Ovarian pathology for the pediatric urologist

Diagnosis and treatment of the intra-abdominal gonad in the pediatric population: Testes, ovaries, dysgenetic gonads, streaks, and ovotestes

BACKGROUND/PURPOSE

Pediatric surgical specialists are often confronted with the difficult task of identifying, diagnosing and managing intra-abdominal gonads in children. Ranging from the intra-abdominal cryptorchid testis to normal or pathologic ovaries and gonads in disorders of sexual development, all intra-abdominal gonads in the pediatric population pose different diagnosis and management challenges. Understanding the hormonal and fertility potential of the gonad and knowing its potential cancer risk is essential when deciding how to manage these patients. In addition, the ideal surgical management for each one of these patients is often debated.

METHODS

Descriptive literature review.

RESULTS/CONCLUSION

Herein, we reviewed gonadal formation, common etiologies, diagnosis and management of intra-abdominal testes, pathologic ovaries and gonads in disorders of sexual development. Fertility potential and cancer risk for each were also reviewed and how both affect surgical management of the gonad.

TYPE OF STUDY/LEVEL OF EVIDENCE

Review Article, Level V.

Ovarian teratoma with recurrent urinary retention is misdiagnosed as bladder disease: A rare case report and review of the literature

We present a 22-year-old ovarian teratoma female patient with recurrent urinary retention. It was first misdiagnosed as bladder disease and the treatment is catheterization. During the follow-up, urinary abdominopelvic examination showed a heterogeneous hypoechoic zone of 66 mm × 25 mm on the upper wall of the bladder with 1125 mL residual urine, so the patient was reevaluated. Vaginal ultrasound showed no obvious abnormalities in the uterus and accessories. In the further evaluation, urinary computed tomography (CT) revealed a visible huge space-occupying lesions in the pelvis and lower abdomen, was considered a benign lesion, and it might be the accessories teratoma. Abdominal magnetic resonance imaging (MRI) revealed a visible huge cystic shadow in the pelvis and lower abdomen. Post-operative pathology confirmed the presence of pelvic mature cystic teratoma and mature neural tissue. Post-operative follow-up for 1 year, the patient had no symptoms such as abdominal pain, dysuria, or urinary retention. The clinical manifestations of ovarian teratoma are complex, but imaging examinations (e.g. CT, MRI, and ultrasound) are characteristic and valuable for clinical diagnosis.