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Childress KJ, Patil NM, Muscal JA, Dietrich JE, Venkatramani R. Borderline Ovarian Tumor in the Pediatric and Adolescent Population: A Case Series and Literature Review. J Pediatr Adolesc Gynecol 2018; 31:48-54. [PMID: 28899828 DOI: 10.1016/j.jpag.2017.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/01/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE To determine the diagnosis, management, and outcome for children and adolescents with borderline ovarian tumor (BOT), and to provide a review of the literature on BOT in children and adolescents. DESIGN A retrospective cohort study of female adolescents younger than age 21 years diagnosed with BOT between January 2001 and May 2016. SETTING Texas Children's Hospital, Houston, Texas. PARTICIPANTS Fourteen patients (ages 12 to 18 years) diagnosed with BOT. MAIN OUTCOME MEASURES Clinical presentation, preoperative characteristics, surgical technique, cancer stage, histology, treatment, and recurrence. RESULTS Median age at diagnosis was 15.5 years, with most postmenarchal. Abdominal mass/pain were the most common presenting symptoms. Median tumor size was 16.6 cm (range, 4-32 cm). Preoperative cancer antigen 125 (CA 125) was elevated in 54% (7/13) of cases. All patients had fertility-preserving surgery, either cystectomy (CY) or unilateral salpingo-oophorectomy (USO): 5 via laparoscopy (LSC) and 9 via laparotomy. Most were stage I with 5 serous and 9 mucinous BOT histology. No one received adjuvant chemotherapy. Two patients had recurrence. One had ipsilateral recurrence 2 months after LSC CY for FIGO stage IC1 mucinous BOT. The second had contralateral recurrence 15 months after laparotomy, right USO for FIGO stage IIIC serous BOT treated with LSC CY, then a second recurrence treated with USO after oocyte cryopreservation for fertility preservation. All patients were alive at last follow-up, 1 with disease. CONCLUSIONS BOT in children and adolescents can be treated conservatively with fertility-preserving techniques and surveillance with good outcome. The role of adjuvant therapy is not known.
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Affiliation(s)
- Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Ninad Mohan Patil
- Departments of Pathology and Immunology, and Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jodi A Muscal
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Rajkumar Venkatramani
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Cowan RA, Haber EN, Faucz FR, Stratakis CA, Gomez-Lobo V. Mucinous Cystadenoma in Children and Adolescents. J Pediatr Adolesc Gynecol 2017; 30:495-498. [PMID: 28216128 PMCID: PMC6379898 DOI: 10.1016/j.jpag.2017.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/05/2017] [Accepted: 02/09/2017] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE Mucinous cystadenomas (MCAs) are benign epithelial ovarian tumors that occur rarely in children and adolescents. Because children and adolescents typically have their childbearing years ahead of them, conservative therapy is indicated. However, there is concern that ovarian cystectomy might be associated with significant recurrence risk in patients with MCA. Furthermore, guanine nucleotide binding protein, alpha stimulating (GNAS) gene mutations are associated with McCune-Albright syndrome, which is associated with cystic ovaries. We sought to evaluate the outcomes of children and adolescents with MCA treated conservatively. A subset of patients underwent GNAS gene testing. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS After institutional board review approval, the pathology database of a large urban children's hospital was queried to identify adolescents with MCA between the years 2008 and 2014. Fourteen patients, aged 8-18 years (median, 14), were identified. A buccal swab for genetic testing was obtained from a subset of consenting patients. MAIN OUTCOME MEASURES MCA recurrence; ovarian return to normal size; GNAS gene variants. RESULTS Two patients underwent oophorectomies, and the remaining 12 underwent cystectomies. Follow-up ultrasound examination revealed slow return of ovary to normal size. Of the 10 patients with available follow-up data, there were no recurrences at a median of 225 days from surgery. Four patients consented to a buccal swab for genetic testing, and the GNAS gene was noted to have rare variants in 2 patients. CONCLUSION This series supports the use of ovary-sparing surgery in the treatment of MCA. Further research exploring possible genetic variants such as the GNAS gene in children and adolescents diagnosed with MCA is warranted.
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Affiliation(s)
- Renee A Cowan
- Children's National Medical Center, MedStar Washington Hospital Center, Washington, DC.
| | - Erin N Haber
- MedStar Georgetown University Hospital, Washington, DC
| | - Fabio R Faucz
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Veronica Gomez-Lobo
- Children's National Medical Center, MedStar Washington Hospital Center, Washington, DC
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3
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Fan R. Unique features and insights from mucinous tumors of ovary in childhood: clinicopathological study of 15 cases including four premenarchal cases. Fetal Pediatr Pathol 2014; 33:166-75. [PMID: 24575832 DOI: 10.3109/15513815.2014.888111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mucinous tumors of ovary are primarily diagnosed in middle-aged and elder woman. They are very infrequent in the first two decades of life and exceedingly rare in premenarchal girls. We reviewed the past 20 years of our institutional pathology files and studied the clinicopathological features of the childhood ovarian mucinous tumor cases. The study concluded that ovarian mucinous tumor cases in childhood, including premenarchal cases, may not be as rare as people previously estimated and discovered some unique features of the tumors in this age group that are beneficial for better prognosis prediction and clinical management, as well as better understanding of pathogenesis of ovarian epithelial tumors.
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Affiliation(s)
- Rong Fan
- Department of Pathology, Indiana University, IN, USA
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4
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Höhne S, Milzsch M, Stiefel M, Kunze C, Hauptmann S, Finke R. Ovarian borderline tumors in pre-menarche girls. Pediatr Hematol Oncol 2013; 30:253-62. [PMID: 23480305 DOI: 10.3109/08880018.2013.774450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
By reason of a new case of an ovarian mucinous borderline tumor (BOT) in a pre-menarche girl, a research of current literature was implemented. Low-grade malignant epithelial tumors are extremely rare in young children and, as far as we know, only a few case reports exist. The patients presented with vomiting, pain, and a swollen lower abdomen. Pre-operative diagnosis primarily consists of imaging techniques. At Stage Ia, the tumor is confined to the ovary without penetration of the capsule, no malignant ascites or peritoneal implants. Treatment consists of removal of the tumor combined with concurrent salpingo oophorectomy, appendectomy, omentectomy, and peritoneal lavage. Although the treatment recommendations are not uniform, basically, preservation of fertility is the main objective. The prognosis is very good, but recurrence is possible even after 10 years.
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Affiliation(s)
- Sven Höhne
- Clinic of Pediatric Surgery, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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5
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Cevik M, Guldur ME. An extra-large ovarian mucinous cystadenoma in a premenarchal girl and a review of the literature. J Pediatr Adolesc Gynecol 2013; 26:22-6. [PMID: 22854108 DOI: 10.1016/j.jpag.2012.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 04/14/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Epithelial ovarian neoplasms are extremely uncommon in children. Ovarian mucinous cystadenoma is benign and an extremely rare presentation in the premenarchal period. We present a case of giant mucinous cystadenoma of the left ovary in a 13-year-old and a review of the supporting literature. CASE REPORT The patient was admitted with a history of increasing abdominal distension and pain for approximately 3 months and a history of an ovarian mass for 3 years. An adnexal mass measuring 40 × 30 × 20 cm was detected by abdominal ultrasonography and computed tomography. The tumor markers CEA, CA 19-9, and CA-125 were elevated, although α-fetoprotein and human chorionic antigen levels were within the normal range. The patient underwent surgery. The smooth-surfaced mass filled the abdomen. A frozen section biopsy was performed, and the results indicated a benign mucinous cystadenoma. A unilateral oophorectomy with tumor removal was performed. CONCLUSION The ovarian mass was revealed by abdominal distension, and a diagnosis was established by frozen biopsy. Complete and careful surgical resection provides satisfactory results; however, careful follow-up is required.
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Affiliation(s)
- Muazez Cevik
- Harran University, Faculty of Medicine, Department of Pediatric Surgery, Sanliurfa, Turkey.
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6
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Willems RPP, Slangen B, Busari JO. Abdominal swelling in two teenage girls: two case reports of massive ovarian tumours in puberty. BMJ Case Rep 2012; 2012:bcr.11.2011.5143. [PMID: 22605874 DOI: 10.1136/bcr.11.2011.5143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The following report describes two 15-year-old girls with a giant abdominal swelling. Signs and symptoms differed between those two girls, as serum tumour markers showed different elevation patterns. Additional investigations including a CT scan and a MRI scan were performed and revealed masses originating from the ovary. Histopathological evaluation after cystectomy showed a mature teratoma and a mucinous cystadenoma.
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Affiliation(s)
- Rick P P Willems
- Pediatrics Department, Atrium Medical Center, Heerlen, Netherlands
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Iwasaki M, Taira K, Kobayashi H, Saiga T. Ovarian mucinous cystadenoma of borderline malignancy in a premenarchal girl. J Pediatr Adolesc Gynecol 2010; 23:e119-23. [PMID: 19896401 DOI: 10.1016/j.jpag.2009.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/21/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
Abstract
Ovarian mucinous cystadenomas are benign epithelial neoplasms that occur most often in the third to sixth decade of life. Ovarian mucinous cystadenoma can be classified into 3 categories (benign, borderline malignancy, malignancy) based on histopathologic evaluation. Premenarchal cases of ovarian mucinous cystadenoma of borderline malignancy are exceedingly rare. To the best of our knowledge, there have been only 4 reported cases of borderline ovarian mucinous cystadenoma prior to 2009. Here we report a 13-year-old premenarchal girl with a giant mass occupying almost the whole of the abdomino-pelvic cavity.
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Affiliation(s)
- Minoru Iwasaki
- Department of Pediatric Surgery, Otsu Red-Cross Hospital, Otsu City, Shiga 520-8511, Japan.
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8
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Njim L, Moussa A, Saïdani Z, Touil N, Mlik L, Belghith M, Zakhama A. Bilateral ovarian serous borderline tumor with a giant non-invasive peritoneal implant in a four-year-old girl. J Pediatr Adolesc Gynecol 2010; 23:e1-4. [PMID: 19837620 DOI: 10.1016/j.jpag.2009.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 08/06/2009] [Accepted: 08/10/2009] [Indexed: 10/20/2022]
Abstract
Epithelial ovarian tumors are uncommon before 20 years of age and rarely occur before puberty. The vast majority of these tumors are benign, and few cases of malignant and borderline tumors are described. We report a case of a 4-year-old premenarchal girl, previously healthy, who presented with two abdominal masses. Laboratory analysis of blood showed elevation of the serum level of the CA-125. Ultrasonographic examination disclosed bilateral cystic ovarian masses. Laparoscopic exploration revealed bilateral ovarian multicystic masses with retro-uterine peritoneal implant. Bilateral salpingo-oophorectomy with implant resection was performed. Histologic findings were consistent with a serous borderline tumors of both ovaries and the peritoneal implant was of the non-invasive type. There is no evidence of recurrence at 3-year follow-up. To our knowledge, there are only four cases of ovarian borderline tumors in premenarchal girls reported in the English literature: three of the mucinous type and only one of the serous type.
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Affiliation(s)
- Leila Njim
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
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9
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Karaman A, Azili MN, Boduroğlu EC, Karaman I, Erdoğan D, Cavuşoğlu YH, Aslan MK, Cakmak O. A huge ovarian mucinous cystadenoma in a 14-year-old premenarchal girl: review on ovarian mucinous tumor in premenarchal girls. J Pediatr Adolesc Gynecol 2008; 21:41-4. [PMID: 18312801 DOI: 10.1016/j.jpag.2007.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 09/17/2007] [Accepted: 09/18/2007] [Indexed: 11/28/2022]
Abstract
Superficial epithelial ovarian tumors are unusual in adolescent girls (when compared with adult women) and extremely rare before menarche. Mucinous cystadenoma (MCA) in children that is a rare form of epithelial tumor is a benign cystic ovarian neoplasm. To our knowledge, there are only eight cases of mucinous cystadenoma, three of borderline mucinous cystadenoma, and three of mucinous cystadenocarcinoma reported in the English-language literature. We present a 14-year-old premenarchal girl with a giant ovarian mucinous cystadenoma. This review is supported by the finding that epithelial ovarian neoplasms are extremely rare prior to puberty and that only 14 mucinous tumors have been reported prior to menarche.
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Affiliation(s)
- Ayşe Karaman
- Dr. Sami Ulus Children's Hospital, Department of Pediatric Surgery and Pathology, Ankara, Turkey.
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10
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Luo JJ, Baksh FK, Pfeifer JD, Eastman JT, Beyer FC, Dehner LP. Abdominal mucinous cystic neoplasm in a male child. Pediatr Dev Pathol 2008; 11:46-9. [PMID: 18237233 DOI: 10.2350/07-01-0220.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 05/15/2007] [Indexed: 12/22/2022]
Abstract
Mucinous cystic neoplasms (MCNs) make up a morphologic family of similar appearing tumors arising in the ovary and various extraovarian sites, including the pancreas, hepatobiliary tract, paratesticular soft tissues, and mesentery. Other than the uncommon mucinous cystadenoma of the ovary presenting in adolescence, MCNs are rarely seen by the pediatric pathologist. The present case is a 5-year-old boy with an abdominal mass appearing to arise in the mesentery of the small intestine. Because of its unresectability, a generous biopsy was performed and disclosed a MCN with focal complex papillary architecture in the absence of appreciable cytologic atypia or invasion into the wall. Like other MCNs, this tumor had an inhibin-positive, ovarian-like stroma that was nonreactive for estrogen and progesterone receptors. Only 1 other case of a mesenteric MCN has been reported to date in a child and none in a male. The MCN of the mesentery joins other, somewhat more common cystic lesions of the omentum and mesentery presenting in childhood.
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Affiliation(s)
- Jean J Luo
- The Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St Louis Children's Hospitals, Washington University Medical Center, St Louis, MO, USA
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Bilateral ovarian mucinous cystadenoma in an adolescent presenting as abdominal compartment syndrome. Eur J Obstet Gynecol Reprod Biol 2008; 140:278-9. [PMID: 18164120 DOI: 10.1016/j.ejogrb.2007.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/19/2007] [Accepted: 11/20/2007] [Indexed: 11/22/2022]
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12
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Guedes R, Gonçalves C, do Bom Sucesso Cardoso M, de Sousa P. Cistadenoma ovárico gigante en adolescente. An Pediatr (Barc) 2007; 66:95-6. [PMID: 17266865 DOI: 10.1016/s1695-4033(07)70307-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sri Paran T, Mortell A, Devaney D, Pinter A, Puri P. Mucinous cystadenoma of the ovary in perimenarchal girls. Pediatr Surg Int 2006; 22:224-7. [PMID: 16416281 DOI: 10.1007/s00383-005-1624-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 11/24/2005] [Indexed: 10/25/2022]
Abstract
Ovarian masses in children are an uncommon occurrence. They represent less than 2% of all tumours in girls less than 16 years of age. Mucinous tumours of the ovary occur principally in middle adult life and are extremely rare prior to menarche. To the best of our knowledge, there are only 13 previous cases of benign mucinous cystadenoma (MCA) of the ovary in perimenarchal girls reported in the literature. We present six cases of this rare tumour. We reviewed the charts of six patients who presented with large MCA of the ovary. The patient's ages ranged from 13 to 14 years (mean 13.6 years). Two were premenarchal and four were within 1 year of menarche. All children presented with marked abdominal distension and discomfort. Except for one child who had ultrasound scan alone, all the others had either CT or MRI scan as well. Ultrasound demonstrated a large multiloculated cystic mass arising from the pelvis reaching the level of the xiphoid. CT demonstrated an enormous mass occupying almost the entire abdomen. The mass was partly solid, partly cystic and the cystic elements were multiloculated in all patients. Three patients demonstrated contralateral hydronephrosis on imaging. Laparotomy revealed a tumour arising from the left ovary in five patients and from the right ovary in one. Several litres of fluid were aspirated in order to deliver the tumour from the abdomen. All patients underwent oophorectomy or salpingo-oophorectomy. Histology revealed benign MCA of the ovary in all cases. On follow up, ranging from 2.4 to 5 years, all patients were well with no evidence of recurrence. MCA in perimenarchal girls usually affects the left ovary. Although this tumour is rare, this diagnosis should be considered in 11 to 15-year-old girls presenting with a very large abdominal mass.
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Affiliation(s)
- T Sri Paran
- Children's Research Centre and Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Vizza E, Galati GM, Corrado G, Atlante M, Infante C, Sbiroli C. Voluminous mucinous cystadenoma of the ovary in a 13-year-old girl. J Pediatr Adolesc Gynecol 2005; 18:419-22. [PMID: 16338609 DOI: 10.1016/j.jpag.2005.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mucinous cystadenoma of the ovary constitutes about 15% of ovarian tumors. It is more common in women between 20 and 40, but is rare in teenagers and exceptional in pre-menstrual girls. Malignant transformation is possible in 5-10% of cases. Spontaneous or iatrogenic breaks are more common. It makes the different diagnosis of pseudomixoma peritonei more difficult. CASE REPORT A 13-year-old girl came to the National Cancer Institute "Regina Elena" of Rome, with increasing abdominal distension over 2 months. The abdominal mass was removed and a left salpingo-oophorectomy was performed. Histological examination of the mass revealed a 40-cm diameter mucinous cystadenoma of the ovary. CONCLUSION The rapid enlargement of the ovarian mass, the young age and the difficulty of certain pre-operative diagnosis, make this case interesting. Management of this pathology and fertility-conserving treatment need careful follow-up because of the possibility of recurrence in the remaining ovary.
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Affiliation(s)
- Enrico Vizza
- Division of Oncology and Gynaecology, Department of Oncologic Surgery, National Cancer Institute, Regina Elena, Rome, Italy.
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