - Li Huang
- Children's Oncology Group, Monrovia, California
| | - Mark Krailo
- Department of Research Preventive Medicine, University of Southern California, Monrovia, California
| | - Farzana Pashankar
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Lindsay Frazier
- Department of Pediatrics, Harvard University, Dana Farber Cancer Institute, Boston, Massachusetts
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20
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Farràs Roca L, Alshehri ED, Goldberg HR, Amirabadi A, Kives S, Allen L, Navarro OM, Lam CZ. Diagnostic Performance of a Sonographic Volume and Solid Vascular Tissue Score (VSVTS) for Preoperative Risk Assessment of Pediatric and Adolescent Adnexal Masses. J Pediatr Adolesc Gynecol 2021; 34:377-382. [PMID: 33271292 DOI: 10.1016/j.jpag.2020.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE To evaluate the diagnostic performance of a Volume and Solid Vascular Tissue Score (VSVTS) for preoperative risk assessment of pediatric and adolescent adnexal masses. DESIGN A retrospective cohort study comprised of all female individuals who presented with an adnexal mass that was managed surgically between April 2011 and March 2016. SETTING The Hospital for Sick Children (Toronto, Ontario, Canada). PARTICIPANTS Female individuals 1-18 years of age who presented to a large tertiary pediatric hospital with an adnexal mass that was managed surgically. MAIN OUTCOME MEASURES Main outcome measures included diagnostic performance of the VSVTS for malignancy via sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and receiver operating characteristic area-under-the-curve (AUC) analysis. RESULTS A total of 179 masses in 169 subjects were included. The malignancy rate was 10.6%. The AUC for the VSTVS was 0.919. A VSTVS cut-off value of 4 achieved a sensitivity of 79% (95% CI 0.54-0.93), specificity of 88% (95% CI 0.82-0.93), PPV of 0.44 (95% CI 0.33-0.56), NPV of 0.97 (95% CI 0.94-0.99), LR+ of 6.77 (95% CI 4.18-10.97), and LR- of 0.24 (95% CI 0.10-0.57). CONCLUSIONS A sonographic scoring system based on the volume and presence of solid vascular tissue improves PPV for preoperative risk stratification of adnexal masses in the pediatric and adolescent population compared to existing ultrasound-only approaches. Further prospective research is needed to determine how best to incorporate components of such scoring systems into clinical management algorithms.
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Affiliation(s)
- Lara Farràs Roca
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ebtehaj D Alshehri
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Hanna R Goldberg
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sari Kives
- Section of Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Lisa Allen
- Section of Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Oscar M Navarro
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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21
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Pecorelli S, Tonegatti UG, Stern MV, Bulotta AL, Laffranchi F, Stegher C, Odicino F, Alberti D. Management of Large Pediatric and Adolescent Ovarian Neoplasms with a Leak-Proof Extracorporeal Drainage Technique: Our Experience Using a Hybrid Minimally Invasive Approach. J Pediatr Adolesc Gynecol 2021; 34:394-399. [PMID: 32828966 DOI: 10.1016/j.jpag.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE In a pediatric setting, laparoscopic management of large cystic ovarian neoplasms with low malignancy probability is not suitable, because of the mass size; nevertheless, an effort should be made to be as minimally invasive as possible, without violating the principles of oncologic surgery. We describe our experience in managing these neoplasms with leak-proof extracorporeal drainage through mini laparotomy, followed by cyst excision or oophorectomy. DESIGN Case series study, describing interventions and outcomes. SETTING Department of pediatric surgery in a tertiary pediatric and adult university hospital. PARTICIPANTS Pediatric patients affected by large cystic ovarian mass. INTERVENTIONS Hybrid minimally invasive approach using leak-proof extracorporeal drainage. MAIN OUTCOME MEASURES Data on demographic characteristics, tumor marker values, and imaging findings were collected and analyzed. Outcome of surgical technique was evaluated and reported. RESULTS Between 2011 and 2018, 17 patients (mean age, 10.2 years; range, 2-14 years) affected by large cystic ovarian mass, were eligible for this technique. All patients had negative preoperative tumor markers. Of the seventeen subjects, 13/17 girls (76%) underwent pelvic magnetic resonance imaging. No sign of lymphadenopathy or metastasis was found. Surgery was successful in all patients, with ovarian preservation in 5/17 cases (29.4%). Mean surgical time was 98 minutes; no intra-abdominal leakage of neoplasm content or postoperative complications occurred. Mature cystic teratoma was the most frequent histopathological diagnosis (71%). CONCLUSION After a thorough patient selection, the management of large cystic ovarian neoplasms with leak-proof extracorporeal drainage performed through a mini laparotomy is a feasible and safe approach, with excellent cosmetic results. When achievable, ovarian-sparing surgery has to be considered.
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Affiliation(s)
- Silvia Pecorelli
- Department of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy.
| | - Uca Giacomo Tonegatti
- Department of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Maria Vittoria Stern
- Department of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Anna Lavinia Bulotta
- Department of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | | | - Claudia Stegher
- Department of Obstetrics and Gynecology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynecology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Daniele Alberti
- Department of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Sharma R, Khera S, Sinha A, Yadav T. Pure yolk sac tumor of sacrococcygeal region. Autops Case Rep 2021; 11:e2021287. [PMID: 34249791 PMCID: PMC8214897 DOI: 10.4322/acr.2021.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/11/2021] [Indexed: 11/23/2022]
Abstract
The sacrococcygeal region is the most common site for the extragonadal germ cell tumors comprising seminomatous and non-seminomatous tumors. Seminomatous tumors are seminomas, and non-seminomatous tumors comprise mainly teratoma (mature and immature), yolk sac tumor (YST), embryonal carcinoma (EC), and choriocarcinoma. These tumors occur in newborns, infants, and adolescents. Other common sites for extragonadal germ cell tumors are the brain and mediastinum, although they may occur anywhere in the body. These tumors may occur in mixed as well as pure form. So, sectioning from different areas should be done before labeling them as pure germ cell tumors. YST, in its pure form, is rare and therefore should not be missed as it is chemosensitive. The patient should be thoroughly assessed clinically. Imaging also becomes necessary while evaluating swelling in the sacrococcygeal region and can aid in differentials. When the clinical and imaging suspicion of either Sacrococcygeal teratoma or other germ cell tumor is high, serum biomarkers as alfa-fetoprotein should be requested. The serum levels are necessary and should be done preoperatively, postoperatively, and during the course of chemotherapy as follow-up. However, the final diagnosis rests on the histopathological diagnosis. We report one such case of pure YST in the sacrococcygeal region in a 9-month-old female child. The imaging suggested sacrococcygeal teratoma type 4, and high alfa-fetoprotein levels were determined postoperatively.
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Affiliation(s)
- Rashim Sharma
- All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India
| | - Sudeep Khera
- All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India
| | - Arvind Sinha
- All India Institute of Medical Sciences, Department of Pediatric Surgery, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- All India Institute of Medical Sciences, Diagnostic and Interventional Radiology, Jodhpur, Rajasthan, India
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23
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The diagnostic value of magnetic resonance imaging in differentiating benign and malignant pediatric ovarian tumors. Pediatr Radiol 2021; 51:427-434. [PMID: 33185738 PMCID: PMC7897193 DOI: 10.1007/s00247-020-04871-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/21/2020] [Accepted: 10/04/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The diagnostic workup of ovarian tumors in children and adolescents is challenging because preserving fertility, in addition to oncological safety, is of particular importance in this population. Therefore, a thorough preoperative assessment of ovarian tumors is required. OBJECTIVE To investigate the diagnostic value of MR imaging in differentiating benign from malignant ovarian tumors in children and adolescents. MATERIALS AND METHODS We conducted a retrospective study of all children and adolescents age <18 years who underwent MR imaging of ovarian tumors during 2014-2019 at a pediatric specialty center. Two radiologists reviewed all MR imaging. We used pathology reports to define the histological diagnosis. RESULTS We included 30 girls who underwent MR imaging for an ovarian tumor. Signs indicative for malignancy were tumors with a diameter ≥8 cm, with areas of contrast enhancement, irregular margins, extracapsular tumor growth, and ascites. All benign and malignant ovarian tumors were correctly identified by the radiologists. CONCLUSION The diagnostic utility of MR imaging in classifying ovarian tumors in children and adolescents as benign or malignant is promising and might aid in defining the indication for ovarian-sparing versus non-ovarian-sparing surgery. We recommend evaluating these tumors with MR imaging prior to deciding on surgical treatment.
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24
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Banlı-Cesur I, Tanrıdan-Okcu N, Özçelik Z. Ovarian masses in children and adolescents: Analysis on 146 patients. J Gynecol Obstet Hum Reprod 2020; 50:101901. [PMID: 32889112 DOI: 10.1016/j.jogoh.2020.101901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Ovarian masses in pediatric population are the most common genital neoplasms, and these masses are often benign. The purpose of this study is to evaluate the pediatric ovarian masses operated in our hospital. METHOD The records of patients, under the age of 18 who were operated in our hospital due to ovarian mass between 2012 and 2018 were reviewed retrospectively. Clinical findings, operational procedures, histopathologies, tumor markers and radiological images were evaluated. FINDINGS During the study, 146 patients (5 patients were bilateral) were evaluated. The average age of the study patients was 14.01 ± 4.02 years. 107 of the study patients were benign, 37 were malignant and 2 were borderline. The most common symptom in benign masses was tenderness in lower abdominal (75.7 %). 124 of the patients (86.1 %) were in post-menarche period. 34 of the patients had ovarian torsion. Open surgery was conducted on 79.5 % (116/146) of the patients, and laparoscopic surgery was conducted on 20.5 % (30/146). The rate of oophorectomy was 24.6 % (36/146) throughout the operations. The most frequently conducted surgical procedure was cyst excision in benign masses and oophorectomy in malignant masses. In neoplastic masses, the ratio of pelvic mass palpation; and in non-neoplastic masses, lower abdominal tenderness was more apparent. The rate of ovarian torsion was 23.6 % (25/107) in benign masses and 24.3 % (9/37) in malignant masses. OUTCOMES Pediatric and adolescent ovarian masses are mostly benign and majority of these occur at post-menarche period. The most common symptom was pelvic tenderness in benign masses, and palpable pelvic masses in malignant masses. For future fertility and low incidence of malignancy in these patients, ovarian preserving surgery should be considered for the first operation.
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Affiliation(s)
- I Banlı-Cesur
- University of Health Sciences, Adana City Training and Research Hospital, Department of Pediatric Surgery, Adana, Turkey.
| | - N Tanrıdan-Okcu
- University of Health Sciences, Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Adana, Turkey.
| | - Z Özçelik
- University of Health Sciences, Adana City Training and Research Hospital, Department of Pediatric Surgery, Adana, Turkey.
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25
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Elgendy A, Mostafa M, Salem MA, Ali A, Khairi A, Shehata S. Surgical resection and outcome of malignant ovarian germ cell tumors in children-a national multicentric study compared to international results. Pediatr Surg Int 2020; 36:1067-1075. [PMID: 32681191 DOI: 10.1007/s00383-020-04716-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the outcome of pediatric malignant ovarian germ cell tumors treated by three tertiary Egyptian institutions, and to compare our national experience to internationally published data. METHODS This is a retrospective analysis of all patients presenting between September 2014 and September 2019. Management protocol was Children's Oncology Group (COG) in all participating centers. Overall survival (OS), event-free survival (EFS) and univariate prognostic factors were estimated by Kaplan-Meier and log-rank test. Additionally, a review of various practices that reported survival outcome was conducted. MAIN RESULTS Thirty-seven patients were included with a median age of 10.5 years (1-18 years). Thirty-five patients had unilateral salpingo-oophorectomy. Mixed germ cell and yolk sac tumors represented 75.7% of patients. There were 7 (19%), 14 (37.8%), 12 (32.4%) and 4 (10.8%) stage I, II, III and IV, respectively. Seven patients were low risk (LR), 26 intermediate risk (IR) and 4 high risk (HR). Platinum-based chemotherapy was administered as per risk stratification. Follow-up to March 2020 revealed that five patients had relapsed. There were no statistical significances of pathological types and patients' age regarding OS (p value 0.392 and 0.281, respectively) and EFS (p value 0.420 and 0.437, respectively). Three-year OS was 84%: 100% for stages I and II, and 62% for stages III and IV (p = 0.003); 100% for LR, 89% for IR, and 24% for HR (p < 0.001). Three-year EFS was 87%: 96% for stages I and II, and 71% for stages III and IV (p = 0.025); 100% for LR, 92% for IR, and 26% for HR (p < 0.001). CONCLUSION Surgical resection combined with chemotherapy achieves excellent outcome for such tumors in both, present study and previous reports. On the basis of our results, COG staging and risk stratification were significantly correlated with prognosis, whereas tumor pathology and age had no significant impact. Prognostic factors are controversial among studies, and further research is still required.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Mahmoud Mostafa
- Pediatric Surgery Department, Assiut University, Assiut, Egypt
| | | | - Amany Ali
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmed Khairi
- Pediatric Surgery Department, Alexandria University, Alexandria, Egypt
| | - Sameh Shehata
- Pediatric Surgery Department, Alexandria University, Alexandria, Egypt
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26
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Lawrence AE, Minneci PC, Deans KJ. Ovarian Masses and Torsion: New Approaches for Ovarian Salvage. Adv Pediatr 2020; 67:113-121. [PMID: 32591055 DOI: 10.1016/j.yapd.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Amy E Lawrence
- Department of Pediatric Surgery, Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Peter C Minneci
- Department of Pediatric Surgery, Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Katherine J Deans
- Department of Pediatric Surgery, Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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27
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Terzic M, Rapisarda AMC, Della Corte L, Manchanda R, Aimagambetova G, Norton M, Garzon S, Riemma G, King CR, Chiofalo B, Cianci A. Diagnostic work-up in paediatric and adolescent patients with adnexal masses: an evidence-based approach. J OBSTET GYNAECOL 2020; 41:503-515. [DOI: 10.1080/01443615.2020.1755625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Milan Terzic
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Rahul Manchanda
- Department of Gynae Endoscopy, Manchanda’s Endoscopic Centre, Pushawati Singhania Research Institute, Delhi, India
| | - Gulzhanat Aimagambetova
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Melanie Norton
- Department of Urogynaecology, Whittington Hospital, London, UK
| | - Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Cara Robinson King
- Obstetrics, Gynecology, and Womens Health Institute, Section of Minimally Invasive Gynecologic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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28
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Takayasu H, Masumoto K, Tanaka N, Aiyoshi T, Sasaki T, Ono K, Chiba F, Urita Y, Shinkai T. A clinical review of ovarian tumors in children and adolescents. Pediatr Surg Int 2020; 36:701-709. [PMID: 32346848 DOI: 10.1007/s00383-020-04660-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the features which predict torsion and the pre-operative indicators of malignancy in cases of ovarian torsion in ovarian tumors (OTs) in children. METHODS The medical records of 35 pediatric patients who underwent surgery for OT, except for neonate cases, from 1997 to 2018 at our institution were reviewed retrospectively. RESULTS The pathological diagnosis was mature teratoma in 17, immature teratoma in 9, yolk sac tumor in 3, and others in 6. The preoperative diagnosis, which was made based on the imaging findings and the serum tumor marker values, matched with the pathological diagnosis in 29/35 (83%). Ovarian torsion occurred in 14/35 (40%). All but one case that presented with torsion had intermittent abdominal pain as the primary symptom. The preoperative white blood cell count was significantly higher in cases where ovary preservation was impossible than where it was possible (p = 0.01) among the cases presenting with torsion. CONCLUSION Preoperative imaging findings and the serum tumor marker values enabled us to make an accurate preoperative diagnosis. Patients with intermittent abdominal primary symptoms were more likely to have ovarian torsion than those without such symptoms, and leukocytosis may indicate irreversible ischemic changes in the affected ovary.
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Affiliation(s)
- Hajime Takayasu
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nao Tanaka
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsubasa Aiyoshi
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takato Sasaki
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kentaro Ono
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumiko Chiba
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuhisa Urita
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toko Shinkai
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
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29
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Ye G, Xu T, Liu J, Xu W, Lv Z. The role of preoperative imaging and tumor markers in predicting malignant ovarian masses in children. Pediatr Surg Int 2020; 36:333-339. [PMID: 31701303 DOI: 10.1007/s00383-019-04591-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the clinicopathololgic characteristics and the predicting value of preoperative imaging and tumor markers in children with ovarian masses. METHODS Patients admitted in Shanghai children's hospital with ovary neoplasms between 2010.01 and 2015.12 were retrospectively analyzed. The medical records including age at operation, presentation of symptoms and signs, tumor marker, imaging, pathology, tumor diameter and surgical choice were reviewed. All data were analyzed using SPSS 17.0 RESULTS: A total of 139 patients were included, among which 116 were benign neoplasms and 23 malignant tumors. There was significance difference relation with the tumor diameter, character, torsion and tumor markers, but not the age, position, calculi, and symptoms. The risk factors include tumor diameters ≥ 10 cm, the odds ratio (OR) was 11, 95% confidence interval (CI) was 3-36, solid/complex tumor (OR 6, 95% CI 2, 14) and positive in tumor markers (OR 84, 95% CI 20, 345). Among the patients with benign neoplasms, 77 of them had laparoscopic ovarian cystectomy while 23 patients with malignant tumors had salpingo-oophorectomy and omentum resection. CONCLUSION Preoperative imaging and tumor markers could help identifying the malignant ovarian masses in children. If tumor diameter ≥ 10 cm, solid/complex in imaging and tumor markers abnormal, a radical resection is mandatory; otherwise, an ovarian-sparing surgery is recommended.
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Affiliation(s)
- Guogang Ye
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, China.
| | - Ting Xu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Jiangbin Liu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Weijue Xu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, China
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30
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Hanafy AK, Mujtaba B, Yedururi S, Jensen CT, Sanchez R, Austin MT, Morani AC. Imaging in pediatric ovarian tumors. Abdom Radiol (NY) 2020; 45:520-536. [PMID: 31745573 DOI: 10.1007/s00261-019-02316-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The spectrum of ovarian tumors in the pediatric population differs significantly from that in adults. Germ cell tumors are the predominant class of ovarian tumors in children, whereas epithelial tumors are the most common in adults. Ultrasonography is the modality of choice for the initial evaluation of pediatric ovarian tumors. Determining the diagnosis based on imaging may prove difficult, and combining the imaging findings with the clinical scenario is very helpful in reaching a differential diagnosis during clinical practice. We will discuss the spectrum of ovarian neoplasms in the pediatric population and describe their clinical, pathologic, and imaging characteristics. A few unique entities related to ovarian tumors, such as growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and hereditary ovarian tumor syndromes, are also discussed. In addition, we will review several entities that may mimic ovarian neoplasms as well as their distinct imaging features.
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Affiliation(s)
- Abdelrahman K Hanafy
- Diagnostic Radiology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, 78229, USA
| | - Bilal Mujtaba
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Sireesha Yedururi
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Corey T Jensen
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ramon Sanchez
- Radiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Mary T Austin
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ajaykumar C Morani
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
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Vázquez Rueda F, Murcia Pascual FJ, Siu Uribe A, Ortega Salas RM, Escassi Gil Á, Garrido Pérez JI, Paredes Esteban RM. Analysis of solid ovarian tumours in a Spanish paediatric population. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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32
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Elgendy A, Lakshminarayanan B, Elrouby A, Mostafa M, Salem MA, Turner K, Khairi A, Squire R, K Shehata SM, Shehata S, Powis M. Management of pediatric benign ovarian tumors in England and Egypt: A comparative study. Afr J Paediatr Surg 2020; 17:33-38. [PMID: 33106451 PMCID: PMC7818669 DOI: 10.4103/ajps.ajps_64_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM OF THE STUDY We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions. MATERIALS AND METHODS This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both sides. RESULTS Eighty-nine patients were included (54 English and 35 Egyptians). Median age at diagnosis in England was 13 years (2-16y), while in Egypt it was 7 years (9m-16y) with P =0.001. Mature teratomas or dermoid cysts were the most common findings in England and Egypt; 75.9% and 82.8% of cases, respectively. The presentation with an acute abdomen represented 27.8% of English and 28.6% of Egyptian patients. Incidentally diagnosed lesions constituted 15% of English patients, whereas none of the Egyptian cases were discovered incidentally. There were variations in diagnostic imaging; England: Ultrasound (USS) (54), magnetic resonance imaging (MRI) (37), and computed tomography (CT) (only one)-Egypt: USS (35), CT (17), and MRI (only one). Minimally invasive surgery (MIS) was performed in 15% of English and 23% of Egyptian patients (P = 0.334). Ovarian-sparing surgery (OSS) was performed in: England 35%, Egypt 37%; P = 0.851. OSS was performed using MIS in 87.5% (7/8) of English patients and 100% (8/8) of Egyptians. Patients presented as emergencies generally had open oophorectomies: England; 86.7% open and 80% oophorectomy-Egypt; 100% open and 90% oophorectomy. Recurrences or metachronous disease occurred in 5.6% of English and 5.7% of Egyptian patients. CONCLUSIONS There were no significant differences regarding surgical management, tumor pathology, and recurrence or metachronous disease. However, age, incidental diagnosis, and imaging modalities showed notable differences. MIS was correlated with ovarian preservation, whereas emergency surgery generally resulted in open oophorectomy.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt
| | | | - Ahmed Elrouby
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Mahmoud Mostafa
- Department of Pediatric Surgery, Assiut University, Assiut, Egypt
| | | | - Kerry Turner
- Department of Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | - Ahmed Khairi
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Roly Squire
- Department of Pediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | | | - Sameh Shehata
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Mark Powis
- Department of Pediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
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Lawrence AE, Fallat ME, Hewitt G, Hertweck P, Onwuka A, Afrazi A, Bence C, Burns RC, Corkum KS, Dillon PA, Ehrlich PF, Fraser JD, Gonzalez DO, Grabowski JE, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Overman RE, Rademacher BL, Raiji MT, Sato TT, Scannell M, Sujka JA, Wright T, Minneci PC, Deans KJ, Aldrink JH. Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms. J Pediatr Surg 2020; 55:122-125. [PMID: 31677824 PMCID: PMC7181461 DOI: 10.1016/j.jpedsurg.2019.09.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/29/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the diagnostic accuracy of tumor markers for malignancy in girls with ovarian neoplasms. METHODS A retrospective review of girls 2-21 years who presented for surgical management of an ovarian neoplasm across 10 children's hospitals between 2010 and 2016 was performed. Patients who had at least one concerning feature on imaging and had tumor marker testing were included in the study. Sensitivity, specificity, and negative and positive predictive values (PPV) of tumor markers were calculated. RESULTS Our cohort included 401 patients; 22.4% had a malignancy. Testing for tumor markers was inconsistent. AFP had high specificity (98%) and low sensitivity (42%) with a PPV of 86%. The sensitivity, specificity, and PPV of beta-hCG was 44%, 76%, and 32%, respectively. LDH had high sensitivity (95%) and Inhibin A and Inhibin B had high specificity (97% and 92%, respectively). CONCLUSIONS Tumor marker testing is helpful in preoperative risk stratification of ovarian neoplasms for malignancy. Given the variety of potential tumor types, no single marker provides enough reliability, and therefore a panel of tumor marker testing is recommended if there is concern for malignancy. Prospective studies may help further elucidate the predictive value of tumor markers in a pediatric ovarian neoplasm population. TYPE OF STUDY Retrospective Cohort Review. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amy E. Lawrence
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Mary E. Fallat
- Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Geri Hewitt
- Department of Surgery, Division of Pediatric and Adolescent Gynecology, The Ohio State University, Nationwide Children’s Hospital, Columbus, OH
| | - Paige Hertweck
- Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY,Department of Obstetrics and Gynecology, Louisville University School of Medicine, Louisville, KY
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH
| | - Amin Afrazi
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christina Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Robert C. Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Kristine S. Corkum
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Patrick A. Dillon
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jason D. Fraser
- Division of Pediatric Surgery, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO
| | - Dani O. Gonzalez
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Julia E. Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dave R. Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew P. Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Charles M. Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Grace Z. Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - R. Elliott Overman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Brooks L. Rademacher
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Manish T. Raiji
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - Thomas T. Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Madeline Scannell
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Joseph A. Sujka
- Division of Pediatric Surgery, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO
| | - Tiffany Wright
- Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Peter C. Minneci
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Jennifer H. Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
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van Heerden J, Tjalma W. The multidisciplinary approach to ovarian tumours in children and adolescents. Eur J Obstet Gynecol Reprod Biol 2019; 243:103-110. [DOI: 10.1016/j.ejogrb.2019.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/02/2019] [Accepted: 10/17/2019] [Indexed: 01/30/2023]
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Abstract
Ovarian neoplasms are rare in children. Although usually asymptomatic, they sometimes present with abdominal pain, abdominal distension or palpable mass. The distribution of neoplasms in the pediatric population is different from in adults; benign mature cystic teratoma is the most common ovarian tumor in children. Radiologists should be familiar with the variable sonographic, CT and MRI findings of ovarian neoplasms. Although the less frequently encountered ovarian malignancies cannot be reliably distinguished by imaging alone, it does play an important role in workup. This review discusses the imaging and relevant clinical manifestations of the more commonly encountered pediatric ovarian neoplasms.
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van Nimwegen LWE, Mavinkurve-Groothuis AMC, de Krijger RR, Hulsker CCC, Goverde AJ, Zsiros J, Littooij AS. MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review. Eur Radiol 2019; 30:1166-1181. [PMID: 31529256 PMCID: PMC6957553 DOI: 10.1007/s00330-019-06420-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/03/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The use of magnetic resonance (MR) imaging in differentiation between benign and malignant adnexal masses in children and adolescents might be of great value in the diagnostic workup of sonographically indeterminate masses, since preserving fertility is of particular importance in this population. This systematic review evaluates the diagnostic value of MR imaging in children with an ovarian mass. METHODS The review was made according to the PRISMA Statement. PubMed and EMBASE were systematically searched for studies on the use of MR imaging in differential diagnosis of ovarian masses in both adult women and children from 2008 to 2018. RESULTS Sixteen paediatric and 18 adult studies were included. In the included studies, MR imaging has shown good diagnostic performance in differentiating between benign and malignant ovarian masses. MR imaging techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to further improve the diagnostic performance. CONCLUSION The addition of DWI with apparent diffusion coefficient (ADC) values measured in enhancing components of solid lesions and DCE imaging may further increase the good diagnostic performance of MR imaging in the pre-operative differentiation between benign and malignant ovarian masses by increasing specificity. Prospective age-specific studies are needed to confirm the high diagnostic performance of MR imaging in children and adolescents with a sonographically indeterminate ovarian mass. KEY POINTS • MR imaging, based on several morphological features, is of good diagnostic performance in differentiating between benign and malignant ovarian masses. Sensitivity and specificity varied between 84.8 to 100% and 20.0 to 98.4%, respectively. • MR imaging techniques like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to improve the diagnostic performance. • Specific studies in children and adolescents with ovarian masses are required to confirm the suggested increased diagnostic performance of DWI and DCE in this population.
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Affiliation(s)
- Lotte W E van Nimwegen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | | | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline C C Hulsker
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - Angelique J Goverde
- Department of Reproductive Medicine and Gynaecology, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - Annemieke S Littooij
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Madenci AL, Vandewalle RJ, Dieffenbach BV, Laufer MR, Boyd TK, Voss SD, Frazier AL, Billmire DF, Rescorla FJ, Weil BR, Weldon CB. Multicenter pre-operative assessment of pediatric ovarian malignancy. J Pediatr Surg 2019; 54:1921-1925. [PMID: 30867096 DOI: 10.1016/j.jpedsurg.2019.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to develop a pre-operative risk assessment tool for childhood and adolescent ovarian malignancy, in order to guide operative management of pediatric ovarian masses. METHODS We conducted a retrospective analysis of patients <18 years old who underwent ovarian surgery at two quaternary care pediatric centers over 4 years (1/1/13-12/31/16). Probability of malignancy was estimated based on imaging characteristics (simple cyst, heterogeneous, or solid), maximal diameter, and tumor markers (α-fetoprotein, β-human chorionic gonadotropin). RESULTS Among 188 children with ovarian masses, 11% had malignancies. For simple cysts, there were no malignancies (0/24, 95% CI = 0-17%). Among solid lesions, 44% (15/34, 95% CI = 28-62%) were malignant. Among marker-elevated heterogeneous masses, 40% (2/5, 95% CI = 12-77%) were malignant. Conversely, small (≤10 cm) and large (>10 cm) marker-negative heterogeneous lesions had malignancy proportions of 0% (0/39, 95% CI = 0-11%) and 5% (2/40, 95% CI = 1-18%), respectively. CONCLUSIONS Given the malignancy estimates identified from these multi-institutional data, we recommend an attempt at ovarian-sparing resection for simple cysts or tumor marker-negative heterogeneous lesions ≤10 cm. Oophorectomy is recommended for solid masses or heterogeneous lesions with elevated markers. Finally, large (>10 cm) heterogeneous masses with non-elevated markers warrant a careful discussion of ovarian-sparing techniques. Complete surgical staging is mandatory regardless of operative procedure. TYPE OF STUDY Study of Diagnostic Test. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Arin L Madenci
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Robert J Vandewalle
- Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Bryan V Dieffenbach
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Theonia K Boyd
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Stephan D Voss
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA
| | - Deborah F Billmire
- Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Frederick J Rescorla
- Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA
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Lawrence AE, Gonzalez DO, Fallat ME, Aldrink JH, Hewitt GD, Hertweck SP, Onwuka A, Bence C, Burns RC, Dillon PA, Ehrlich PF, Fraser JD, Grabowski JE, Hirschl RB, Kabre R, Kohler JE, Lal DR, Landman MP, Leys CM, Mak GZ, Sato TT, Scannell M, Sujka JA, Minneci PC, Deans KJ. Factors Associated With Management of Pediatric Ovarian Neoplasms. Pediatrics 2019; 144:peds.2018-2537. [PMID: 31164439 DOI: 10.1542/peds.2018-2537] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. METHODS A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. RESULTS Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). CONCLUSIONS The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.
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Affiliation(s)
- Amy E Lawrence
- Division of Pediatric Surgery, Department of Surgery and the Research Institute and
| | - Dani O Gonzalez
- Department of Surgery, Mt. Sinai Hospital, New York, New York
| | | | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery and the Research Institute and
| | - Geri D Hewitt
- Division of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio
| | - S Paige Hertweck
- Pediatric and Adolescent Gynecology, Norton Children's Hospital and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Amanda Onwuka
- Division of Pediatric Surgery, Department of Surgery and the Research Institute and
| | - Christina Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert C Burns
- Division of Pediatric Surgery, Department of Surgery, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Patrick A Dillon
- Division of Pediatric Surgery, Department of Surgery, School of Medicine, Washington University, St Louis, Missouri
| | - Peter F Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Julia E Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin; and
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin; and
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, the University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Madeline Scannell
- Division of Pediatric Surgery, Department of Surgery, School of Medicine, Washington University, St Louis, Missouri
| | - Joseph A Sujka
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Peter C Minneci
- Division of Pediatric Surgery, Department of Surgery and the Research Institute and
| | - Katherine J Deans
- Division of Pediatric Surgery, Department of Surgery and the Research Institute and
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Abstract
PURPOSE OF REVIEW This review highlights progress in the management of pediatric ovarian neoplasms. Recent research has identified disparities in the management of patients with benign ovarian neoplasms based on a variety of factors. However, the long-term effects of unilateral oophorectomy have prompted an emphasis on ovary-sparing surgery (OSS) for benign masses. One of the challenges still facing providers is the preoperative differentiation between benign and malignant masses. RECENT FINDINGS Recent studies highlight the variability in practice patterns surrounding the management of benign ovarian neoplasms. Progress continues to be made in identifying reliable factors that can be used to inform preoperative risk stratification of patients who present with ovarian neoplasms. These factors include imaging characteristics, symptoms and tumor markers. In addition, the safety of OSS with regard to recurrence and upstaging in appropriate settings continues to be demonstrated. SUMMARY This review highlights the importance of multidisciplinary collaboration in the treatment of ovarian neoplasms given the varied surgical approach by specialty. Multiple retrospective studies have identified factors that can be used for preoperative risk stratification and selection of patients for OSS. Prospective studies evaluating the accuracy of these factors for preoperative risk stratification are needed.
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Vázquez Rueda F, Murcia Pascual FJ, Siu Uribe A, Ortega Salas RM, Escassi Gil Á, Garrido Pérez JI, Paredes Esteban RM. [Analysis of solid ovarian tumours in a Spanish paediatric population]. An Pediatr (Barc) 2019; 92:88-93. [PMID: 30975583 DOI: 10.1016/j.anpedi.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Ovarian tumours are rare in childhood, and account for 1-5% of all tumours. The aim of this study is to determine the epidemiological features, histological subtypes, and therapeutic management of ovarian solid ovarian tumours of the paediatric population of the province of Cordoba, in Spain. MATERIAL AND METHODS A retrospective, descriptive, observational and institutional study was conducted in which a review was made of the clinical histories of patients younger than 14years-old diagnosed with ovarian tumours, excluding secondary tumours in a University Hospital between 1994 and 2017. A review was carried out on the age, clinical presentation, laterality, diagnostic methodology, treatment, histopathology, and evolution of these tumours. RESULTS A total of 37 ovarian tumours were reviewed in 31 patients, 6 of them being bilateral. The mean age was 10.3 (0-14) years, with 58% presenting as a palpable mass. There was no predominance of laterality. The tumour markers were negative. Conservative surgery was performed in 29.7% and adnexectomy in 70.3%. Only one case required post-operative adjuvant chemotherapy treatment (stageI immature teratoma with peritoneal gliomatosis). The histological study shows a predominance of germ cell tumours (65%) against those of epithelial lineage (22%). There were 3 stromal tumours that corresponded to fibroma (Gorlin syndrome), and bilateral gonadoblastoma associated with Frasier syndrome. The most frequent type of tumour was mature cystic teratoma (35.1%). There were no complications in the follow-up. CONCLUSIONS Given that most childhood ovarian tumours are benign, conservative surgery is considered as the first choice, being even more important in bilateral tumours. If there is a family history, it is essential to carry out molecular genetic studies, to rule out associated syndromes.
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Affiliation(s)
- Fernando Vázquez Rueda
- UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España; Facultad de Medicina, Universidad de Córdoba; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España.
| | | | - Ariadna Siu Uribe
- UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
| | | | - Álvaro Escassi Gil
- UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
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Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review. J Pediatr Surg 2019; 54:369-377. [PMID: 30220452 DOI: 10.1016/j.jpedsurg.2018.08.058] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy. METHODS The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review. RESULTS Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence. CONCLUSIONS Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature. TYPE OF STUDY Systematic review of level 1-4 studies. LEVEL OF EVIDENCE Level 1-4 (mainly 3-4).
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Elgendy A, Shehata S. National survey on current management of ovarian tumors in pediatric age group. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2018. [DOI: 10.1016/j.epag.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Phelps HM, Lovvorn HN. Minimally Invasive Surgery in Pediatric Surgical Oncology. CHILDREN-BASEL 2018; 5:children5120158. [PMID: 30486309 PMCID: PMC6306705 DOI: 10.3390/children5120158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023]
Abstract
The application of minimally invasive surgery (MIS) to resect pediatric solid tumors offers the potential for reduced postoperative morbidity with smaller wounds, less pain, fewer surgical site infections, decreased blood loss, shorter hospital stays, and less disruption to treatment regimens. However, significant controversy surrounds the question of whether a high-fidelity oncologic resection of childhood cancers can be achieved through MIS. This review outlines the diverse applications of MIS to treat pediatric malignancies, up to and including definitive resection. This work further summarizes the current evidence supporting the efficacy of MIS to accomplish a definitive, oncologic resection as well as appropriate patient selection criteria for the minimally invasive approach.
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Affiliation(s)
- Hannah M Phelps
- School of Medicine, Vanderbilt University, Nashville, TN 37232, USA.
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Łuczak J, Bagłaj M. Ovarian teratoma in children: a plea for collaborative clinical study. J Ovarian Res 2018; 11:75. [PMID: 30165903 PMCID: PMC6116467 DOI: 10.1186/s13048-018-0448-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/21/2018] [Indexed: 02/08/2023] Open
Abstract
Background Although teratomas are the most common histologic subtype of childhood ovarian germ cell tumors, their appropriate treatment in this age group still remains unclear. Paucity of research dedicated exclusively to both mature and immature teratomas of the ovary, contribute to decision making difficulties. Therefore, we decided to review retrospectively our experience in treatment of pediatric ovarian teratomas in order to assess the epidemiology, presenting features, and diagnostic as well as surgical management of these lesions. Results The study comprised 58 patients. Fifty percent of patients were between 9 and 15 years old. Mature teratoma was diagnosed in 55(94.83%) patients, while 3(5.17%) patients presented with immature teratoma. Twenty eight (50.91%) girls with mature teratoma had laparotomy and 23 (41.82%) had laparoscopy performed as an initial operative approach. Ovarian tissue sparing technique (preservation of the ovarian tissue of the affected gonad) was applied in only 11.11% of patients operated in the first study period (years 1999–2003) and increased to 40.54% in the second half of our study (years 2004–2016). The extent of gonadal resection was not related with the size of the lesion. Bilateral lesions were noted in 8 patients with mature teratoma. All girls with immature teratoma were subjected to formal laparotomy. Two patients had stage III of the disease and one had stage IV. They underwent at least resection of the affected gonad. Adjuvant chemotherapy was given to all girls with immature teratoma after the surgery. Conclusions Under particular conditions ovarian-sparing surgery might be successfully applied in children with mature teratoma. Laparotomy is the treatment of choice in large masses, suspicious for malignancy and if surgical staging is required. High quality prospective multi-institutional studies are required in order to get an objective insight into biology and prognostic factors of teratomas in children.
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Affiliation(s)
- Justyna Łuczak
- Pediatric Surgery and Urology Department, Wroclaw Medical University, 52 M. Sklodowskiej - Curie ST, 50-369, Wroclaw, Poland.
| | - Maciej Bagłaj
- Pediatric Surgery and Urology Department, Wroclaw Medical University, 52 M. Sklodowskiej - Curie ST, 50-369, Wroclaw, Poland
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Abid I, Zouari M, Jallouli M, Sahli S, Bouden A, Ben Abdallah R, Trabelsi F, Jabloun A, Charieg A, Mrad C, Marzouki M, Mosbahi S, Ezzi A, Mootamri R, Hamzaoui M, Kaabar N, Jlidi S, Nouri A, Mhiri R. Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia. Gynecol Endocrinol 2018; 34:243-247. [PMID: 28942697 DOI: 10.1080/09513590.2017.1381839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.
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Affiliation(s)
- I Abid
- a Department of Pediatric Surgery , Hedi Chaker Hospital , Sfax , Tunisia
| | - M Zouari
- a Department of Pediatric Surgery , Hedi Chaker Hospital , Sfax , Tunisia
| | - M Jallouli
- a Department of Pediatric Surgery , Hedi Chaker Hospital , Sfax , Tunisia
| | - S Sahli
- b Department of Pediatric Surgery "A" , Children Hospital , Tunis , Tunisia
| | - A Bouden
- b Department of Pediatric Surgery "A" , Children Hospital , Tunis , Tunisia
| | - R Ben Abdallah
- c Department of Pediatric Surgery , Habib Thameur Hospital , Tunis , Tunisia
| | - F Trabelsi
- c Department of Pediatric Surgery , Habib Thameur Hospital , Tunis , Tunisia
| | - A Jabloun
- c Department of Pediatric Surgery , Habib Thameur Hospital , Tunis , Tunisia
| | - A Charieg
- d Department of Pediatric Surgery "B" , Children Hospital , Tunis , Tunisia
| | - C Mrad
- d Department of Pediatric Surgery "B" , Children Hospital , Tunis , Tunisia
| | - M Marzouki
- d Department of Pediatric Surgery "B" , Children Hospital , Tunis , Tunisia
| | - S Mosbahi
- e Department of Pediatric Surgery , Fattouma Bourguiba Hospital , Monastir , Tunisia
| | - A Ezzi
- e Department of Pediatric Surgery , Fattouma Bourguiba Hospital , Monastir , Tunisia
| | - R Mootamri
- e Department of Pediatric Surgery , Fattouma Bourguiba Hospital , Monastir , Tunisia
| | - M Hamzaoui
- b Department of Pediatric Surgery "A" , Children Hospital , Tunis , Tunisia
| | - N Kaabar
- c Department of Pediatric Surgery , Habib Thameur Hospital , Tunis , Tunisia
| | - S Jlidi
- d Department of Pediatric Surgery "B" , Children Hospital , Tunis , Tunisia
| | - A Nouri
- e Department of Pediatric Surgery , Fattouma Bourguiba Hospital , Monastir , Tunisia
| | - R Mhiri
- a Department of Pediatric Surgery , Hedi Chaker Hospital , Sfax , Tunisia
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Surgical considerations and challenges in the pediatric and adolescent gynecologic patient. Best Pract Res Clin Obstet Gynaecol 2017; 48:128-136. [PMID: 29239814 DOI: 10.1016/j.bpobgyn.2017.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
It is important for practitioners to recognize that there are special considerations when performing gynecologic surgery in a pediatric or adolescent patient. A provider must be familiar with differences in anatomy, physiology, surgical technique, and psychosocial concerns. This can be challenging for a provider who does not routinely operate on patients in this population. A minimally invasive surgical approach is preferred in the pediatric and adolescent patient whenever possible. While a good command of laparoscopy in the adult patient is certainly a useful skill when operating on pediatric and adolescent patients, there are technical adaptations and challenges to consider. This chapter reviews the pre-operative preparation, operative technique and challenges, and post-operative care of the surgical pediatric and adolescent gynecologic patient.
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Trotman G, Foley CE, Taylor J, DeSale S, Gomez-Lobo V. Postoperative Outcomes among Pediatric and Adolescent Patients Undergoing Minilaparotomy vs Laparoscopy in the Management of Adnexal Lesions. J Pediatr Adolesc Gynecol 2017; 30:632-635. [PMID: 28669786 DOI: 10.1016/j.jpag.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare institutional experience in postoperative recovery in children and adolescents who undergo laparoscopy vs minilaparotomy in the management of benign adnexal cystic lesions. DESIGN Retrospective cohort study. SETTING Tertiary care children's hospital. PARTICIPANTS Patients ages 6-21 years who underwent surgical management for benign adnexal lesions. INTERVENTIONS AND MAIN OUTCOME MEASURES Comparison of surgery times, size of lesions, pain scores, and patient length of stay after minilaparotomy vs laparoscopy. RESULTS Forty-four patients were identified. Of those, 59% (n = 26) had a laparoscopic procedure and 41% (n = 18) underwent minilaparotomy. Patients who underwent minilaparotomy were more likely to have a larger adnexal mass than those in the laparoscopy group with a median size of 15.5 cm vs 6.0 cm, respectively (P < .001). Postoperative length of stay and recovery were comparable in both groups. CONCLUSION Minilaparotomy offers a minimally invasive option for the management of benign adnexal lesions in the pediatric and adolescent age group with recovery comparable to that of laparoscopy. The minilaparotomy approach should be considered when laparoscopy is limited.
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Affiliation(s)
- Gylynthia Trotman
- MedStar Washington Hospital Center, Washington, DC; Children's National Health Services, Washington, DC.
| | | | | | - Sameer DeSale
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Veronica Gomez-Lobo
- MedStar Washington Hospital Center, Washington, DC; Children's National Health Services, Washington, DC
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Alsuhaibani M, Al Harbi M, Al-lababidi NH, Almuzaini AS, Alsulaiman A, Aljadaan SA. Ovarian lesions among pediatric patients: A tertiary center experience (1997-2016). Int J Pediatr Adolesc Med 2017; 4:129-132. [PMID: 30805516 PMCID: PMC6372493 DOI: 10.1016/j.ijpam.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/22/2022]
Abstract
Introduction Ovarian lesions are not commonly seen in pediatric females; however, there are some reported cases among different pediatric age groups. Ovarian lesions can show, clinically, in many diverse presentations, and the treatment chosen may be conservative or surgical, accordingly. In this study, we aim to find ovarian lesions commonly operated on and their histopathological and clinical characteristics among pediatric patients at tertiary center in Riyadh, Saudi Arabia. Material and methods A retrospective review of medical records of all pediatric patients (aged 14 or younger) who underwent surgical removal of ovarian lesions from January 1997 to August 2016 at King Abdulaziz Medical City, Riyadh, Saudi Arabia was conducted. Results Records for a total of 14 girls with a mean age of 5.7 ± 5.1 years were reviewed. The most common clinical presentation was acute abdominal pain (n = 5, 35.7%). There were four patients without any complaints who were diagnosed incidentally (28.6%). More than half of the patients underwent laparoscopy (n = 8, 57.1%) and cystectomy procedures were performed on 50% of the patients (n = 7). Simple ovarian cysts (n = 5) were the most common ovarian lesions followed by mature cystic teratomas (n = 3) with 35.7% and 21.4%, respectively. Furthermore, simple ovarian cysts were more common among infants. There was only one death reported and she had been diagnosed with a mixed germ cell tumor. Conclusion The majority of ovarian lesions in the studied pediatric patients were benign. The most common lesions were simple ovarian cysts. Abdominal pain was the most common presenting symptom.
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Affiliation(s)
- Marya Alsuhaibani
- College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
- Corresponding author.
| | - Majed Al Harbi
- College of Medicine, Almaarefa Colleges for Science and Technology, Riyadh, Saudi Arabia
| | | | - Alaa Sunaid Almuzaini
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Saud A. Aljadaan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pediatric Surgery, King Abdullah Specialist Children Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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50
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Aldrink JH, Gonzalez DO, Sales SP, Deans KJ, Besner GE, Hewitt GD. Using quality improvement methodology to improve ovarian salvage for benign ovarian masses. J Pediatr Surg 2017; 53:S0022-3468(17)30638-3. [PMID: 29106919 DOI: 10.1016/j.jpedsurg.2017.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Most ovarian masses in children are benign and potentially amenable to ovarian salvage surgery (OSS). Despite the common use of OSS among pediatric and adolescent gynecologists (PAG) in recognition of reproductive and hormonal health advantages, this technique is not commonly performed by pediatric surgeons. The aim of this quality improvement (QI) initiative was to improve our institutional rate of OSS for benign ovarian masses. METHODS Baseline data were obtained retrospectively from surgical procedures performed for benign ovarian masses between January 2012 and February 2016. Designed interventions to improve the rate of OSS included the development of an ovarian mass algorithm, standardization of radiologic templates, multidisciplinary analyses of ovarian procedures, and implementation of a training model for performing OSS. Procedures performed for benign ovarian masses from March 2016 to February 2017 comprised the process stage. RESULTS Our institutional baseline OSS rate was 28.8%. After implementation of the institutional algorithm, a single oophorectomy was performed for a benign mass, increasing the OSS rate to 96%. There have been no missed ovarian malignancies. CONCLUSIONS Utilizing preoperative risk assessment, QI methodology and multidisciplinary collaboration resulted in improved OSS rates for benign ovarian masses with no evidence of missed ovarian malignancies. LEVEL OF EVIDENCE Level II. This is a prospective comparative study, with comparison to a retrospective cohort. This is a quality improvement initiative without randomization.
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Affiliation(s)
- Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
| | - Dani O Gonzalez
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH
| | - Stephen P Sales
- Department of Quality Improvement, Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH
| | - Gail E Besner
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Geri D Hewitt
- Department of Surgery, Division of Obstetrics and Gynecology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
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