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Hu Z, Fan S, Feng X, Liu L, Zhou J, Wu Z, Zhou L. Performance of grayscale combined with contrast-enhanced ultrasound in differentiating benign and malignant pediatric ovarian masses. Eur Radiol 2024:10.1007/s00330-024-11011-z. [PMID: 39120792 DOI: 10.1007/s00330-024-11011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/26/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To evaluate grayscale US combined with contrast-enhanced ultrasound (CEUS) in the preoperative differentiation between benign and malignant ovarian masses in a pediatric population. MATERIALS AND METHODS This retrospective study enrolled patients who underwent grayscale US and CEUS before surgery because of ovarian masses between July 2018 and September 2023, with available histopathologic or follow-up results. Two senior radiologists summarized the grayscale US and CEUS characteristics of all ovarian masses, including percentage of solidity, ascites, vascularity, and enhanced vessel morphology. These characteristics were then independently reviewed by radiologists with different experience to assess interobserver agreement. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC), while interobserver agreement was evaluated by intraclass correlation coefficient (ICC). RESULTS A total of 26 children (median age: 10.1 [7.5, 11.7] years; age range: 0-14 years; benign: 15 patients) were included. The main characteristics of malignant ovarian tumors were abundant blood flow and twisted blood vessels within the mass, enhanced portion of the mass over 50 percent (all p < 0.001). The grayscale US combined with CEUS showed better diagnostic performance than the grayscale US alone (AUC = 0.99 [95% CI: 0.95, 1.00] vs AUC = 0.70 [95% CI: 0.50, 0.90] p < 0.001). A statistically significant AUC before and after CEUS was also shown between two junior radiologists (0.75 vs 0.92 and 0.69 vs 0.86, respectively, both p < 0.05). ICC of CEUS was better than that of grayscale US among radiologists. CONCLUSION The combination of grayscale US and CEUS might improve the diagnostic accuracy in differentiating benign and malignant pediatric ovarian masses. CLINICAL RELEVANCE STATEMENT Grayscale ultrasound combined with contrast-enhanced ultrasound can improve the diagnostic performance in the preoperative differentiation of benign and malignant ovarian lesions in a pediatric population. KEY POINTS Correctly distinguishing benign from malignant ovarian masses in pediatric patients is critical for determining treatments. Grayscale combined with contrast-enhanced ultrasound (CEUS) differentiated benign and malignant pediatric ovarian masses better than grayscale US alone. Junior radiologists' diagnostic performances could be and were significantly improved with the application of CEUS.
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Affiliation(s)
- Zehang Hu
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Shumin Fan
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Xia Feng
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Lei Liu
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Jingran Zhou
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Zhixia Wu
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Luyao Zhou
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China.
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Lahnine G, Benabderrazik B, Akammar A, Bouardi NE, Alami B, Lamrani MY, Maaroufi M, Boubbou M, Haloua M. Imaging appearance of ovarian dysgerminoma: A report of two cases. Radiol Case Rep 2024; 19:3434-3438. [PMID: 38872745 PMCID: PMC11169066 DOI: 10.1016/j.radcr.2024.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 06/15/2024] Open
Abstract
Ovarian dysgerminoma is a rare germ cell tumor accounting for 1%-2% of all malignant ovarian tumors and is generally associated with a good prognosis. The condition is more frequent in young women and can arise in dysgenetic gonads that contain gonadoblastomas. Imaging findings, particularly MRI, have a prominent role in the early and correct identification of ovarian dysgerminoma, the most common ovarian malignant germ cell tumor. On CT and MR images, ovarian dysgerminoma often appears as a large, solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging, which can guide the radiologists to make an accurate diagnosis. This article describes 2 cases of patients with ovarian dysgerminoma who presented with pelvic pain. Imaging showed a right ovarian mass that was surgically and histologically confirmed.
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Affiliation(s)
- Ghita Lahnine
- Service de radiologie, hôpital mère-enfant, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Btissam Benabderrazik
- Service de radiologie, hôpital mère-enfant, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Amal Akammar
- Service de radiologie, hôpital mère-enfant, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Nizar El Bouardi
- Service de radiologie central, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Badreddine Alami
- Service de radiologie central, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Moulay Y.A. Lamrani
- Service de radiologie central, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Mustapha Maaroufi
- Service de radiologie central, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Meryem Boubbou
- Service de radiologie, hôpital mère-enfant, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
| | - Meriem Haloua
- Service de radiologie, hôpital mère-enfant, CHU Hassan II, université Sidi Mohammed Benabdellah, Fès, Maroc
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Ahmed G, Khalil SA, Elshafiey M, Abdelfattah N, Eid M, Zakaria AS, Elwakeel M, Elgendy A. Management strategy for children with ovarian immature teratoma: results from a tertiary pediatric oncology center. World J Surg Oncol 2024; 22:176. [PMID: 38965563 PMCID: PMC11223275 DOI: 10.1186/s12957-024-03452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES We present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection. METHODS A retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children's Oncology Group (COG), grading based on the Norris system, management, and outcomes. RESULTS Thirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively. CONCLUSIONS Surgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.
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Affiliation(s)
- Gehad Ahmed
- General Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt
- Surgical Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Sahar Ahmed Khalil
- Pediatric Oncology Department, National Cancer Institute - Cairo University, Cairo, Egypt
- Pediatric Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Maged Elshafiey
- Surgical Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
- Surgical Oncology Department, National Cancer Institute - Cairo University, Cairo, Egypt
| | - Nihal Abdelfattah
- Department of Research, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Mohamed Eid
- Pediatric Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Al-Shaimaa Zakaria
- Pathology Department, National Cancer Institute - Cairo University, Cairo, Egypt
- Pathology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Madeeha Elwakeel
- Radio-Diagnosis Department, National Cancer Institute - Cairo University, Cairo, Egypt
- Radio-Diagnosis Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, 35 Ali Beek Elkbeer street, Tanta, 31515, Egypt.
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Ergun-Longmire B, Greydanus DE. Ovarian tumors in the pediatric population: An update. Dis Mon 2024; 70:101691. [PMID: 38281826 DOI: 10.1016/j.disamonth.2024.101691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Research reveals that 1% of neoplasms in females under 17 years of age are ovarian neoplasms and though usually benign, malignant tumors may occur in the pediatric age group. This review considers various current concepts of these tumors including the epidemiology, risk factors, clinical presentations, diagnosis, differential diagnosis, and treatment options including the need to provide fertility-sparing surgery as well as their potential impacts on the psychological well-being of children and adolescents. We gathered data from the published articles ranging from studies, meta-analyses, retrospective studies, and reviews. We focused on the articles published in English between January 1, 2000, and August 31, 2023. Only a few articles published prior to 2000 were included for historical perspective.
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Affiliation(s)
- Berrin Ergun-Longmire
- Department of Pediatric and Adolescent Medicine, Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.
| | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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Kim RC, Goldberg I, Van Brunt T, Tul-Bushra H, Batiste R, Lane AH, Hsieh H. Juvenile Granulosa Cell Tumor Mimicking HAIR-AN in a 4-year-old: A Case Report. J Clin Res Pediatr Endocrinol 2024; 16:200-204. [PMID: 36112066 DOI: 10.4274/jcrpe.galenos.2022.2022-4-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Predominantly androgen secreting juvenile granulosa cell tumors (JGCT) are uncommon and few reports have been published. We present a case of a JGCT that presented with signs of prepubertal hyperandrogenism and insulin resistance to highlight the possible interaction between hyperandrogenemia and hyperinsulinism. A 4-year-old girl presented with acanthosis nigricans and hyperinsulinism, mimicking the hyperandrogenism, insulin resistance and acanthosis nigricans syndrome at an age much younger than is typical for this diagnosis. Laboratory studies revealed elevated insulin, inhibin A and B, and total testosterone. All laboratory results normalized after unilateral salpingo-oophorectomy. The final diagnosis was Stage 1A JGCT. This case highlights the importance of including ovarian tumors in the differential diagnosis when considering causes of virilization and insulin resistance. This case also suggests a potential relationship between excess testosterone secretion and hyperinsulinemia and strengthens evidence that hyperandrogenemia may promote hyperinsulinism in ovarian disease.
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Affiliation(s)
- Rachel Choe Kim
- Stony Brook University, Renaissance Faculty of Medicine, New York, USA
| | - Iliya Goldberg
- Stony Brook University, Renaissance Faculty of Medicine, Department of Surgery, New York, USA
| | - Trevor Van Brunt
- Stony Brook University, Renaissance Faculty of Medicine, New York, USA
| | - Hamama Tul-Bushra
- Stony Brook University, Renaissance Faculty of Medicine, Department of Pathology, New York, USA
| | - Rebecca Batiste
- Stony Brook University, Renaissance Faculty of Medicine, Department of Pathology, New York, USA
| | - Andrew H Lane
- Stony Brook Children’s Hospital, Clinic of Pediatrics, New York, USA
| | - Helen Hsieh
- Stony Brook University, Renaissance Faculty of Medicine, Department of Surgery, Division of Pediatric Surgery, New York, USA
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Ray LA, Billmire DF, Ferguson MJ, Eugster EA. Diagnostic Conundrum of a Sertoli Cell Tumor in a 2-Year-Old Girl with Peripheral Precocious Puberty and a Café-au-Lait Macule: A Case Report. Horm Res Paediatr 2024:1-6. [PMID: 38626741 DOI: 10.1159/000538945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/13/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Ovarian Sertoli cell tumors represent a subset of sex cord stromal tumors and are exceedingly rare in prepubertal children. Here, we report a girl with vaginal bleeding due to a Sertoli cell tumor who was originally thought to have McCune-Albright syndrome (MAS). CASE PRESENTATION A previously healthy girl presented at age 2 years 6 months with breast development and vaginal bleeding. On exam, she had Tanner 4 breasts, Tanner 1 pubic hair, estrogenized vaginal mucosa, and a café-au-lait macule. Laboratory studies revealed an elevated estradiol with suppressed gonadotropins and negative tumor markers. Her bone age was advanced by more than 3 years. Pelvic ultrasound (US) revealed an enlarged uterus and a slightly larger left compared to right ovary. She was started on tamoxifen for presumed MAS. A repeat pelvic US 1 month later showed a heterogenous mass in the left ovary which was subsequently resected. Pathology revealed a Sertoli cell tumor, lipid-rich variant. Germline sequencing revealed a pathogenic STK11 variant, diagnostic for Peutz-Jeghers syndrome (PJS). CONCLUSION The findings in our patient were strikingly similar to those encountered in MAS. To our knowledge, our patient is the youngest ever reported to present with precocious puberty due to a Sertoli cell tumor in the setting of PJS.
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Affiliation(s)
- Lauren A Ray
- Division of Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Deborah F Billmire
- Department of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Michael J Ferguson
- Division of Hematology and Oncology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Erica A Eugster
- Division of Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
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7
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Bergus KC, Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Markel TA, Merchant N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ. Diagnostic Performance of Magnetic Resonance Imaging for Pediatric Ovarian Neoplasms: A Multi-Institutional Review. J Pediatr Adolesc Gynecol 2024; 37:192-197. [PMID: 38008283 DOI: 10.1016/j.jpag.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
STUDY OBJECTIVE To assess the diagnostic performance of MRI to predict ovarian malignancy alone and compared with other diagnostic studies. METHODS A retrospective analysis was conducted of patients aged 2-21 years who underwent ovarian mass resection between 2009 and 2021 at 11 pediatric hospitals. Sociodemographic information, clinical and imaging findings, tumor markers, and operative and pathology details were collected. Diagnostic performance for detecting malignancy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for MRI with other diagnostic modalities. RESULTS One thousand and fifty-three patients, with a median age of 14.6 years, underwent resection of an ovarian mass; 10% (110/1053) had malignant disease on pathology, and 13% (136/1053) underwent preoperative MRI. MRI sensitivity, specificity, PPV, and NPV were 60%, 94%, 60%, and 94%. Ultrasound sensitivity, specificity, PPV, and NPV were 31%, 99%, 73%, and 95%. Tumor marker sensitivity, specificity, PPV, and NPV were 90%, 46%, 22%, and 96%. MRI and ultrasound concordance was 88%, with sensitivity, specificity, PPV, and NPV of 33%, 99%, 75%, and 94%. MRI sensitivity in ultrasound-discordant cases was 100%. MRI and tumor marker concordance was 88% with sensitivity, specificity, PPV, and NPV of 100%, 86%, 64%, and 100%. MRI specificity in tumor marker-discordant cases was 100%. CONCLUSION Diagnostic modalities used to assess ovarian neoplasms in pediatric patients typically agree. In cases of disagreement, MRI is more sensitive for malignancy than ultrasound and more specific than tumor markers. Selective use of MRI with preoperative ultrasound and tumor markers may be beneficial when the risk of malignancy is uncertain. CONCISE ABSTRACT This retrospective review of 1053 patients aged 2-21 years who underwent ovarian mass resection between 2009 and 2021 at 11 pediatric hospitals found that ultrasound, tumor markers, and MRI tend to agree on benign vs malignant, but in cases of disagreement, MRI is more sensitive for malignancy than ultrasound.
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Affiliation(s)
- Katherine C Bergus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amanda J Onwuka
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amin Afrazi
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lesley Breech
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kristine S Corkum
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick A Dillon
- St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Peter F Ehrlich
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mary E Fallat
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jason D Fraser
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Samir K Gadepalli
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julia E Grabowski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Paige Hertweck
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rashmi Kabre
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dave R Lal
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew P Landman
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Charles M Leys
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Grace Z Mak
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Troy A Markel
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Naila Merchant
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - R Elliott Overman
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brooks L Rademacher
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Manish T Raiji
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Beth Rymeski
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Thomas T Sato
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tiffany Wright
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jennifer H Aldrink
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Geri D Hewitt
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Department of Surgery, Nemours Children's Health, Delaware Valley, Wilmington, Delaware.
| | - Katherine J Deans
- Department of Surgery, Nemours Children's Health, Delaware Valley, Wilmington, Delaware
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8
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Costa J, Alves S, Silva F, Leite F, Bartosch C. Gynecologic Adnexal Tumors and Tumor-Like Lesions in Children and Adolescents: Experience at a Cancer Center. Int J Surg Pathol 2024:10668969241232698. [PMID: 38378017 DOI: 10.1177/10668969241232698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Introduction. Tumors and tumor-like lesions of the uterine adnexa in children and adolescents are uncommon but may carry devastating consequences. Methods. We conducted an observational retrospective cohort study, to describe patients aged 0 to 19 years diagnosed with tumors and tumor-like lesions of the uterine adnexa at our institution between 2000 and 2018. Results. Eighty-nine patients with 105 adnexal lesions were included. Thirty-seven (42%) patients presented with benign tumors, 13 (15%) with borderline tumors, 25 (28%) with malignant tumors and 14 (16%) with tumor-like lesions. Germ cell tumors (n = 45|43%) were the most frequent, followed by epithelial tumors (n = 30|29%). No significant differences were found in the age distribution of the lesions by malignant potential or histologic group. Most patients (n = 80|90%) were treated primarily with conservative surgery, including cystectomy (n = 25|28%) and unilateral oophorectomy/adnexectomy (n = 54|61%). Thirty-four (38%) underwent surgical staging (partial omentectomy and peritoneal biopsies). Twenty (23%) patients with borderline and malignant tumors were submitted to chemotherapy. Four (5%) patients with borderline or malignant tumors relapsed, one of whom died from disease. Conclusion. Gynecological lesions in children and adolescents encompass a wide range of rare histological tumor subtypes, requiring evaluation by experienced pathologists. Most tumors were diagnosed at early stages, with low relapse and mortality rates. Conservative management, with fertility sparing surgery and limited use of adjuvant chemotherapy, is of utmost importance.
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Affiliation(s)
- João Costa
- Deparment of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Sara Alves
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Fernanda Silva
- Deparment of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Filipa Leite
- Department of Pediatrics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Carla Bartosch
- Deparment of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
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9
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Grisales-Gallo JE, Salinas-Castro KJ, Nasner D, Toro-Gutiérrez JS. Mature cystic teratoma overlapping with giant serous cystadenoma of the ovary: A case report. Radiol Case Rep 2024; 19:218-222. [PMID: 38028279 PMCID: PMC10651425 DOI: 10.1016/j.radcr.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Ovarian lesions represent a diagnostic challenge for the radiologist and should be approached according to the patient's age, menstrual cycle, and imaging characteristics. These lesions can be cystic, mixed, or solid-predominant structures. Generally, the occurrence of benign lesions surpasses that of malignant ones at a ratio of 3:1. However, within infantile and juvenile age groups, this becomes an infrequent occurrence, making up only about 5% of ovarian tumor cases. This case report sheds light on a unique scenario involving a pediatric patient who harbored 2 benign tumors simultaneously: a mature cystic teratoma and a serous cystadenoma.
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Affiliation(s)
| | | | - Daniela Nasner
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
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10
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Buendía López S, Peláez Mata DJ, Martín Boizas R, Sanz Villa N. Suspected ovarian teratoma with a simple X-ray. An Pediatr (Barc) 2023; 99:451-452. [PMID: 37932160 DOI: 10.1016/j.anpede.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/11/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Susana Buendía López
- Servicio de Onco-Hematología Pediátrica y Trasplante de Progenitores Hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | | | - Ruth Martín Boizas
- Servicio de Radiodiagnóstico, Hospital Universitario San Rafael, Madrid, Spain
| | - Nieves Sanz Villa
- Servicio de Cirugía Pediátrica, Hospital Universitario San Rafael, Madrid, Spain
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11
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Watanabe T, Soeda S, Okoshi C, Fukuda T, Yasuda S, Fujimori K. Landscape of somatic mutated genes and inherited susceptibility genes in gynecological cancer. J Obstet Gynaecol Res 2023; 49:2629-2643. [PMID: 37632362 DOI: 10.1111/jog.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Traditionally, gynecological cancers have been classified based on histology. Since remarkable advancements in next-generation sequencing technology have enabled the exploration of somatic mutations in various cancer types, comprehensive sequencing efforts have revealed the genomic landscapes of some common forms of human cancer. The genomic features of various gynecological malignancies have been reported by several studies of large-scale genomic cohorts, including The Cancer Genome Atlas. Although recent comprehensive genomic profiling tests, which can detect hundreds of genetic mutations at a time from cancer tissues or blood samples, have been increasingly used as diagnostic clinical biomarkers and in therapeutic management decisions, germline pathogenic variants associated with hereditary cancers can also be detected using this test. Gynecological cancers are closely related to genetic factors, with approximately 5% of endometrial cancer cases and 20% of ovarian cancer cases being caused by germline pathogenic variants. Hereditary breast and ovarian cancer syndrome and Lynch syndrome are the two major cancer susceptibility syndromes among gynecological cancers. In addition, several other hereditary syndromes have been reported to be associated with gynecological cancers. In this review, we highlight the genes for somatic mutation and germline pathogenic variants commonly seen in gynecological cancers. We first describe the relationship between clinicopathological attributes and somatic mutated genes. Subsequently, we discuss the characteristics and clinical management of inherited cancer syndromes resulting from pathogenic germline variants in gynecological malignancies.
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Affiliation(s)
- Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Chihiro Okoshi
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
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12
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Choi H, Kim SE, Lee NH, Lee DY, Choi D. Clinical Characteristics of Gynecologic Problems During Childhood in the Korean Population. J Korean Med Sci 2023; 38:e279. [PMID: 37724492 PMCID: PMC10506899 DOI: 10.3346/jkms.2023.38.e279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND This study analyzed common gynecologic problems among Korean patients younger than ten years. METHODS We performed a retrospective analysis of medical records of patients younger than ten years who visited the Pediatric and Adolescent Gynecology Clinic at Samsung Medical Center between 1995 and 2020. RESULTS Among the 6,605 patients who visited the Pediatric and Adolescent Gynecology Clinic, data from 642 patients younger than ten years were analyzed in this study. The most common chief complaint was genital anomalies, followed by increased vaginal discharge and abnormal findings on clinical examinations. The most common disease entity was agglutination of the labia minora, which was commonly discovered incidentally during routine screenings. Vulvovaginitis, the second most common disease, was identified by symptoms of vaginal discharge, pruritus, and vaginal spotting. Neoplasm, issues with vaginal bleeding, and "other causes" were additional categories of gynecologic problems. 245 patients (38.2%) were referred from primary care sources, 175 patients (27.4%) sought care directly at the clinic, 169 patients (26.3%) were referrals from the institution's pediatric department, and the remainder were referrals from other departments. CONCLUSION This study provides information about the gynecologic problems most frequently encountered in pediatric patients. The study provides helpful insight for primary care physicians into the proper management and timing of referrals for these gynecologic problems of pediatric patients.
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Affiliation(s)
- Haewon Choi
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - Nae Hyun Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - Dong-Yun Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - DooSeok Choi
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea.
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13
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Birbas E, Kanavos T, Gkrozou F, Skentou C, Daniilidis A, Vatopoulou A. Ovarian Masses in Children and Adolescents: A Review of the Literature with Emphasis on the Diagnostic Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1114. [PMID: 37508611 PMCID: PMC10377960 DOI: 10.3390/children10071114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Most abdominal masses in the pediatric population derive from the ovaries. Ovarian masses can occur in all ages, although their incidence, clinical presentation and histological distribution vary among different age groups. Children and adolescents may develop non-neoplastic ovarian lesions, such as functional cysts, endometrioma, torsion, abscess and lymphangioma as well as neoplasms, which are divided into germ cell, epithelial, sex-cord stromal and miscellaneous tumors. Germ cell tumors account for the majority of ovarian neoplasms in the pediatric population, while adults most frequently present with epithelial tumors. Mature teratoma is the most common ovarian neoplasm in children and adolescents, whereas dysgerminoma constitutes the most frequent ovarian malignancy. Clinical manifestations generally include abdominal pain, palpable mass, nausea/vomiting and endocrine alterations, such as menstrual abnormalities, precocious puberty and virilization. During the investigation of pediatric ovarian masses, the most important objective is to evaluate the likelihood of malignancy since the management of benign and malignant lesions is fundamentally different. The presence of solid components, large size and heterogenous appearance on transabdominal ultrasonography, magnetic resonance imaging and computed tomography indicate an increased risk of malignancy. Useful tumor markers that raise concern for ovarian cancer in children and adolescents include alpha-fetoprotein, lactate dehydrogenase, beta subunit of human chorionic gonadotropin, cancer antigen 125 and inhibin. However, their serum levels can neither confirm nor exclude malignancy. Management of pediatric ovarian masses needs to be curative and, when feasible, function-preserving and minimally invasive. Children and adolescents with an ovarian mass should be treated in specialized centers to avoid unnecessary oophorectomies and ensure the best possible outcome.
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Affiliation(s)
- Effrosyni Birbas
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Theofilos Kanavos
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Fani Gkrozou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| | - Chara Skentou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| | - Angelos Daniilidis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
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14
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Yoeli-Bik R, Lengyel E, Mills KA, Abramowicz JS. Ovarian Masses: The Value of Acoustic Shadowing on Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:935-945. [PMID: 36114807 DOI: 10.1002/jum.16100] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Adnexal lesions are a common finding in women and pose a clinical challenge since ovarian cancer is a highly lethal disease. However, most adnexal masses are benign, benefiting from a more conservative approach. In preoperative assessment, transvaginal ultrasound plays a key role in evaluating morphologic features that correlate with the risk of malignancy. The acoustic shadow is the loss of echo behind sound-absorbing components, such as calcifications or fibrous tissues, which are predominantly found in benign lesions. However, recognizing the acoustic shadow is a difficult skill to master, and its usefulness may be underappreciated.
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Affiliation(s)
- Roni Yoeli-Bik
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois, USA
| | - Kathryn A Mills
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois, USA
| | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology/Section of Maternal Fetal Medicine, University of Chicago, Chicago, Illinois, USA
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15
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Bourgioti C, Konidari M, Moulopoulos LA. Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI. Cancers (Basel) 2023; 15:cancers15072106. [PMID: 37046767 PMCID: PMC10093428 DOI: 10.3390/cancers15072106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life.
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Affiliation(s)
- Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Marianna Konidari
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
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16
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Therapeutic Management and Prognostic Factors for Ovarian Malignant Tumours in Adolescents: A Comprehensive Review of Current Guidelines. Diagnostics (Basel) 2023; 13:diagnostics13061080. [PMID: 36980387 PMCID: PMC10047001 DOI: 10.3390/diagnostics13061080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Ovarian malignant tumours are rarely diagnosed in adolescents but may have a significant impact on their survival, future fertility and quality of life. The management of such cases is rather complex and requires expertise and careful planning according to scarce existing evidence and recommendations. Objective: The aim of this study was to review and compare recommendations from published guidelines regarding the diagnosis, prognosis and treatment of malignant ovarian tumours in adolescents. Evidence acquisition: A comparative descriptive/narrative review of guidelines issued by L’Observatoire des Tumeurs Malignes Rares Gynécologiques, the British Society for Paediatric & Adolescent Gynaecology, the European Society for Medical Oncology, the European Society of Gynecological Oncology-European Society for Paediatric Oncology and the European Cooperative Study Group for Pediatric Rare Tumors was conducted. Results: All guidelines recommend a thorough diagnostic work-up, consisting of both imaging tests and serum tumour marker measurement, as well as the use of immunohistochemical methods to confirm the diagnosis and complete surgical staging prior to constructing the treatment plan. There is a lack of recommendations regarding the assessment of prognostic factors, with only one guideline providing detailed information. Treatment strategies, as suggested by the majority of guidelines and with only a few discrepancies between them, should include both surgery and adjuvant therapies, mainly chemotherapy, with great emphasis on fertility preservation when it is considered oncologically safe and on the significance of regular and long-term follow-up. Conclusions: There is a significant degree of agreement among recommendations of existing guidelines. The reported differences, although limited, highlight the need for the adoption of an international consensus in order to further improve the management of adolescent ovarian cancer.
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17
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Sertic M, Devins KM, Oliva E, Lee SI, Kilcoyne A. Sex Cord-Stromal Tumors of the Ovary. Radiol Clin North Am 2023; 61:595-608. [PMID: 37169426 DOI: 10.1016/j.rcl.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Ovarian sex cord-stromal tumors (OSCSTs) are a rare group of ovarian neoplasms that can be benign or malignant. They are classified into pure sex cord tumors, pure stromal tumors, and mixed SCST. The most common malignant OSCSTs are adult granulosa cell tumors. In contrast to the more common ovarian epithelial malignancies, OSCSTs present in younger patients, often at early stages, with better prognoses. Imaging features are variable, and pathology is required for diagnosis. However, certain tumors demonstrate characteristic imaging appearances that can be useful in narrowing the differential diagnosis.
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18
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Mitchell JR, Siegelman ES, Sundaram KM. MR Imaging of Germ Cell and Sex Cord Stromal Tumors. Magn Reson Imaging Clin N Am 2023; 31:65-78. [DOI: 10.1016/j.mric.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Gkrozou F, Tsonis O, Vatopoulou A, Galaziou G, Paschopoulos M. Ovarian Teratomas in Children and Adolescents: Our Own Experience and Review of Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101571. [PMID: 36291507 PMCID: PMC9599961 DOI: 10.3390/children9101571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
Background: Ovarian teratomas are the most common type of ovarian mass during childhood and adolescence. There is no clear guidance for the management of the ovarian teratomas in children and adolescents. It is necessary, however, to understand the feature of these tumours and the indications for operating on them, and to put subjective criteria for the management in elective or emergency presentations. Methods: Medical records of patients between the age of 12 and 20 years old that underwent surgery for ovarian teratomas at the Department of Obstetrics and Gynaecology in University Hospital of Ioannina, between January 2000 and August 2022, were reviewed. A medical database was searched between January 2000 and August 2022 with the following keywords: ovarian teratoma, paediatrics and adolescents. Results: We present the results of forty patients, with a mean age of 11.8 years of age. All patients had surgery, where three out of four underwent oophorectomy and only one out of four underwent ovary-sparing operation; similar results were found in the literature. Conclusion: Ovary-sparing treatment is more common recently compared with the past, such as MIS compared with laparotomy. Better-organised and -planned prospective multi-centre studies are necessary to gain a deeper knowledge of the physiology and prognostic factors of teratomas in children.
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Affiliation(s)
- Fani Gkrozou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Orestis Tsonis
- Assisted Conception Unit, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Georgia Galaziou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
- Correspondence: ; Tel.: +30-6985726869
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20
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Affiliation(s)
- Rachel C Sisodia
- From Massachusetts General Hospital and Harvard Medical School - both in Boston
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21
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Rickards J, Brooks BA, Rivera-Betancourt A, Velasquez D. A Rare Case of Low-Grade Serous Cystadenocarcinoma of the Ovary in a Seventeen-Year-Old Woman. Cureus 2022; 14:e28086. [PMID: 36128000 PMCID: PMC9478196 DOI: 10.7759/cureus.28086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/05/2022] Open
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22
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Review of a 25-Year Experience in the Management of Ovarian Masses in Neonates, Children and Adolescents: From Laparoscopy to Robotics and Indocyanine Green Fluorescence Technology. CHILDREN 2022; 9:children9081219. [PMID: 36010109 PMCID: PMC9406417 DOI: 10.3390/children9081219] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Background: Ovarian masses in pediatric populations are the most common abdominal masses in young girls. In neonates, the majority of masses are benign while in children and teen-agers the risk of malignancy exists. The aim of this study is to perform a 25-year experience retrospective analysis of clinical and therapeutic aspects of ovarian tumors in girls, in order to show how the development of minimally invasive technology has changed the management of this pathology. Methods: The records of patients under the age of 18 who were operated in three pediatric surgical units due to ovarian mass, in the last 25 years, were reviewed retrospectively. The study group comprised 147 patients operated between 1996 and 2021 with a diagnosis of ovarian masses. Data involved were demographical, surgical, follow-up and final diagnosis. We analyzed the type of surgical technique, intra-operative data (operative time, the use of different technologies), complications, length of stay and long-term follow-up. Based on these data, we assessed how the surgical approach to ovarian masses has changed in the last 25 years in newborns and young girls. Results: The patients ages ranged between 7 days and 15 years (median, 59 days). All the procedures were completed in laparoscopy or robotics without conversion in open surgery. One-hundred and eleven patients were neonates; they all had follicular cysts and they were all managed in laparoscopy using 1 or 3 trocars. In 80/111 patients (72%), a small part of ovarian parenchyma was saved; in 31/111 patients (28%), in which the ovarian parenchyma was not available, an ovariectomy was performed. Patients in which we saved a small part of ovary, at long term follow-up (minimum follow-up of 12 years) (29/80, 36%), developed a normal ovary at US control. Thirty-six were older patients. They had a histological diagnosis of benign (30) or malign (6) tumors. All the patients (8/36) with a pre-operative suspicion of ovarian malignancy received an ovariectomy and an adnexectomy using sealing devices. In the last 10 years in all the children, except neonates, we adopted sealing devices and, in the last 4 years, in 20 cases, we always adopted ICG fluorescence technology to check ovarian vascularization in case of torsion or to check lympho-nodes condition in case of malignancy. Conclusions: In neonatal ovarian cysts, surgical management remained unchanged and an ovarian sparing procedure is always indicated and the long-term follow-ups confirm this hypothesis. The principal innovation in this age period is the use of ICG fluorescence technology to check ovarian vascularization in case of torsion. In teenagers, the decision-making strategy is based on the tumoral markers and on the morphological aspects of the mass. Robotics cystectomy or ovariectomy now-days represents the safer and faster way to perform this. Sealing devices are essential tools for dissection and resection to avoid bleeding. ICG fluorescence technology in all ages is fundamental to check ovary vascularization after detorsion or to check lympho-node status in case of malignancy. All the suspected lesions have to be removed with an endo-bag.
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23
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Khatun F, Das A, Sengupta M, Chatterjee U, Sarkar R. Fine-needle aspiration cytology of juvenile granulosa cell tumour: A case report with summary of prior published cases. Diagn Cytopathol 2022; 50:E373-E376. [PMID: 35942608 DOI: 10.1002/dc.25037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/02/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022]
Abstract
Juvenile granulosa cell tumours (JGCT) are uncommon tumours of the ovary and can present diagnostic difficulty both on histology and cytology because of its rarity. Here we present the fine-needle aspiration cytology (FNAC) findings of a 4 year-old girl who came with a large abdominal mass and bleeding per vaginum. FNAC from the mass showed features suggestive of granulosa cell tumour (GCT) and which was later confirmed on histology to be of juvenile type. Only two cases of cytological findings of JGCT have been described earlier, both of which were recurrent cases and at metastatic sites. The main cytological feature in our case was presence of thick colloid like fluid containing apparent bubbles along with small clusters of uniform cells with eosinophilic cytoplasm and fine vacuolation. The presence of these secretions corresponding to the macrofollicles on histology has not been reported earlier.
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Affiliation(s)
| | - Anirban Das
- Department of Pediatric Surgery, IPGME&R, Kolkata, India
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24
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Segal NL, Hur YM. Personality traits, mental abilities and other individual differences: Monozygotic female twins raised apart in South Korea and the United States. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Marie E, Navallas M, Katz DS, Farajirad E, Punnett A, Davda S, Shammas A, Oudjhane K, Vali R. Non-Hodgkin Lymphoma Imaging Spectrum in Children, Adolescents, and Young Adults. Radiographics 2022; 42:1214-1238. [PMID: 35714040 DOI: 10.1148/rg.210162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In children, adolescents, and young adults (CAYA), non-Hodgkin lymphoma (NHL) is characterized by various age-related dissimilarities in tumor aggressiveness, prevailing pathologic subtypes, and imaging features, as well as potentially different treatment outcomes. Understanding the imaging spectrum of NHL in CAYA with particular attention to children and adolescents is critical for radiologists to support the clinical decision making by the treating physicians and other health care practitioners. The authors discuss the currently performed imaging modalities including radiography, US, CT, MRI, and PET in the diagnosis, staging, and assessment of the treatment response. Familiarity with diagnostic imaging challenges during image acquisition, processing, and interpretation is required when managing patients with NHL. The authors describe potentially problematic and life-threatening scenarios that require prompt management. Moreover, the authors address the unprecedented urge to understand the imaging patterns of possible treatment-related complications of the therapeutic agents used in NHL clinical trials and in practice. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Eman Marie
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - María Navallas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Douglas S Katz
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Elnaz Farajirad
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Angela Punnett
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Sunit Davda
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Amer Shammas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Kamaldine Oudjhane
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Reza Vali
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
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Shanta K, Nakayama K, Hossain MM, Razia S, Ishibashi T, Ishikawa M, Yamashita H, Kanno K, Sato S, Nakayama S, Otsuki Y, Kyo S. Promising Therapeutic Impact of a Selective Estrogen Receptor Downregulator, Fulvestrant, as Demonstrated In Vitro upon Low-Grade Serous Ovarian Carcinoma Cell Lines. Curr Oncol 2022; 29:4020-4033. [PMID: 35735430 PMCID: PMC9221871 DOI: 10.3390/curroncol29060321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have reported hormonal agent use in the treatment of low-grade serous ovarian carcinomas (LGSOCs), which are chemoresistant. Considering the need for novel effective therapies, we investigated the hormone receptor expression and hormonal inhibition efficacy in LGSOCs. Using immunohistochemistry, we assessed the estrogen receptor (ER) expression status in 33 cases of histologically confirmed serous ovarian tumors, including 10, 11, and 12 cases of LGSOCs, serous borderline tumors (SBTs), and serous cystadenomas (SCAs), respectively. The genetic background reported in our previous study was used in the current study. MPSC1 cells, which were established from LGSOCs, were used in cell proliferation assays. We observed a higher ER expression in LGSOCs and SBTs than in SCAs (70%, 81%, and 50%, respectively). Thus, LGSOCs and SBTs exhibit higher ER expression than SCAs. Moreover, the PIK3CA mutation positively correlated with ER expression in LGSOCs (p = 0.0113). MPSC1 cells showed low ER expression on Western blotting. MPSC1 cell proliferation was significantly inhibited by fulvestrant (a selective ER downregulator). The activation of ER and PI3K/AKT signaling pathways may play an important role in LGSOC carcinogenesis. ER downregulation with fulvestrant or combination therapy with PI3K inhibitors is a possible novel treatment for patients with LGSOCs.
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Affiliation(s)
- Kamrunnahar Shanta
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Kentaro Nakayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
- Correspondence: ; Tel.: +81-853-20-2268
| | - Mohammad Mahmud Hossain
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Sultana Razia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Tomoka Ishibashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Masako Ishikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Hitomi Yamashita
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Kosuke Kanno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Seiya Sato
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
| | - Satoru Nakayama
- Department of Obstetrics and Gynecology, Seirei Hamamatsu Hospital, Hamamatsu 430-8558, Japan;
| | - Yoshiro Otsuki
- Department of Organ Pathology, Seirei Hamamatsu Hospital, Hamamatsu 430-8558, Japan;
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan; (K.S.); (M.M.H.); (S.R.); (T.I.); (M.I.); (H.Y.); (K.K.); (S.S.); (S.K.)
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Beroukhim G, Ozgediz D, Cohen PJ, Hui P, Morotti R, Schwartz PE, Yang-Hartwich, Vash-Margita A. Progression of Cystadenoma to Mucinous Borderline Ovarian Tumor in Young Females: Case Series and Literature Review. J Pediatr Adolesc Gynecol 2022; 35:359-367. [PMID: 34843973 DOI: 10.1016/j.jpag.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/23/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To study the progression of benign ovarian lesions to mucinous borderline ovarian tumors (mBOTs); analyze the clinicopathologic features, diagnosis, and management of mBOTs in pediatric and adolescent girls; and provide a review of the literature on mBOTs in this population. DESIGN Retrospective chart review of female adolescents younger than 18 years diagnosed with mBOTs between July 2017 and February 2021. SETTING Yale New Haven Hospital, New Haven, Connecticut; and Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut. PARTICIPANTS Three female patients diagnosed with mBOTs between ages 12 and 17 years. INTERVENTIONS None. MAIN OUTCOME MEASURES Clinical presentation, preoperative characteristics, surgical technique, histology, tumor stage, treatment, progression, outcome, and rate of recurrence. RESULTS Three adolescent patients were identified to have mBOTs. All three patients presented with a chief complaint of abdominal pain. One of the 3 patients was premenarchal at presentation. Two of the 3 patients were initially diagnosed with a mucinous cystadenoma and had recurrences of an ovarian cyst in the same ovary within 5 and 17 months, respectively. Pathology of the recurrent cyst was consistent with mBOT. Two of the 3 patients initially underwent cystectomy, and all ultimately had a unilateral salpingo-oophorectomy. Subsequent surveillance over 2 to 4 years found no evidence of disease recurrence. CONCLUSION mBOTs are rare in the pediatric and adolescent population and could arise from benign ovarian tumors.
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Affiliation(s)
- Gabriela Beroukhim
- Department of Obstetrics, Gynecology and Reproductive Sciences at Yale New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut
| | - Doruk Ozgediz
- Department of Pediatric Surgery at University of California, San Francisco (UCSF), San Francisco, California
| | - Paul J Cohen
- Department of Pathology at Bridgeport Hospital and Yale University, New Haven, Connecticut
| | - Pei Hui
- Department of Pathology at Yale New Haven Hospital and Yale University, New Haven, Connecticut
| | - Raffaella Morotti
- Department of Pathology at Yale New Haven Hospital and Yale University, New Haven, Connecticut
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences at Yale New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut
| | - Yang-Hartwich
- Department of Obstetrics, Gynecology and Reproductive Sciences at Yale New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology and Reproductive Sciences at Yale New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut.
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Pereira PN, Yoshida A, Sarian LO, Barros RHDO, Jales RM, Derchain S. Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes. Radiol Bras 2022; 55:137-144. [PMID: 35795605 PMCID: PMC9254700 DOI: 10.1590/0100-3984.2021.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/05/2021] [Indexed: 01/18/2023] Open
Abstract
Objective To assess the performance of the Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) score in the evaluation of adnexal masses and to provide technical notes about its current MRI parameters and concepts. Materials and Methods This was a prospective study of 226 patients with 287 adnexal masses (190 submitted to surgery or biopsy and 97 followed for at least one year). We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the O-RADS MRI score, using ≥ 4 as the cutoff for malignancy. We performed a technical analysis of the main updates to the score, announced in September 2020 by the American College of Radiology, in comparison with the original (2013) version. Results We found that an O-RADS MRI score of 4 or 5 was associated with malignancy of an adnexal mass, with a sensitivity of 91.11% (95% CI: 83.23-96.08), specificity of 94.92% (95% CI: 90.86-97.54), positive predictive value of 89.13% (95% CI: 81.71-93.77), negative predictive value of 95.90% (95% CI: 92.34-97.84), and overall accuracy of 93.73% (95% CI: 90.27-96.24). Conclusion Our findings support the use of the O-RADS MRI score for evaluating adnexal masses, especially those considered indeterminate on ultrasound. The updates made recently to the O-RADS MRI score facilitate its interpretation and will allow its more widespread use, with no loss of diagnostic accuracy.
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Affiliation(s)
- Patrick Nunes Pereira
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Adriana Yoshida
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Luís Otavio Sarian
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Ricardo Hoelz de Oliveira Barros
- Department of Radiology, Hospital das Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Rodrigo Menezes Jales
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
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Appearances Are Deceptive: Two Case Reports in Teenagers on the Conservative Laparoscopic Surgery for Adnexal Torsion with Apparent Infarction. Case Rep Obstet Gynecol 2022; 2022:1798599. [PMID: 35531128 PMCID: PMC9068344 DOI: 10.1155/2022/1798599] [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: 11/20/2021] [Revised: 02/21/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Torsion of the ovary, tube, or both is estimated to be responsible for 2-7% of all gynaecological emergencies. Oophorectomy is commonly performed for adnexal torsion with a possible negative impact on fertility in women of reproductive age. Case Presentations. We report two cases of teenage girls presented with adnexal torsion describing their laparoscopy features. Detorsion without additional surgical intervention could save their ovaries. Discussion. Detorsion is a more conservative surgical approach that should be considered in all younger women with ovarian torsion.
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30
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Juvenile Granulosa Cell Tumor in a Child Born with Ambiguous Genitalia. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-021-00604-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Persano G, Crocoli A, Martucci C, Vinti L, Cassanelli G, Stracuzzi A, Cardoni A, Inserra A. Case report: Primary ovarian Burkitt's lymphoma: A puzzling scenario in pediatric population. Front Pediatr 2022; 10:1072567. [PMID: 36714645 PMCID: PMC9875037 DOI: 10.3389/fped.2022.1072567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
Burkitt's lymphoma (BL) is defined as a highly invasive B-cell lymphoma, usually characterized by an excellent prognosis, more than 90% of children and adolescents being cured with highly dose-intensive multiagent chemotherapy. Primary ovarian localization without involvement of other organs is a rare manifestation of BL, especially in pediatric population. Symptoms at diagnosis are similar to other ovarian lesions and differential diagnosis may be challenging for clinicians. A 12-year-old girl was referred to our institution for abdominal pain and palpable mass observed by the pediatrician. Diagnostic work-up demonstrated a large mass arising from the right ovary, causing compression on abdominal aorta, inferior vena cava, ureters and bowel, with a second smaller lesion on the left ovary. At surgery, a 15 cm-large, ruptured mass arising from the right ovary was found, associated with a second lesion originating from the left ovary (8 cm) and multiple nodules of the greater omentum. Right salpingo-oophorectomy was performed, incisional biopsies were taken from the left ovary and omental nodules and peritoneal fluid samples were collected for cytology. Pathology revealed a Burkitt lymphoma and the patient underwent chemotherapy according to AIEOP LNH-97 Protocol, group R3 with Rituximab. Preoperative diagnosis of primary ovarian lymphoma is extremely difficult. Surgical exploration is often necessary in patients presenting with acute abdominal or pelvic pain; when the suspicion of primary ovarian lymphoma arises intraoperatively, every effort should be made to minimize invasive procedure in order to enhance post-operative recovery.
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Affiliation(s)
- Giorgio Persano
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Cristina Martucci
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Luciana Vinti
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Giulia Cassanelli
- Department of Imaging, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | | | - Antonello Cardoni
- Department of Pathology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Alessandro Inserra
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
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32
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Reitere D, Mašinska M, Līdaka L, Franckeviča I, Baurovska I, Apine I. Bilateral ovarian fibromas in a 15-year-old primary amenorrhea patient: a case report. Radiol Case Rep 2021; 17:368-372. [PMID: 34925667 PMCID: PMC8649117 DOI: 10.1016/j.radcr.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
A 15-year-old female with primary amenorrhea, obesity, and insulin resistance, was admitted for further examination due to large pelvic masses found during a transabdominal ultrasound, which was performed while assessing the amenorrhea. The magnetic resonance imaging showed bilateral, multifocal fibrosing tumors, originating from both ovaries. A laparotomy was performed, during which the right ovary masses were enucleated and the left adnexectomy was performed. A histological examination of the tissue material revealed bilateral ovarian fibromas with calcification and ossification. The genetic examination confirmed the diagnosis of Gorlin syndrome. The patient recovered well, and on the first follow-up 1 month after surgery, already experienced her first spontaneous menstrual bleeding.
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Affiliation(s)
- Dīna Reitere
- Riga Stradins University, Dzirciema Street 16, Riga, Latvia, LV-1007.,Riga East Clinical University Hospital, Hipokrata Street 2, Riga, Latvia, LV-1038
| | - Madara Mašinska
- Riga Stradins University, Dzirciema Street 16, Riga, Latvia, LV-1007.,Children Clinical University Hospital, Vienibas Alley 45, Riga, Latvia, LV-1004
| | - Lāsma Līdaka
- Riga Stradins University, Dzirciema Street 16, Riga, Latvia, LV-1007.,Children Clinical University Hospital, Vienibas Alley 45, Riga, Latvia, LV-1004
| | - Ivanda Franckeviča
- Riga Stradins University, Dzirciema Street 16, Riga, Latvia, LV-1007.,Children Clinical University Hospital, Vienibas Alley 45, Riga, Latvia, LV-1004
| | - Ieva Baurovska
- Children Clinical University Hospital, Vienibas Alley 45, Riga, Latvia, LV-1004
| | - Ilze Apine
- Riga Stradins University, Dzirciema Street 16, Riga, Latvia, LV-1007.,Children Clinical University Hospital, Vienibas Alley 45, Riga, Latvia, LV-1004
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Dunn CL, Wessler JM, Pragani JK, Stewart SE. Fever and Abdominal Pain in a 10-year-old with Autism. Pediatr Rev 2021; 42:706-711. [PMID: 36017950 DOI: 10.1542/pir.2020-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Charles L Dunn
- Department of Pediatrics, 673rd Medical Group, Joint Base Elmendorf-Richardson, Anchorage, AK
| | - Jacob M Wessler
- Department of Pediatric Hematology/Oncology, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Jaisal K Pragani
- Department of Pediatrics, 673rd Medical Group, Joint Base Elmendorf-Richardson, Anchorage, AK
| | - Scott E Stewart
- Department of Pediatrics, 673rd Medical Group, Joint Base Elmendorf-Richardson, Anchorage, AK
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Shen SH, Lai WA, Lin SC, Chang WH, Horng HC, Wang PH. Sertoli-Leydig cell tumor of the ovary: Radiologic-operative-histologic finding. Taiwan J Obstet Gynecol 2021; 59:987-990. [PMID: 33218429 DOI: 10.1016/j.tjog.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taiwan
| | - Wei-An Lai
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Shih-Chieh Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Wen-Hsun Chang
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Huann-Cheng Horng
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Female Cancer Foundation, Taipei, Taiwan.
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35
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Anton-Păduraru DT, Miron IC, Lupu VV, Lupu A, Hanganu E. Ovarian teratoma in a teenager causing ureterohydronephrosis: Case report and literature review. Medicine (Baltimore) 2021; 100:e26472. [PMID: 34232179 PMCID: PMC8270627 DOI: 10.1097/md.0000000000026472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Teratomas are solid tumors that may occur in both gonadal and extragonadal locations, depending on the age of the child. Benign cystic teratomas are relatively common tumors among women of reproductive age, but they can occur at any age. The clinical presentation is not specific. They can be found incidentally when patients are investigated for other conditions or they can present as emergencies when the ovarian teratoma is torsioned or ruptured. PATIENT CONCERNS We present the case of a 17-year-old adolescent girl that was seen in our emergency department on several occasions for recurrent episodes of abdominal pain ongoing for 6 months. DIAGNOSIS An ultrasonography (US) was performed as an outpatient and a left ovarian mass was found along with right ureterohydronephrosis (UHN). Further assessment of the mass was done by abdominal and pelvic CT and tumoral markers. CT appearance was more suggestive of a teratoma. INTERVENTIONS She underwent laparotomy with complete excision of the tumor. OUTCOME The patient had an uneventful recovery. A renal US follow up showed reduction of the dilatation, demonstrating that the condition was secondary to tumor compression. LESSONS In a teenager with nonspecific symptoms, a high suspicion index for tumors is mandatory. An early diagnosis and management avoid complications like UHN.
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Affiliation(s)
| | | | | | | | - Elena Hanganu
- Discipline of Rehabilitation in Pediatrics, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
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36
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Wang Q, Yu D, Wang F. Clinical and Computed Tomographic Features of Ovarian Lesions in Infants, Children, and Adolescents: A Series of 222 Cases. J Pediatr Adolesc Gynecol 2021; 34:387-393. [PMID: 33144230 DOI: 10.1016/j.jpag.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/10/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE To investigate the clinical and computed tomography (CT) characteristics of ovarian lesions in infants, children, and adolescents. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of the clinical and CT data was performed in 222 patients who were 20 years or younger with ovarian lesions. Patients' age, medical history, symptoms, tumor marker levels, and CT imaging findings were recorded. INTERVENTIONS None. MAIN OUTCOME MEASURES Identification of the clinical and CT features of ovarian lesions in infants, children, and adolescents. RESULTS A total of 136 patients had abdominal pain, and 73 patients had palpable abdominal mass. The β-HCG was elevated in 4 and AFP was elevated in 16 of the 222 cases. A total of 235 lesions were found in 222 cases, including 75 non-neoplastic and 160 neoplastic lesions. Ovarian cyst exhibited homogeneous low density. The torsion of a normal-sized ovary demonstrated mild or no enhancement. The torsion associated with an ovarian mass demonstrated a thickened, hyperdense wall. Mature teratoma presented as a cystic mass, with bulk fat and coarse calcification. Immature teratoma appeared as a solid mass with foci of fat and fine calcification. Yolk sac tumor was shown as cystic-solid mass with intense enhancement of solid component. Wall and septation of benign epithelial tumors were relatively uniform in thickness; mural nodule was detected in borderline tumor; and malignant epithelial tumor was predominantly a solid mass with intense enhancement. CONCLUSION Ovarian cyst is the most common non-neoplastic lesion. Torsion of a normal-sized ovary was the second most common non-neoplastic lesion, almost always causing abdominal pain. Germ cell tumor has the highest incidence among neoplastic lesions. Fat and calcification are highly specific for germ cell tumor. The elevation of AFP and HCG levels in serum indicates germ cell tumor. Ovarian epithelial tumor is usually large, benign, and predominantly cystic. The combination of clinical and imaging features is helpful for correct diagnosis.
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Affiliation(s)
- Qing Wang
- Radiology Department, Qilu Hospital of Shandong University, Shandong Province, China
| | - Dexin Yu
- Radiology Department, Qilu Hospital of Shandong University, Shandong Province, China
| | - Fang Wang
- Radiology Department, Qilu Hospital of Shandong University, Shandong Province, China.
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37
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Pastorczak A, Krajewska K, Urbanska Z, Szmyd B, Salacinska-Los E, Kobos J, Mlynarski W, Trelinska J. Ovarian carcinoma in children with constitutional mutation of SMARCA4: single-family report and literature review. Fam Cancer 2021; 20:355-362. [PMID: 33907931 PMCID: PMC8484133 DOI: 10.1007/s10689-021-00258-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023]
Abstract
Ovarian carcinoma is an extremely rare malignancy in children, often developing on the underlying inherited background. Female carriers of pathogenic germline mutations of SMARCA4 are at risk of an aggressive type of undifferentiated ovarian cancer called small cell carcinoma of the ovary, hypercalcemic type (SCCOHT). Regardless of age of the patient, stage of the disease, and oncological treatment, the prognosis for SCCOHT is poor. Therefore, early intervention with risk-reducing surgeries is recommended for these patients. In this study, we report genetic testing of a family with two children carrying pathogenic germline mutations of SMARCA4 and summarize the course of SCCOHT in all pediatric patients reported in the literature with constitutional defects identified within the SMARCA4 locus.
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Affiliation(s)
- Agata Pastorczak
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland.
| | - Karolina Krajewska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | - Zuzanna Urbanska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | - Bartosz Szmyd
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | | | - Józef Kobos
- Department of Histology and Embryology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | - Joanna Trelinska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
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38
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Roos EJ, Simms-Cendan J, Cheung C, Laufer D, Grover SR. Pediatric and adolescent gynecology through a global lens. Int J Gynaecol Obstet 2021; 156:189-196. [PMID: 33905533 DOI: 10.1002/ijgo.13723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 11/09/2022]
Abstract
Girls and adolescents, aged 0-19 years make up almost 30% of the world's female population yet their specific healthcare needs often slip between the gaps of pediatrics and adult women's health. Pediatric and adolescent gynecology is the clinical field that endeavors to address the reproductive health needs of this age group. The environment and psychosocial well-being, social determinants of health, have direct bearing on reproductive health, affecting menstrual cycles, menstrual hygiene, and risks for unintended pregnancy and sexually transmitted infections. This narrative review will highlight common gynecologic conditions of adolescents, especially where diagnosis and management are distinct from adult women. It will also present preventive health strategies to improve reproductive health through vaccination, improved access to hygiene supplies and contraception.
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Affiliation(s)
- Eveline J Roos
- Department of Obstetrics and Gynecology, Tergooi, The Netherlands
| | | | - Charleen Cheung
- Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong
| | | | - Sonia R Grover
- Department of Gynecology, Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Vic., Australia
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Piskunowicz M, Back SJ, Darge K, Humphries PD, Jüngert J, Ključevšek D, Lorenz N, Mentzel HJ, Squires JH, Huang DY. Contrast-enhanced ultrasound of the small organs in children. Pediatr Radiol 2021; 51:2324-2339. [PMID: 33830288 PMCID: PMC8566395 DOI: 10.1007/s00247-021-05006-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/17/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
In pediatric and adult populations, intravenous contrast-enhanced ultrasound (CEUS) remains off-label for imaging of organs other than the liver and heart. This limited scope inhibits potential benefits of the new modality from a more widespread utilization. Yet, CEUS is potentially useful for imaging small organs such as the thyroid gland, lymph nodes, testes, ovaries and uterus, with all having locations and vasculature favorable for this type of examination. In the adult population, the utility of CEUS has been demonstrated in a growing number of studies for the evaluation of these small organs. The aim of this article is to present a review of pediatric CEUS of the thyroid gland, lymph nodes, testes, ovaries and uterus as well as to draw from the adult literature indications for possible applications in children.
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Affiliation(s)
- Maciej Piskunowicz
- Department of Radiology, Medical University of Gdansk, M. Sklodowskiej-Curie 3a Street, 80-210, Gdansk, Poland.
| | - Susan J. Back
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kassa Darge
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Paul D. Humphries
- grid.424537.30000 0004 5902 9895Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jörg Jüngert
- grid.5330.50000 0001 2107 3311Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Damjana Ključevšek
- grid.29524.380000 0004 0571 7705Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Norbert Lorenz
- grid.4488.00000 0001 2111 7257Children’s Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - Hans-Joachim Mentzel
- grid.275559.90000 0000 8517 6224Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Judy H. Squires
- grid.239553.b0000 0000 9753 0008Department of Radiology, University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Dean Y. Huang
- grid.46699.340000 0004 0391 9020Department of Radiology, King’s College Hospital, Denmark Hill, London, UK
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Yüksel D, Ayhan S, Korkmaz V, Çakır C, Kılıç Ç, Akgor U, Özgül N, Kılıç F, Ersak B, Esen S, Kuru O, Uncu D, Gökcü M, Özdal B, Gültekin M, Salman MC, Boran N, Toptaş T, Üreyen I, Taşcı T, Kimyon Cömert G, Türkmen O, Moraloğlu Tekin Ö, Engin Üstün Y, Turan T. Retrospective Analysis of Pure Ovarian Immature Teratoma in Patients Aged 15-39 Years: A Turkish Multicenter Study. J Adolesc Young Adult Oncol 2020; 10:697-702. [PMID: 33296263 DOI: 10.1089/jayao.2020.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To evaluate the clinicopathological characteristics and surgical outcomes in patients with pure ovarian immature teratomas (POITs). Materials and Methods: In this multicenter study, a retrospective review was made of the databases of six Gynecology Oncology Departments in Turkey to identify patients with POITs who had undergone surgery between 1993 and 2019. Results: Evaluation was made of 48 patients with a median age at diagnosis of 22.5 years (range, 15-37 years). In 40 (83%) patients, stage I was determined and in eight patients, an advanced stage (IIIB, IIIC, and IVB) was determined. Tumors were found to be grade I in 17 (35.4%) cases, grade II in 12 (25%), and grade III in 19 (39.6%). Fertility-sparing surgery was applied to 42 (87.5%) patients and radical surgery to 6 (12.5%). The median follow-up was 60 months (range, 3-246 months). Recurrence was seen in seven patients, all with grade III tumors. In the final pathological examination of recurrent tumors, mature teratoma was reported in five patients, and immature teratoma in one patient. Salvage surgery was not performed in one patient as the tumor was unresectable and so a regimen of bleomycin, etoposide, and cisplatin (BEP) was administered. Conclusion: POITs are rare tumors seen at a young age, and benign or malignant relapse can be seen in these tumors. In this cohort, the malignant recurrence rate was 4.1%, and the benign recurrence rate was 10.4%. All the recurrences were in grade III tumors. Benign recurrences can be treated with surgery alone and the malignant group should be treated with surgery followed by chemotherapy.
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Affiliation(s)
- Dilek Yüksel
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Sevgi Ayhan
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Vakkas Korkmaz
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Caner Çakır
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Çiğdem Kılıç
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Utku Akgor
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Özgül
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Kılıç
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Burak Ersak
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Selin Esen
- Division of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Oğuzhan Kuru
- Division of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Doğan Uncu
- Division of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Gökcü
- Division of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Bülent Özdal
- Division of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Murat Gültekin
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Coşkun Salman
- Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nurettin Boran
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Tayfun Toptaş
- Antalya Education and Research Hospital Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Işın Üreyen
- Antalya Education and Research Hospital Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Tolga Taşcı
- Division of Gynecologic Oncology, Faculty of Medicine Bahçeşehir University, Istanbul, Turkey
| | - Günsu Kimyon Cömert
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Osman Türkmen
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | | | - Yaprak Engin Üstün
- Division of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Taner Turan
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
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Estell D, Asanad K, Baker Z, Vasquez E. Mature Ovarian Cystic Teratoma Mimicking a Bladder Diverticulum in a 16-year-old Female. Urology 2020; 149:e56-e59. [PMID: 32916187 DOI: 10.1016/j.urology.2020.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 11/26/2022]
Abstract
A 16-year-old female was incidentally found to have an abnormal pelvic ultrasound while undergoing evaluation for mild scoliosis. A large, thick-walled, lobular, fluid-filled structure was found at midline in the pelvis that initially resembled bladder diverticula due to its anatomical position and sonographic appearance. Voiding cystourethrogram and computed tomography later revealed a large cystic mass originating from the right ovary. This report outlines a case of a mature cystic teratoma convincingly mimicking bladder anomaly on sonography.
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Affiliation(s)
- Danielle Estell
- University of Southern California, Keck School of Medicine, Los Angeles, CA.
| | - Kian Asanad
- Children's Hospital of Los Angeles, Division of Pediatric Urology, Los Angeles, CA
| | - Zoe Baker
- Children's Hospital of Los Angeles, Division of Pediatric Urology, Los Angeles, CA
| | - Evalynn Vasquez
- Children's Hospital of Los Angeles, Division of Pediatric Urology, Los Angeles, CA
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42
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Gaspari L, Paris F, Taourel P, Soyer-Gobillard MO, Kalfa N, Sultan C. Adolescent ovarian thecoma presenting as progressive hyperandrogenism: case report and review of the literature. Gynecol Endocrinol 2020; 36:839-842. [PMID: 32174224 DOI: 10.1080/09513590.2020.1739265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Hyperandrogenism is frequent and under investigated in adolescent girls. A 15-year-6-month-old French girl presented with oligomenorrhea and slowly progressing virilization 2 years post-menarche. Medical history revealed prenatal pesticide exposure through maternal professional activity and recurrent premature thelarche. Severe hirsutism, mild facial acne and clitoromegaly were noted. Serum androgens (testosterone: 94 ng/dL, 4-androstenedione: 8.23 ng/mL) were high and non-classic 21-hydroxylase deficiency was excluded. Pelvic ultrasonography showed a left ovarian mass, confirmed by computed tomography scan. Tumor markers were negative. Laparoscopic surgery was performed. The pathological diagnosis was benign luteinized thecoma. Postoperatively, the menstrual cycle and serum androgens became normal and hirsutism slowly improved. Hyperandrogenism 2 years after menarche should be systematically investigated, even if slowly progressive, since it may be a symptom of a rare virilizing ovarian tumor, like thecoma.
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Affiliation(s)
- Laura Gaspari
- Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital A.-de-Villeneuve, CHU Montpellier et Université Montpellier, Montpellier, France
| | - Françoise Paris
- Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital A.-de-Villeneuve, CHU Montpellier et Université Montpellier, Montpellier, France
| | - Patrice Taourel
- Département d'Imagerie, Hôpital Lapeyronie, CHU Montpellier et Université Montpellier, Montpellier, France
| | | | - Nicolas Kalfa
- Département de Chirurgie Pédiatrique, Hôpital Lapeyronie, CHU Montpellier et Université Montpellier, Montpellier, France
| | - Charles Sultan
- Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital A.-de-Villeneuve, CHU Montpellier et Université Montpellier, Montpellier, France
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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
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Zhao S, Sun F, Bao L, Chu C, Li H, Yin Q, Guan W, Wang D. Pure dysgerminoma of the ovary: CT and MRI features with pathological correlation in 13 tumors. J Ovarian Res 2020; 13:71. [PMID: 32552845 PMCID: PMC7301981 DOI: 10.1186/s13048-020-00674-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/08/2020] [Indexed: 12/22/2022] Open
Abstract
Background To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary. Methods CT and MRI imaging of 12 patients with 13 histologically proven dysgerminomas of the ovary were retrospectively reviewed. Patients, ages ranged from 6 ~ 27 years (mean, 17.2 years). Two observers evaluated the following CT and MRI features of the tumor by consensus: (i) location, shape, and size; (ii) attenuation, T2 signal intensity, and ADC value; (iii) patterns of contrast enhancement; (iv) presence of fibrovascular septa; (v) presence of necrosis, hemorrhage, and calcification; (vi) presence of “ovarian vascular pedicle” sign. We also noted the extent or stage of the tumors. Results 75% lesions arised in the right ovary. Bilateral ovaries were involved in one case. Tumors displayed as a purely or predominantly solid mass (mean size, 17.0 ± 7.8 cm). Ten tumors were shaped multilobulated. The mean ADC value of lesions was 0.830 ± 0.154 × 10− 3 mm2/s. Characteristic fibrovascular septa were observed in all lesions. Among them, classic septa were present in 69% lesions. They were thin, hypointense on T2WI with a linear intense enhancement indicating the blood vessels in septa. Due to the stromal edema, fibrovascular septa may become thick even amorphous in shape, hyperintense on T2WI and even low attenuation on CT with a slight enhancement except for a bright blood vessel on the edge. Massive necrosis was observed only in one lesion. Calcification was present in 3 of the 5 tumors on CT. “Ovarian vascular pedicle” sign was present in 12 lesions. Lymphadenopathy, retroperitoneal spread, and distant metastases combined with an implantation in Douglas’ cul-de-sac were present in one patient respectively. Conclusion On CT and MR images, ovarian dysgerminoma often appears as a large solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging which then can guide the radiologists to make an accurate diagnosis. Calcifications often occur in the tumor. Nonspecific low ADC value and “ovarian vascular pedicle” sign may narrow the differential diagnosis.
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Affiliation(s)
- Shuhui Zhao
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Fan Sun
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lei Bao
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Caiting Chu
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Haiming Li
- Department of Radiology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, China
| | - Qiufeng Yin
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Wenbin Guan
- Department of Pathology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Takayasu H, Masumoto K, Tanaka N, Aiyoshi T, Sasaki T, Ono K, Chiba F, Urita Y, Shinkai T. A clinical review of ovarian tumors in children and adolescents. Pediatr Surg Int 2020; 36:701-709. [PMID: 32346848 DOI: 10.1007/s00383-020-04660-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the features which predict torsion and the pre-operative indicators of malignancy in cases of ovarian torsion in ovarian tumors (OTs) in children. METHODS The medical records of 35 pediatric patients who underwent surgery for OT, except for neonate cases, from 1997 to 2018 at our institution were reviewed retrospectively. RESULTS The pathological diagnosis was mature teratoma in 17, immature teratoma in 9, yolk sac tumor in 3, and others in 6. The preoperative diagnosis, which was made based on the imaging findings and the serum tumor marker values, matched with the pathological diagnosis in 29/35 (83%). Ovarian torsion occurred in 14/35 (40%). All but one case that presented with torsion had intermittent abdominal pain as the primary symptom. The preoperative white blood cell count was significantly higher in cases where ovary preservation was impossible than where it was possible (p = 0.01) among the cases presenting with torsion. CONCLUSION Preoperative imaging findings and the serum tumor marker values enabled us to make an accurate preoperative diagnosis. Patients with intermittent abdominal primary symptoms were more likely to have ovarian torsion than those without such symptoms, and leukocytosis may indicate irreversible ischemic changes in the affected ovary.
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Affiliation(s)
- Hajime Takayasu
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nao Tanaka
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsubasa Aiyoshi
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takato Sasaki
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kentaro Ono
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumiko Chiba
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuhisa Urita
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toko Shinkai
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
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Hanafy AK, Mujtaba B, Yedururi S, Jensen CT, Sanchez R, Austin MT, Morani AC. Imaging in pediatric ovarian tumors. Abdom Radiol (NY) 2020; 45:520-536. [PMID: 31745573 DOI: 10.1007/s00261-019-02316-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The spectrum of ovarian tumors in the pediatric population differs significantly from that in adults. Germ cell tumors are the predominant class of ovarian tumors in children, whereas epithelial tumors are the most common in adults. Ultrasonography is the modality of choice for the initial evaluation of pediatric ovarian tumors. Determining the diagnosis based on imaging may prove difficult, and combining the imaging findings with the clinical scenario is very helpful in reaching a differential diagnosis during clinical practice. We will discuss the spectrum of ovarian neoplasms in the pediatric population and describe their clinical, pathologic, and imaging characteristics. A few unique entities related to ovarian tumors, such as growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and hereditary ovarian tumor syndromes, are also discussed. In addition, we will review several entities that may mimic ovarian neoplasms as well as their distinct imaging features.
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Affiliation(s)
- Abdelrahman K Hanafy
- Diagnostic Radiology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, 78229, USA
| | - Bilal Mujtaba
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Sireesha Yedururi
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Corey T Jensen
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ramon Sanchez
- Radiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Mary T Austin
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ajaykumar C Morani
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
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47
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Pelizzo G, Nakib G, Calcaterra V. Pediatric and adolescent gynecology: Treatment perspectives in minimally invasive surgery. Pediatr Rep 2019; 11:8029. [PMID: 31871603 PMCID: PMC6908954 DOI: 10.4081/pr.2019.8029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/05/2019] [Indexed: 12/01/2022] Open
Abstract
Minimally invasive surgery (MIS) is widely utilized across multiple surgical disciplines, including gynecology. To date, laparoscopy is considered a common surgical modality in children and adolescents to treat gynecological conditions. Robotic surgical devices were developed to circumvent the limitations of laparoscopy and have expanded the surgical armamentarium with better magnification, dexterity enhanced articulating instruments with 5-7 degrees of freedom, and ability to scale motion thus eliminating physiologic tremor. There are well-documented advantages of MIS over laparotomy, including decreased post-operative pain, shorter recovery times, and better cosmetic results. Indications for MIS in pediatric gynecology are reported in this review and technical considerations are described to highlight new treatment perspectives in children and adolescents, which have already been described in the literature regarding adult patients.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital, ARNASCivico-Di Cristina-Benfratelli, Palermo, Italy
| | - Ghassan Nakib
- Department of Pediatric Surgery, Mediclinic Middle East, Mediclinic City Hospital Dubai, UAE
| | - Valeria Calcaterra
- Pediatric Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Italy
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van Heerden J, Tjalma W. The multidisciplinary approach to ovarian tumours in children and adolescents. Eur J Obstet Gynecol Reprod Biol 2019; 243:103-110. [DOI: 10.1016/j.ejogrb.2019.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/02/2019] [Accepted: 10/17/2019] [Indexed: 01/30/2023]
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van Nimwegen LWE, Mavinkurve-Groothuis AMC, de Krijger RR, Hulsker CCC, Goverde AJ, Zsiros J, Littooij AS. MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review. Eur Radiol 2019; 30:1166-1181. [PMID: 31529256 PMCID: PMC6957553 DOI: 10.1007/s00330-019-06420-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/03/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The use of magnetic resonance (MR) imaging in differentiation between benign and malignant adnexal masses in children and adolescents might be of great value in the diagnostic workup of sonographically indeterminate masses, since preserving fertility is of particular importance in this population. This systematic review evaluates the diagnostic value of MR imaging in children with an ovarian mass. METHODS The review was made according to the PRISMA Statement. PubMed and EMBASE were systematically searched for studies on the use of MR imaging in differential diagnosis of ovarian masses in both adult women and children from 2008 to 2018. RESULTS Sixteen paediatric and 18 adult studies were included. In the included studies, MR imaging has shown good diagnostic performance in differentiating between benign and malignant ovarian masses. MR imaging techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to further improve the diagnostic performance. CONCLUSION The addition of DWI with apparent diffusion coefficient (ADC) values measured in enhancing components of solid lesions and DCE imaging may further increase the good diagnostic performance of MR imaging in the pre-operative differentiation between benign and malignant ovarian masses by increasing specificity. Prospective age-specific studies are needed to confirm the high diagnostic performance of MR imaging in children and adolescents with a sonographically indeterminate ovarian mass. KEY POINTS • MR imaging, based on several morphological features, is of good diagnostic performance in differentiating between benign and malignant ovarian masses. Sensitivity and specificity varied between 84.8 to 100% and 20.0 to 98.4%, respectively. • MR imaging techniques like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to improve the diagnostic performance. • Specific studies in children and adolescents with ovarian masses are required to confirm the suggested increased diagnostic performance of DWI and DCE in this population.
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Affiliation(s)
- Lotte W E van Nimwegen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | | | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline C C Hulsker
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - Angelique J Goverde
- Department of Reproductive Medicine and Gynaecology, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - Annemieke S Littooij
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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50
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Caprio MG, Di Serafino M, De Feo A, Guerriero E, Perillo T, Barbuto L, Vezzali N, Rossi E, Ferro F, Vallone G, Orazi C. Ultrasonographic and multimodal imaging of pediatric genital female diseases. J Ultrasound 2019; 22:273-289. [PMID: 30778893 PMCID: PMC6704207 DOI: 10.1007/s40477-019-00358-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Abstract
Ultrasonography is the first-line imaging modality in the evaluation of the female pelvis in childhood and adolescence, because it is easy to perform, non-invasive and it does not require sedation. The transabdominal approach is preferred in children and adolescents, after filling the bladder to move away the bowel loops from the pelvis. The probe frequency must be adapted to age, thickness of tissues and depth of the structures under examination. High-frequency (4-12 MHz) linear or convex probes are used in newborns; high-frequency linear probes (4-12 MHz) in toddler, convex 5-7.5 MHz probes in girls and convex 3.5-5 MHz probes in teenagers. In this article, the main pathological conditions of the genital female tract in pediatric age are examined, such as congenital anomalies, disorders of sex development, ovarian cysts, ovarian tumors, adnexal torsion, primary amenorrhea, precocious puberty and pelvic inflammatory disease.
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Affiliation(s)
- Maria Grazia Caprio
- Institute of Biostructure and Bioimaging National Research Council, Via Tommaso De Amicis, 95, 80145 Naples, Italy
| | | | - Alessia De Feo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Elvira Guerriero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Barbuto
- Radiology Department, Umberto I Hospital, Nocera Inferiore, Salerno Italy
| | - Norberto Vezzali
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Eugenio Rossi
- Radiology Department, “Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Federica Ferro
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Gianfranco Vallone
- Paediatric Radiology Department, “Federico II” University Hospital, Naples, Italy
| | - Cinzia Orazi
- Department of Imaging, Bambino Gesù Children’s Hospital Research Institute, P.za S.Onofrio 4, Via Torre di Palidoro, Palidoro, Rome, Italy
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