1
|
Pramana C, Almarjan L, Mahaputera P, Wicaksono SA, Respati G, Wahyudi F, Hadi C. A Giant Ovarian Cystadenoma in A 20-Year-Old Nulliparous Woman: A Case Report. Front Surg 2022; 9:895025. [PMID: 35599793 PMCID: PMC9117763 DOI: 10.3389/fsurg.2022.895025] [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: 03/12/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Giant ovarian cyst itself is defined as a cyst >10 cm in diameter from radiological- examination or the size of the cyst exceeds the umbilicus. Extra-large benign and malignant cysts of the ovary are uncommon and involve diagnostic and management challenges. We present the case of a 20-year-old nulliparous woman who was referred to our center with complaints of abdominal pain and heavy breathing. She benefited from a salphingo-oophorectomy laparotomy procedure. Benign and malignant gynecologic and non-gynecologic etiologies are included in the differential diagnosis of an abdominal mass. Because of the infrequent occurrence or absence of distinctive clinical presentation of the giant ovarian cyst, accurate preoperative diagnosis is challenging.
Collapse
Affiliation(s)
- Cipta Pramana
- Faculty of Medicine Wahid Hasyim University, Semarang, Indonesia
- Obstetrics and Gynecology Department Medical Faculty Tarumanagara University, Jakarta, Indonesia
- Correspondence: Cipta Pramana
| | - Lulu Almarjan
- Department of Obstetrics and Gynecology, Tarumanagara University, Jakarta, Indonesia
| | - Pramadio Mahaputera
- Department of Obstetrics and Gynecology, Tarumanagara University, Jakarta, Indonesia
| | - Satrio Adi Wicaksono
- Department of Anesthesiology and Intensive Therapy, Medical Faculty, Diponegoro University, Semarang, Indonesia
| | - Giri Respati
- Department of Obstetrics and Gynecology,Pondok Indah Hospital, Jakarta, Indonesia
| | - Firdaus Wahyudi
- Department of Public Health, Medical Faculty, Diponegoro University,Semarang, Indonesia
| | - Cahyono Hadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
- Dr. Moewardi Hospital, Surakarta, Indonesia
| |
Collapse
|
2
|
Cerovac A, Habek D, Hudić I, Kamerić L. Laparoendoscopic Ovarian-Sparing Surgery of Adnexal Tumors in Children and Adolescents by General Gynecologists: A 10-Year, Retrospective Cohort Study. J Laparoendosc Adv Surg Tech A 2021; 31:1055-1060. [PMID: 34252315 DOI: 10.1089/lap.2020.0894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In pediatric and adolescent gynecology, ovarian-sparing surgery (OSS) is an approach for preserving the ovaries affected by tumors and torsion during surgical treatment. Materials and Methods: We analyzed participants from a tertiary Gynecology and Obstetrics University Hospital. Participants were patients <19 years of age with adnexal tumors managed surgically with removal of pathologically confirmed ovarian tissue in the period from 2008 to 2017. Results: The average age of 38 patients who underwent surgery for adnexal tumors and were included in the study was 16.78 ± 2.15 years, from 12 to 19 years, with significantly younger patients in the salpingo-oophorectomy/oophorectomy and laparotomy group (P = .036 and P = .001). The laparoscopic approach was performed in 28 (73.68%) patients and laparotomy in 10 (26.31%) patients (P < .0001). Cystectomy was performed in 29 (76.31%), oophorectomy in 1 (2.63%), and salpingo-oophorectomy in 8 (21.05%) patients. A significantly higher number of patients underwent OSS with laparoscopy in scheduled surgical procedure and emergency surgery groups (P = .021 and P = .028). Benign ovarian tumors were found in 31 (81.57%), borderline in 3 (7.89%), and malignant in 4 (10.52%) patients. Conclusion: Our study has shown a high trend in OSS using the endoscopic approach in management of adnexal tumors despite the fact that the management was done by general gynecologists.
Collapse
Affiliation(s)
- Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina.,Department of Anatomy, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dubravko Habek
- Department of Obstetrics and Gynecology, "Sveti Duh" University Hospital, Zagreb, Croatia.,School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Igor Hudić
- Department of General Gynecology, Clinic for Gynecology and Obstetrics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Lejla Kamerić
- Department of General Gynecology, Clinic for Gynecology and Obstetrics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| |
Collapse
|
3
|
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
| |
Collapse
|
4
|
Guillén G, Martín-Giménez MP, López-Fernández S, Molino JA, López M. Results of Ovarian Sparing Surgery in Pediatric Patients: Is There a Place for Laparoscopy? J Laparoendosc Adv Surg Tech A 2020; 30:458-463. [PMID: 32013689 DOI: 10.1089/lap.2019.0515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Laparoscopy is widely accepted for the surgical treatment of benign ovarian lesions in adult women, with results similar to an open approach when spillage is avoided by different means such as endobag retrieval. This approach is controversial in children. Materials and Methods: Retrospective study (2009-2018) of all pediatric ovarian tumors with histological confirmation treated in a tertiary center. Data regarding preoperative selection criteria, surgical technique, and follow-up were registered. Laparoscopy was used only in tumors without malignant features and whose size allowed retrieving them through a small incision without morcellating. Emphasis was set in ovarian sparing surgery (OSS), comparing the results of open (OP) and laparoscopic (LPC) approach. Results: During the study period, 48 suspicious lesions in 45 patients were operated. Thirty cases (32 tumors) showed benign features (10 cystadenomas, 14 mature teratomas, 6 nontumor lesions); treatment consisted in oophorectomy in 13 (OP 6, LPC 7) and OSS in 17 (OP 5, LPC 12). There was one conversion in the LPC group. Mean follow-up was 3.44 years (range 0.03-8.84), based on annual ultrasound (US) and tumor markers during at least 5 years, recommending a lifetime follow-up by a gynecologist. There was only one relapse in a laparoscopically enucleated cystadenoma, and 2 patients developed contralateral metacronous teratomas. No procedure-related complications happened. Conclusions: Our series, although small and with a limited follow-up, suggest that laparoscopy could be an option of treatment in a subset of highly selected patients, although laparotomy remains the gold standard approach if malignancy is suspected.
Collapse
Affiliation(s)
- Gabriela Guillén
- Pediatric Surgical Oncology Unit, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Sergio López-Fernández
- Pediatric Surgical Oncology Unit, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - José Andrés Molino
- Pediatric Surgical Oncology Unit, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
5
|
Peeraully R, Henderson K, Fairbrother K, Patel R, Fraser N, Shenoy M, Williams A. Effect of Surgical Specialty on Management of Adnexal Masses in Children and Adolescents: An 8-Year Single-Center Review. J Pediatr Adolesc Gynecol 2020; 33:89-92. [PMID: 31254617 DOI: 10.1016/j.jpag.2019.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE Children with adnexal masses might be managed by pediatric surgeons, urologists or gynecologists, with the potential for different management strategies between specialties. In this study we compared ovarian conservation rates and surgical approach for adnexal masses in children and adolescents managed either by pediatric surgeons/urologists or gynecologists at a tertiary care institution. DESIGN Retrospective cohort review. SETTING Tertiary pediatric and adult university hospital. PARTICIPANTS Patients younger than 18 years of age with an adnexal mass managed surgically with removal of histologically confirmed ovarian or fallopian tube tissue from 2008 to 2015. INTERVENTIONS Laparoscopic or open procedure for adnexal mass. MAIN OUTCOME MEASURES The primary outcome was rate of ovarian conservation relative to surgical specialty. The secondary outcome was surgical approach relative to surgical specialty. RESULTS Forty-eight patients underwent surgery for adnexal masses; 26 (54%) under pediatric surgery/urology and 22 (46%) under gynecology care. Laparoscopy was performed in 5 (19%) pediatric and 19 (86%) gynecology cases (P = .000006). Of 24 patients older than 12 years of age with a benign tumor, 10 (42%) underwent procedures resulting in loss of an ovary with or without fallopian tube; 8 of these (80%) were under pediatric care. Of the remaining 14 (58%) who underwent ovarian conserving surgery, 12 (80%) were under gynecology care (P = .0027). CONCLUSION Patients with a benign tumor were significantly more likely to undergo ovary-preserving surgery under gynecology care than under pediatric surgery/urology care. A multidisciplinary team approach involving gynecology and pediatric surgical specialties would be valuable in assessing the merits of ablative or conservative surgery in each case.
Collapse
Affiliation(s)
- Riyad Peeraully
- Department of Pediatric Urology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom
| | - Katrina Henderson
- Department of Pediatric Urology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom
| | - Kristina Fairbrother
- Department of Pediatric Urology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom
| | - Ramnik Patel
- Department of Pediatric Urology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom
| | - Nia Fraser
- Department of Pediatric Urology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom
| | - Manoj Shenoy
- Department of Pediatric Urology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom
| | - Alun Williams
- Department of Pediatric Urology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom.
| |
Collapse
|
6
|
How JA, Marino JL, Grover SR, Heloury Y, Sullivan M, Mellor A, McNally O, Jayasinghe Y. Surgically Managed Ovarian Masses at the Royal Children's Hospital, Melbourne -19 Year Experience. J Pediatr Surg 2019; 54:1913-1920. [PMID: 31160084 DOI: 10.1016/j.jpedsurg.2019.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 04/07/2019] [Accepted: 05/11/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND/PURPOSE To describe the clinicopathological characteristics and management of surgically removed ovarian masses at the Royal Children's Hospital, Melbourne from 1993 to 2012. METHODS Medical records were reviewed retrospectively. Data regarding clinical findings, imaging and surgical management were evaluated. RESULTS There were 266 ovarian masses found in 258 surgeries (eight had bilateral masses). Most were benign (246/266, 92.5%), 2.3% (6/266) were borderline, and 5.3% (14/266) were malignant. The most common presenting symptom was abdominal pain for benign masses (169/246, 68.7%), and a palpable mass for borderline and malignant masses (12/20, 60.0%). Sensitivity and specificity of ultrasound for detection of malignancy was 64.7% and 52.9% respectively. Ovarian torsion occurred in 22.1% (n=57), none with malignancy, with seven cases diagnosed under one year of age. Sensitivity and specificity of ultrasound for ovarian torsion was 22.0% and 91.9%, respectively. The proportion undergoing ovarian cystectomy rather than oophorectomy has increased from 56.3% during 1993-1997 to 93.8% during 2008-2012 (p<0.005). Ovarian torsion was managed with ovarian conservation in 82.6% of cases between 2008-2012. CONCLUSION The majority of pediatric and adolescent ovarian masses were benign. Sensitivity of ultrasound was fair for detection of malignancy, and poor for ovarian torsion. Conservative surgeries are increasingly common. LEVEL OF EVIDENCE Level IV - case series with no comparison group TYPE OF STUDY: Retrospective Study.
Collapse
Affiliation(s)
- J A How
- Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia.
| | - J L Marino
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, Australia
| | - S R Grover
- Department of Pediatric & Adolescent Gynecology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Y Heloury
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Pediatric Surgery, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia
| | - M Sullivan
- Children's Cancer Centre, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia
| | - A Mellor
- Mater Adolescent and Young Adult Health Centre, Raymond Terrace, South Brisbane, Queensland, Australia
| | - O McNally
- Department of Gynecological Oncology, Royal Women's Hospital, Melbourne, 20 Flemington Road, Parkville, Victoria, Australia
| | - Y Jayasinghe
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, Australia; Department of Pediatric & Adolescent Gynecology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
| |
Collapse
|
7
|
Ripatti L, Taskinen M, Koivusalo A, Taskinen S. Surgically treated ovarian lesions in preadolescent girls. Acta Obstet Gynecol Scand 2019; 99:105-111. [PMID: 31449329 DOI: 10.1111/aogs.13717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the epidemiology and characteristics of surgically treated ovarian lesions in preadolescent girls. MATERIAL AND METHODS This was a retrospective cohort study including all 0- to 11-year-old girls operated at a single center from 1999 to 2016 for ovarian cysts, neoplasms or torsions. Patient charts were reviewed for symptoms, preoperative radiological imaging, operative details and histopathology. RESULTS We identified 78 girls, resulting in a population-based incidence of 4.2/100 000. Infants (n = 44) presented with benign cysts (42/44, 95%, one bilateral), a benign neoplasm (1/44, 2%) and a torsion without other pathology (1/44, 2%). Torsion was found in 25/29 (86%) ovaries with complex cysts and in 3/15 (21%) ovaries with simple cysts in preoperative imaging (P < 0.001). Most infants were symptomless. Lesions in 1- to 11-year-old girls (n = 34) included benign neoplasms (n = 21/34, 62%), malignant neoplasms (n = 5/34, 15%), a cyst with torsion (n = 1/34, 3%) and torsions without other pathology (n = 7/34, 21%). Torsion was more common in benign (17/21, 81%) than in malignant neoplasms (1/5, 20%) (P < 0.020). Ovarian diameter did not differ between ovaries with or without torsion (P = 0.238) or between benign and malignant neoplasms (P = 0.293). The duration of symptoms in lesions with or without torsion was similar. CONCLUSIONS The majority of surgically treated ovarian lesions in preadolescent are benign lesions with torsion. Surgery should be ovary-preserving and performed without delay.
Collapse
Affiliation(s)
- Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland.,Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Antti Koivusalo
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Taskinen
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
8
|
Mărginean CO, Mărginean C, Chinceşan M, Mărginean MO, Meliţ LE, Săsăran V, Mărginean CD. Pediatric ovarian tumors, a challenge for pediatrician and gynecologist: Three case reports (CARE compliant). Medicine (Baltimore) 2019; 98:e15242. [PMID: 31008957 PMCID: PMC6494269 DOI: 10.1097/md.0000000000015242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Ovarian or adnexal tumors are very rare in patients below the age of 18 years, most of them being functional cysts, only 10% being malignant. We report 3 cases of ovarian tumors with the aim of revealing the particularities regarding the diagnosis and management of benign and malignant ovarian tumors in pediatric patients. PATIENT CONCERNS The 1st case, a 9-year-old girl presented for diffuse abdominal pain, distended abdomen and rapid increase in abdominal volume. The 2nd case describes a 13-year-old female patient admitted for acute abdominal pain and nausea, and the 3rd one was an 18-year-old female teenager who presented for distended abdomen, intermittent diffuse abdominal pain and rapid increase in abdomen volume. DIAGNOSES The abdominal ultrasound revealed in all 3 patients suggestive signs for ovarian tumors. INTERVENTIONS The 1st patient underwent laparotomy with adnexectomy, and the histopathological exam showed the diagnosis of dysgerminoma. The 2nd patient underwent laparoscopy with adnexectomy, and the histopathological exam revealed a borderline tumor. The 3rd patient benefited by a laparotomy with left ovariectomy, and the histopathological exam pointed out a mature teratoma. OUTCOMES The outcome was favorable in all 3 cases, but the patients with dysgerminoma and mature teratoma were further referred to the oncologist for proper assessment. LESSONS Laparoscopy may represent the first choice for uncomplicated ovarian masses. The diagnosis and the therapeutic plan must be based on symptoms, pelvic ultrasound, the time of menarche and the potential serum markers.
Collapse
|
9
|
Łuczak J, Bagłaj M. Selecting treatment method for ovarian masses in children - 24 years of experience. J Ovarian Res 2017; 10:59. [PMID: 28893324 PMCID: PMC5594432 DOI: 10.1186/s13048-017-0353-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiology and pathology of ovarian tumors in the pediatric population are very different of these encountered in women. Few attempts have been made to analyze the whole spectrum of ovarian pathology in children, and only some of them included series of more than 200 cases. We performed a retrospective analysis of clinical and diagnostic aspects of ovarian tumors and tumor-like lesions in girls in order to identify the characteristics associated with malignancy with an attempt to elaborate a clinical management algorithm. RESULTS The study group comprised 214 patients operated on for ovarian tumor in years 1991-2014 at the pediatric surgical center. Non-neoplastic ovarian lesion was diagnosed in 127 females. Sixty-five patients had a benign tumor and 22 had a malignant lesion. Abdominal pain was the most common symptom in the non-malignant lesion group. Patients with ovarian malignancy presented predominantly with abdominal distension and palpable mass. In the non-malignant group imaging studies revealed cystic lesion in 124 patients (68.89%) and solid mass in 10 (5.55%). Malignant lesion showed a solid or mixed structure in all cases. Positive tumor markers were noted in 14 (13.7%) patients with a benign lesion and in 14 (70%) with ovarian malignancy. Large lesions were found in 77.3% of girls with a malignant mass, while only in 32.8% of patients with a benign lesion (p < 0.001). In the group of solid tumors positive tumor marker results occurred more frequently in patients with diagnosed malignant tumors (p < 0.05). Positive tumor markers, large size of the lesion and age below 14 years were independent variables differentiating malignant tumors from non-malignant lesions (p = 0.00000). CONCLUSIONS Predominantly solid structures noted on imaging studies, large dimension and positive tumor markers are clinical predictors of malignancy. A diagnosis of purely cystic lesions with negative markers or of a small size should be an indication for a gonad-sparing procedure. Treatment guidelines for ovarian lesions in children should be established on the basis of multicenter prospective studies and introduced as soon as possible in order to improve and unify the ovarian preservation rates across the pediatric surgical centers.
Collapse
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
| |
Collapse
|
10
|
Aydin BK, Saka N, Bas F, Yilmaz Y, Haliloglu B, Guran T, Turan S, Bereket A, Yesiltepe Mutlu G, Cizmecioglu F, Hatun S, Bezen D, Tutunculer F, Cebeci N, Isguven P, Memioglu N, Ercan O, Poyrazoglu S, Bundak R, Darendeliler F. Evaluation and Treatment Results of Ovarian Cysts in Childhood and Adolescence: A Multicenter, Retrospective Study of 100 Patients. J Pediatr Adolesc Gynecol 2017; 30:449-455. [PMID: 28167139 DOI: 10.1016/j.jpag.2017.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To investigate the characteristics of children with ovarian cysts and evaluate treatment strategies. DESIGN Retrospective study. SETTING Eight pediatric endocrinology clinics, Turkey. PARTICIPANTS A total of 100 children and adolescents with ovarian cysts. INTERVENTIONS Patient data collected via retrospective chart review. Patients were stratified according to age into 4 groups (newborns, 1-12 months, 1-8 years, and 8-18 years). MAIN OUTCOME MEASURES Special emphasis was given to torsion and tumor cases, concomitant diseases, treatment modalities, and problems during follow-up. RESULTS Most newborns and infants were asymptomatic with the cysts being discovered incidentally; in girls ages 1-8, symptoms were common, including breast budding (47.1%, 16 of 34) and vaginal bleeding (29.4%, 10 of 34). Girls older than 8 years mostly presented with abdominal pain (31.6%, 12 of 38) and menstrual irregularity (21.1%, 8 of 38). Most of our patients were diagnosed with a simple ovarian cyst, but 9 patients were found to have ovarian tumors. Ovarian torsion was detected in 7 patients; 5 with large and 2 with small cysts (<20 mm). Two patients had central precocious puberty (CPP) at presentation and 5 patients developed CPP during follow-up. The surgical intervention rate was high (38%, 38 of 100), but was associated with earlier treatment year, and this association remained significant after adjusting for confounders (P = .035). CONCLUSION Most girls have simple cysts, which have a favorable prognosis without intervention; however, there might be coexisting pathologies or complications such as tumors, torsion, and CPP; hence these patients should be evaluated accordingly and treated with a multidisciplinary approach.
Collapse
Affiliation(s)
- Banu Kucukemre Aydin
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey.
| | - Nurcin Saka
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Yasin Yilmaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Belma Haliloglu
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Tulay Guran
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Serap Turan
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Abdullah Bereket
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Gul Yesiltepe Mutlu
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Filiz Cizmecioglu
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Sukru Hatun
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Digdem Bezen
- Trakya University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Edirne, Turkey
| | - Filiz Tutunculer
- Trakya University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Edirne, Turkey
| | - Nurcan Cebeci
- Derince Training and Research Hospital, Department of Pediatrics, Kocaeli, Turkey
| | - Pinar Isguven
- Sakarya University, Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Sakarya, Turkey
| | - Nihal Memioglu
- American Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Oya Ercan
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Rüveyde Bundak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| |
Collapse
|
11
|
Stanković ZB, Sedlecky K, Savić D, Lukač BJ, Mažibrada I, Perovic S. Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study. J Pediatr Adolesc Gynecol 2017; 30:405-412. [PMID: 28137453 DOI: 10.1016/j.jpag.2017.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical management of uncomplicated functional ovarian cysts. DESIGN A prospective diagnostic study using clinical and ultrasound data collected for all patients younger than 19 years of age with adnexal masses managed between 2006 and 2015. SETTING Mother and Child Health Institute of Serbia 'Dr Vukan Čupić' (Belgrade, Serbia). PARTICIPANTS Patients (N = 1499) with adnexal masses, of whom 318 were surgically treated. INTERVENTIONS AND MAIN OUTCOME MEASURES Ultrasonographic characteristics (Ueland's Morphology Index [MI] and the ovarian crescent sign [OCS]). Patients were managed expectantly or surgically, in line with 3 rules of the DTS. Rule 1: asymptomatic patients having a mass with MI of 4 or less and OCS present, were managed expectantly. Rule 2 (emergency): malignancy was suspected if the MI was 7 or more and no edema of the OCS was present. Rule 3 (nonemergency): malignancy was suspected if the OCS was absent and MI was 5 or more. The diagnostic accuracy was assessed using sensitivity and specificity (P < .05). RESULTS No malignancy was found in the group of 1236 patients selected according to the DTS rule 1. Torsion was confirmed in 36% of surgically treated masses (n = 115). The OCS was present in 96% of benign masses in the non-emergency group (n = 149) and in three with microscopic malignancy. In predicting malignancy, the DTS (rules 2 and 3) showed a sensitivity of 93 (95% confidence interval [C.I.]: 82-98); and a specificity of 97 (C.I.: 95-99). Ovarian tissue was preserved from benign (n = 254, 93%) and malignant tumors (n = 3, 7%). Only five (2%) uncomplicated ovarian cysts were surgically treated. CONCLUSION The DTS with 3 rules is a very accurate diagnostic tool in the differentiation between benign and malignant ovarian masses. The DTS rule 1 reduces the number of surgical procedures on functional cysts, rules 2 and 3 are very useful in choosing the optimal treatment of adnexal masses, whether or not they are twisted.
Collapse
Affiliation(s)
- Zoran B Stanković
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia.
| | - Katarina Sedlecky
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
| | - Djordje Savić
- Department of Pediatric Abdominal Surgery, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
| | - Branislav J Lukač
- Department of Radiology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ilijana Mažibrada
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
| | - Svetlana Perovic
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
| |
Collapse
|
12
|
Winer I, Patel D, Dalton V, Johnston C, Quint EH, Zochowski M, Munkarah A, Morris R, Haefner H. Involvement and comfort of gynecologic oncologists in the treatment of pediatric, adolescent, and young adult patients with gynecologic malignancies. Int J Gynaecol Obstet 2017; 138:177-182. [PMID: 28485838 DOI: 10.1002/ijgo.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/21/2017] [Accepted: 05/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the provision of care for pediatric and adolescent patients by gynecologic oncologists. METHODS The present prospective cross-sectional study enrolled attending physicians and fellows specializing in gynecologic oncology from the USA during December 2012 and January 2013. A 33-question survey collecting demographic data and details of participant opinions on existing practices was distributed to potential respondents. Survey responses were aggregated and descriptive analyses were performed. RESULTS The survey was distributed to 1252 physicians and 178 (14.2%) surveys were returned; 105 (59.0%) participants thought that the care of patients aged younger than 21 years should be included in their practice. Only 7 (3.9%) participants had received formal training in caring for pediatric patients and young adults; however, 85 (47.8%) felt this should be incorporated into formal fellowship training. Multidisciplinary teams were reported to be the best method for caring pediatric patients by 160 (88.9%) participants but only 42 (23.6%) participants reported that multidisciplinary teams were involved in pediatric gynecologic oncology care at their institutions. CONCLUSION Gynecologic oncologists wanted to be involved in pediatric care and open dialogue between specialists could help in the provision of optimal, longitudinal care to these patients. Furthermore, the incorporation of formal pediatric patient-focused training into gynecologic oncology fellowship programs should be considered.
Collapse
Affiliation(s)
- Ira Winer
- Division of Gynecologic Oncology, Department of Oncology, Wayne State University and Karmanos Cancer Institute, Detroit, MI, USA
| | - Divya Patel
- Texas Collaborative for Healthy Mothers and Babies (TCHMB), University of Texas, Austin, TX, USA
| | - Vanessa Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Carolyn Johnston
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | | | - Adnan Munkarah
- Division of Gynecologic Oncology, Henry Ford Hospital Department of Obstetrics and Gynecology, Detroit, MI, USA
| | - Robert Morris
- Division of Gynecologic Oncology, Department of Oncology, Wayne State University and Karmanos Cancer Institute, Detroit, MI, USA
| | - Hope Haefner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
13
|
Dural O, Yasa C, Bastu E, Ugurlucan FG, Yilmaz G, Yuksel B, Akhan SE, Buyru F. Laparoscopic Outcomes of Adnexal Surgery in Older Children and Adolescents. J Pediatr Adolesc Gynecol 2017; 30:128-131. [PMID: 27663301 DOI: 10.1016/j.jpag.2016.09.004] [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: 05/12/2016] [Revised: 09/08/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To evaluate the outcomes of laparoscopic surgery for the treatment of adnexal pathology in older children and adolescents. DESIGN A retrospective cohort review. SETTING A tertiary academic center in Istanbul, Turkey. PARTICIPANTS Pediatric and adolescent patients aged between 9 and 19 years (n = 69) who underwent laparoscopic surgery for adnexal pathology from January 2005 through September 2015. The patients who were pregnant or with non-gynecologic pathology detected during surgery were excluded from the study. INTERVENTIONS Patients were divided into 2 groups according to their age. Group 1 consisted of 31 patients aged between 9 and 16 years and group 2 included 38 patients aged between 17 and 19 years. MAIN OUTCOME MEASURES The indication for surgery, procedures performed, anesthesia time, length of hospital stay, pathology findings, and complication rates were evaluated. RESULTS Ovarian cystectomy and adnexal detorsion with or without cystectomy were the most frequently performed. Ovary-sparing conservative surgery was possible for all patients, except those with gonadal dysgenesis and testicular feminization (n = 6), who underwent laparoscopic gonadectomy. The most common pathologic finding was mature cystic teratoma (30.2%), followed by benign paratubal cyst, and simple cysts of the ovary. Anesthesia time was shorter in group 2 (P = .018). The procedures performed, length of hospital stay, complication rate, and pathology findings were not significantly different between the 2 groups. CONCLUSIONS Laparoscopic surgery can be successfully performed as an efficient, safe, and well tolerated procedure for treating a wide variety of adnexal pathology among children and young adolescents without any significant variation between different age groups.
Collapse
Affiliation(s)
- Ozlem Dural
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Cenk Yasa
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ercan Bastu
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Gamze Yilmaz
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahar Yuksel
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Suleyman Engin Akhan
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Faruk Buyru
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
14
|
Madenci AL, Levine BS, Laufer MR, Boyd TK, Voss SD, Zurakowski D, Frazier AL, Weldon CB. Preoperative risk stratification of children with ovarian tumors. J Pediatr Surg 2016; 51:1507-12. [PMID: 27289417 DOI: 10.1016/j.jpedsurg.2016.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/29/2016] [Accepted: 05/08/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The appropriate operative approach to pediatric patients with ovarian tumors must balance real risk of malignancy with maximal preservation of reproductive potential. We evaluate preoperative risk of malignancy in order to more precisely guide treatment, so as to err on the side of ovarian preservation if at all possible. METHODS We retrospectively reviewed the records of all patients undergoing surgical intervention for ovarian tumors at a single institution. The primary endpoint was ovarian malignancy. RESULTS Of 502 patients who underwent surgery for ovarian tumors, 44 (8.8%) had malignancies. Malignancy rate (95% confidence interval) was low for cystic lesions <9cm (0.0%, 0.0-2.9%) and for tumor marker-negative heterogeneous lesions <9cm (2.3%, 0.4-12.1%). High-risk profiles for malignancy included tumor marker-positive heterogeneous lesions (66.7%, 35.4-87.9%) and solid tumors ≥9cm (69.2%, 16.2-40.3%). Intermediate risk tumors included cystic tumors ≥9cm (6.8%, 3.5-20.7%), tumor marker-negative heterogeneous lesions ≥9cm (31.2%, 18.0-48.6%), and solid tumors <9cm (11.1%, 4.4-25.3%). CONCLUSIONS We developed a decision strategy to help determine who may and may not require an ovarian-sparing approach, which warrants prospective application and validation. Ultimately, the decision to pursue an oncologic surgery with oophorectomy and staging (as opposed to fertility-preserving surgery) should be made after individualized discussion involving the surgeon, patient, and family.
Collapse
Affiliation(s)
- Arin L Madenci
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Bat-Sheva Levine
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Theonia K Boyd
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen D Voss
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Management of Large Ovarian Neoplasms in Pediatric and Adolescent Females. J Pediatr Adolesc Gynecol 2016; 29:88-94. [PMID: 26165911 DOI: 10.1016/j.jpag.2014.07.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/22/2022]
Abstract
The overwhelming majority of ovarian cysts in pediatric and adolescent girls are physiologic; however, large simple and complex ovarian lesions often require surgical intervention due to the increased risk of neoplasia. In this review article, we discuss the preoperative evaluation and intraoperative management of large ovarian neoplasms. We review the current literature regarding long term ovarian function and fertility, rates of recurrence and residual disease, and novel surgical approaches. Managing large ovarian neoplasms in the pediatric and adolescent population requires careful preoperative and intraoperative care to optimally resect neoplasia while maximizing fertility and minimizing pain.
Collapse
|
16
|
Gupta B, Guleria K, Suneja A, Vaid NB, Rajaram S, Wadhwa N. Adolescent ovarian masses: A retrospective analysis. J OBSTET GYNAECOL 2016; 36:515-7. [DOI: 10.3109/01443615.2015.1103721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bindiya Gupta
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India and
| | - Kiran Guleria
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India and
| | - Amita Suneja
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India and
| | - Neelam B. Vaid
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India and
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India and
| | - Neelam Wadhwa
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| |
Collapse
|
17
|
Seckin B, Ozdener T, Tapisiz OL, Batioğlu S. Laparoscopic treatment of ovarian cysts in adolescents and young adults. J Pediatr Adolesc Gynecol 2011; 24:300-3. [PMID: 21715192 DOI: 10.1016/j.jpag.2011.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/14/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To investigate the laparoscopic management of ovarian cysts in adolescents and young adults. DESIGN A retrospective chart review study. SETTING Zekai Tahir Burak Women's Health Research and Education Hospital. PARTICIPANTS A total of 282 females aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian cyst. Patients were grouped as adolescents (ages 12-19, n = 79) or young adults (ages 20-25, n = 203). MAIN OUTCOME MEASURES Surgical approach, operative findings and the correlation of intraoperative diagnosis with the definitive pathological reports. RESULTS The mean age of the patients was 21.2 years. At laparoscopic surgery, 89 patients (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts, and 37 (13.1%) had paraovarian cysts. Ninety-seven patients (34.4%) had simple ovarian cysts. Pathological reports revealed that young adults were more likely to have endometriomas (34.0% vs 7.6%, P < 0.01), but dermoid cysts and simple ovarian cysts were more frequent (20.3% vs 15.3%, P < 0.01 and 60.7% vs 40.9%, P < 0.01, respectively).in adolescents. Eleven of the cases (3.9%) were found to have mucinous cystadenomas and fourteen (5.0%) to have serous cystadenomas. Four cysts were malignant (1.4%). Cystectomy was performed in 205 cases (72.7%), fenestration of cyst wall was performed in 53 cases (18.8%), and aspiration was applied in 22 cases (7.8%). The types of operation were not significantly different among adolescents and young adults (P > 0.05). The operative diagnosis was highly correlated with the final pathological reports (kappa value= 0.901, P < 0.001). There were no operative and postoperative complications in our series. CONCLUSION With a careful preoperative screening, the laparoscopic surgery of ovarian cyst is an efficient and safe treatment for adolescents and young adults.
Collapse
Affiliation(s)
- Berna Seckin
- Department of Reproductive Endocrinology and Endoscopic Surgery, Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey.
| | | | | | | |
Collapse
|
18
|
FERTILITY 2011, 5th-7th January 2011, Dublin, 7th biennial conference of the UK Fertility Societies: the Association of Clinical Embryologists, British Fertility Society and the Society for Reproduction & Fertility. Also participating: Irish Clinical Embryologists Association (ICE) and the Irish Fertility Society (IFS). HUM FERTIL 2011:1-88. [PMID: 21780959 DOI: 10.3109/14647273.2011.575665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
Beurdeley M, Gauthier T, Piguet C, Fourcade L. Conservative treatment of big yolk sac tumour of the ovary in young girl. J Visc Surg 2011; 147:e265-7. [PMID: 20920902 DOI: 10.1016/j.jviscsurg.2010.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present the case of a large yolk sac tumour of the ovary in a 14-year-old girl with high level of serum alpha-feto-protein (AFP). Multidisciplinary care is important to do appropriate surgical treatment with the aim of fertility preservation.
Collapse
Affiliation(s)
- M Beurdeley
- Service de Chirurgie Pédiatrique, Hôpital Mère-Enfant, CHU Dupuytren, 87000 Limoges, France
| | | | | | | |
Collapse
|