Ovarian tumours in childhood: a 27-year review

Ovarian masses in children

We evaluated the outcome of children with ovarian mass operated on at our Center over an 8-year period. Thirty-four girls aged 1 day to 17 years were included in the study. Mean duration of follow-up was 39.5 months. Eighteen had a nonneoplastic mass and 16 a neoplastic mass, eight of which were malignant. Patients with a malignant tumor underwent adnexectomy of the affected side and appendectomy, without removal of the uterus or the other ovary and without partial omentectomy; only the one girl with bilateral malignant disease had bilateral adnexectomy. Five of the eight patients with malignant disease received chemotherapy. All patients are alive with no evidence of disease. Pediatric ovarian masses are rare but have a relatively high rate of malignancy. They differ from adult malignant tumors in many aspects. Conservative surgery should be applied to preserve fertility and combined, if necessary, with aggressive chemotherapy. A good prognosis may be expected in most cases, even with progressive disease.

Evaluation of adnexal masses in adolescents

The detection of adnexal masses in adolescents is worrisome to patients, their families, and physicians. Reassurance can be given that the vast majority of these lesions are benign. Furthermore, a significant fraction of benign masses are functional ovarian cysts, most of which resolve spontaneously and never need surgery. Imaging is critical in determining the management of these patients. Sonography is the preferred first-line diagnostic tool. When surgery is necessary, physicians must recognize the importance of conserving the ovaries and uterus to avoid the loss of reproductive and endocrine function.

Germ cell tumors in Indian children

The present paper is a retrospective study of one hundred and thirty five germ cell tumors seen in children at the University Hospital, Varanasi during a period of 21 years. These tumors constituted 7.5% of all solid tumors in the pediatric age group. Histologically 89 tumors (65.9%) were benign and 46 (34.1%) were malignant. Eighty percent of ovarian and all the testicular germ cell tumors were malignant. Thirty per cent of the tumors were located in the sacrococcyx. The ovaries were the next common site. There were 80 girls, 53 boys, and 2 cases in which the sex was not recorded. The predominance amongst girls was mainly due to the more frequent involvement of ovaries as compared to the testes. Twenty nine of the children were in the first year of life. The factors probably responsible for the higher incidence of malignancy, the differences in anatomic location, and the sex distribution in comparison to other reports have been examined and discussed.

Ovarian cancer: diagnosis and management

Ovarian cancer is the leading cause of death from gynecological cancer in the United States. Early diagnosis is a matter of chance rather than a scientific method. Although it is stated that there are no symptoms in the early stage of ovarian cancer, a careful history often reveals vague gastrointestinal symptoms that have been persistent. Surgery is the treatment of choice for ovarian cancer, with chemotherapy employed as adjunctive therapy. Radiation therapy has limited application in treating common epithelial cancers but is valuable in the management of germ cell and gonadal stromal tumors. Of the numerous laboratory tests available, only immunologic assay appears to have the potential for making an early diagnosis and monitoring treatment.

Benign and malignant ovarian tumors in children and adolescents. A review of 63 cases

Sixty-three patients (15 months to 17 years of age) with ovarian tumors were seen. Fifty-six patients had germ cell tumors and 7 epithelial tumors, 6 patients had bilateral tumors, 47 patients had teratomas (41 benign, 3 with embryonic tissue, and 3 malignant), 6 germinomas, 1 endodermal sinus tumor, and 2 mixed germ cell tumors. Of the patients with epithelial tumors, six had cystadenomas and one cystadenocarcinoma. Abdominal pain was the most common symptom, and an abdominal mass the most common sign. A calcification on abdominal films was seen in 29 patients with benign teratoma. At surgery, the opposite ovary was bivalved or biopsied in 31 patients with benign tumors. Two patients had teratomas burried in the ovarian tissue. Among 47 patients with benign tumors, 37 have remained well after the operation and 10 were lost to follow-up. Two girls with embryonic teratoma are well 71 and 19 months after diagnosis but the third died with embryonal carcinoma. Of the 13 patients with malignant tumors, 8 are alive disease free 4 1/2 to 17 years after diagnosis, 4 are dead, and 1 is lost to follow-up (disease free 15 months after diagnosis).

Ovarian cancers in childhood

In dealing with ovarian tumors in children, the gynecologist must use the same principle of assessing operability as those used for adults. This approach offers the maximum opportunity for successful treatment. The ancient medical philosophy of not inflicting harm if one cannot achieve good is especially applicable to children with ovarian cancer. It is better for a child to die at home in the loving care of her parents than alone in a cold, forbidding hospital room. There are certain characteristics that distinguish ovarian tumors in childhood from that in adults: (1) Limited space for tumor expansion. (2) A high degree of virulence in cancer. (3) A less effective immunologic response. (4) The possibility that therapy may affect future physical and emotional development.

Germ cell tumours of childhood: a review of 137 cases

One hundred and thirty-seven germ cell tumours occurring in 134 children included in the Manchester University Children's Tumour Registry over a 25-year period have been studied. The incidence and sites of these tumours as seen in a comprehensive population-based registry are presented and the relation between the primary site and histological type is assessed. There were 48 deaths in this series of which 34 were directly due to the tumour. The cause of death in the other 14 cases is given. The behaviour of the germ cell tumours was closely related to the presence of yolk sac elements.

Endodermal sinus (yolk sac) tumors in infants and children

Endodermal sinus tumors, as a specific entity, were first proposed and described by Teilum on the basis of morphological and histogenetic features. Recent work utilizing tumor markers (alpha-fetoprotein), immunofluorescent and electron microscopic studies have supported Teilum's original concept as to the origin of these tumors. Five typical presentations of endodermal sinus tumors seen in the pediatric age group were reviewed with reference to the original presentation, the utilization of tumor markers (alpha-fetoprotein) and the prognostic implications of this neoplasm.