Surgically treated adnexal masses in infancy, childhood, and adolescence

The utility of magnetic resonance imaging in the diagnosis and management of pediatric benign ovarian lesions

BACKGROUND

The utility of magnetic resonance imaging (MRI) in the diagnosis and management of pediatric ovarian lesions has not been well defined.

METHODS

A retrospective review of all girls who underwent MRI evaluation of ovarian masses during the period 2009-2015 was performed. The accuracy of MRI was evaluated by comparing results with surgical findings, pathology reports, and subsequent imaging. The influence of the MRI on the treatment plan was specifically explored.

RESULTS

Eighteen girls, 12-17years of age, underwent 27 MRIs, subsequent to ultrasound identification of ovarian lesions. Of 9 neoplastic lesions diagnosed on MRI, 8 (89%) were confirmed by surgical and pathological findings. Of 18 functional lesions, 17 (94.4%) were confirmed pathologically or by resolution on subsequent imaging. Twenty MRI exams (74%) directly influenced the treatment plan, by leading to appropriate operative intervention in 9 and appropriate observation in 11. The extent of ovarian resection was guided by MRI findings in 8 of 9 (89%) neoplastic lesions. For characterizing lesions as neoplastic, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI were 89%, 94%, 94%, 89%, and 93% respectively.

CONCLUSIONS

MRI can differentiate functional from neoplastic pediatric ovarian masses, and guide ovarian resection in appropriate cases.

LEVEL OF STUDY

II.

Clinico-histopathological analysis of neoplastic and non-neoplastic lesions of the ovary: a 3-year prospective study in dhule, north maharashtra, India

BACKGROUND

Ovary is the commonest site of neoplastic and non-neoplastic lesion, can present in childhood to postmenopausal age group and accounts for the most prevalent cause of hospital admissions.

AIM

This study was done to analyse the frequency of ovarian lesions their clinico-histological features in a rural set up.

MATERIALS AND METHODS

This is a prospective study of 145 ovarian lesions at tertiary care hospital over a period of 3yr. All the relevant clinical data of patients analysed from hospital record file.

RESULTS

The total number of ovarian lesions studied during study period was 145 cases, amongst them 75 were non-neoplastic and remaining 70 were neoplastic. The most common non-neoplastic lesion seen was solitary follicular cysts i.e. 56 cases (74.66%), followed by corpus luteal cysts 15 cases (20%). Among the 70 neoplastic ovarian lesions 55(78.57%) cases were benign, 1(1.42%) case was at borderline and 14 (20%) cases were malignant. In benign ovarian neoplasm, most commonly seen lesion were serous cystadenoma followed by benign cystic teratoma. In malignant cases, maximum were of serous cystadenocarcinoma, followed by mucinous cystadenocarcinoma and metastatic tumours.

CONCLUSION

Ovarian lesion possess wide gamut of histology. Specific diagnoses are made on routine gross and histological examination or in certain difficult cases require immunohistochemistry.

Clinicopathologic review of ovarian masses in Korean premenarchal girls

OBJECTIVE

To review the clinicopathological characteristics of ovarian masses in Korean premenarchal girls.

DESIGN

The data collected from hospital medical records were reviewed retrospectively regarding age, presentation, diagnosis, treatment, and outcome.

PARTICIPANTS

There were 65 premenarcheal girls who underwent surgery at Seoul St. Mary's Hospital between January 1990 and March 2012.

RESULTS

The most common presenting symptom was abdominal pain (n=31, 47.7%), followed by palpable abdominal masses 16 (n=16, 24.6%), abdominal distension (n=8, 12.3%), vaginal bleeding (n=4, 6.2%), incidental finding (n=3, 4.6%), difficulty in urination or defecation (n=2, 3.1%), and prenatal sonographic findings (n=1, 1.5%). Of the patients with benign tumors, including non-neoplastic lesions and benign cysts, 26 (51%) underwent cystectomy, 6 (11.8%) underwent oophorectomy, 17 (33.3%) underwent unilateral salpingo-oophorectomy and none underwent bilateral salpingo-oophorectomy. Of the patients with malignant tumors, 2 (14.3%) underwent bilateral salpingo-oophorectomy, 7 (50%) underwent unilateral salpingo-oophorectomy, 2 (14.3%) underwent oophorectomy, and 2 (14.3%) underwent cystectomy.

CONCLUSION

Abdominal pain was the most common symptom. However, the incidence of abdominal distension was higher in patients with malignant tumors than in those with benign tumors. We assessed clinical features, operative outcomes, and histological classifications of Korean prememarchal girls with ovarian masses. Further studies with a larger number of subjects are needed to confirm our results.

A pictorial review of imaging of abdominal tumours in adolescence

Neoplastic abdominal tumours, particularly those originating from embryonal tissue (such as hepatoblastoma and nephroblastoma) and neural crest cells (such as neuroblastoma), are well-documented in young children. Neoplasms of adulthood, most commonly carcinoma of different visceral organs, are also well-documented. Abdominal tumours in adolescence constitute a distinct pathological group. The radiological features of some of these tumours have been described only in isolated reports. The purpose of this pictorial essay was to review the imaging findings of various kinds of abdominal tumours in adolescent patients (with an age range of 10-16 years) who presented to the Children Cancer Center of our institution in the past 15 years. Some tumours, though rare, have characteristic imaging appearances (especially in CT) that enable an accurate diagnosis before definite histological confirmation.

Ovarian germ cell tumors in children. Management, survival and ovarian prognosis. A report of 75 cases

BACKGROUND/PURPOSE

The aims of this study were to evaluate survival and ovarian prognosis in patients treated for ovarian germ cell tumor (OGCT) and to propose a decision-making protocol.

METHODS

Charts of girls operated on for OGCT from 1976 up to 2009 were reviewed retrospectively. Tumor characteristics were assessed by tumor markers, imaging, and pathology.

RESULTS

Charts were available in 71 children presenting 75 OGCT. Tumors were benign in 58 cases and malignant in 17 cases. The average of the largest diameter of benign OGCT was significantly lower than that of malignant OGCT (76.5 +/- 49 mm versus 169 +/- 54 mm, P < .0001). Ovarian-sparing tumorectomy was carried out in 27 benign OGCT; 23 (85%) preserved ovaries were follicular. Malignant OGCTs were managed according to the protocols of the French Society for Pediatric Oncology. Bilateral oophorectomy had to be performed in 2 children. One patient presented a recurrence and 1 died.

CONCLUSIONS

In our series, both benign and malignant OGCTs have a good prognosis. A 75-mm cutoff size is proposed as an important criterion to preoperatively differentiate between benign and malignant tumors. In benign OGCT, ovarian-sparing tumorectomy leads to preserve ovaries in approximately 85% of cases, and in malignant OGCT, high survival rate has been obtained.