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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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Littrell LA, Inwards CY, Hazard FK, Wenger DE. Juvenile granulosa cell tumor associated with Ollier disease. Skeletal Radiol 2023; 52:605-612. [PMID: 35296906 DOI: 10.1007/s00256-022-04033-5] [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: 09/07/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/02/2023]
Abstract
Prior case reports have described synchronous ovarian juvenile granulosa cell tumor (JGCT) and enchondromatosis in patients with Ollier disease and Maffucci syndrome. We present a case of a juvenile granulosa cell tumor with an IDH1 somatic mutation identified in the ovarian tissue in a 15-year-old female who presented with abnormal vaginal bleeding, several months of irregular menses, and a large multicystic adnexal mass. Multiple mixed lytic and sclerotic lesions were identified in the bones of the pelvis on imaging studies obtained during the work-up of her abdominal mass. Like previous reports in patients with undiagnosed enchondromatosis, these lesions were presumed to represent skeletal metastases; however, biopsy tissue revealed a hyaline cartilage neoplasm. Subspecialty review of the imaging findings revealed imaging features classic for Ollier disease involving the flat bones of the pelvis. It is important for radiologists to be familiar with the association between enchondromatosis and JGCT. When a female patient with enchondromatosis presents with a large, unilateral, mixed solid-cystic ovarian mass, the diagnosis of JGCT can be suggested. Alternatively, when a patient is diagnosed with JGCT, any skeletal lesions should be scrutinized for imaging features that suggest a hyaline cartilage neoplasm to avoid the misdiagnosis of skeletal metastases in a patient with previously undiagnosed Ollier disease or Maffucci syndrome. To our knowledge, this is the second reported confirmed case of an IDH1 somatic mutation identified in the ovarian tissue of a JGCT in a patient with Ollier disease.
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Affiliation(s)
- Laurel A Littrell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Carrie Y Inwards
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Florette K Hazard
- Departments of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Kaneta K, Khalighi M, Borzutzky C, Bhatia P. Ollier Disease and a Case of Prolonged Menstrual Bleeding in an 11-Year-Old Girl: What's the Missing Link? Clin Pediatr (Phila) 2022; 61:727-731. [PMID: 35678070 DOI: 10.1177/00099228221101733] [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: 11/16/2022]
Affiliation(s)
- Kelli Kaneta
- Pediatric Residency Program, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Misha Khalighi
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Claudia Borzutzky
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Parul Bhatia
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA
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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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Abstract
Ovarian neoplasms are rare in children. Although usually asymptomatic, they sometimes present with abdominal pain, abdominal distension or palpable mass. The distribution of neoplasms in the pediatric population is different from in adults; benign mature cystic teratoma is the most common ovarian tumor in children. Radiologists should be familiar with the variable sonographic, CT and MRI findings of ovarian neoplasms. Although the less frequently encountered ovarian malignancies cannot be reliably distinguished by imaging alone, it does play an important role in workup. This review discusses the imaging and relevant clinical manifestations of the more commonly encountered pediatric ovarian neoplasms.
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Case series: Five pediatric germ cell/sex cord stroma tumors. Ann Med Surg (Lond) 2018; 37:11-20. [PMID: 30581564 PMCID: PMC6287085 DOI: 10.1016/j.amsu.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022] Open
Abstract
This report consists of five pediatric tumors of ovarian cell lineage. These unusual, interesting tumors challenge both surgeon and oncologist. Some appear malignant, seemingly require chemotherapy, but behave with benignity. Some are easily resected; others demand the utmost skill. Complexity perplexes; elucidation is by selection – ignoring some things, attending to others. Case studies illustrate – for good or ill – the process whereby clinical conundrums are resolved.
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Wang JP, Xu ZY, Bao ZQ, Dai XS, Ma L, Yao N, Wang ZP, Tao YS, Chai DM. Ollier disease: two case reports and a review of the literature. Am J Transl Res 2018; 10:3818-3826. [PMID: 30662632 PMCID: PMC6291712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/14/2018] [Indexed: 06/09/2023]
Abstract
Ollier disease is a rare tumor with unclear clinicopathological features and pathogenesis. We herein report two cases of Ollier disease in a 15-year-old boy and a 66-year-old man. We analyzed the clinicopathological, radiographical, and histochemical characteristics of Ollier disease in these two cases. Furthermore, we reviewed the literature to better understand the clinicopathological features of this disease. The boy had multiple enchondromas in the metaphysis and upper region of the left femur, and his left leg is short naturally. The 66-year-old man had multiple enchondromas in his left ribs and lower segment of the left femur. He was sent to the hospital because of pathological fracture of the ribs. In addition, he was diagnosed with gastric cancer 4 years before visiting an orthopedic clinic. Ollier disease is a rare bone disease that often renders a typical asymmetrical distribution and is confined to the appendicular skeleton. It is known as a benign bone tumor and has a high risk of malignant transformation into a chondrosarcoma (5%-50%). Correct diagnosis requires radiographic, histochemical, and morphological analyses. Better understanding of the clinical manifestations and pathological features can improve the diagnosis and prevent malignant transformation and deformity, especially in adolescent patient.
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Affiliation(s)
- Jing-Ping Wang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
| | - Zhou-Yi Xu
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
| | - Zheng-Qi Bao
- Department of Oncology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
| | - Xiu-Song Dai
- Department of Oncology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
| | - Li Ma
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
| | - Nan Yao
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
| | - Z Peter Wang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA
| | - Yi-Sheng Tao
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
| | - Da-Min Chai
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui, China
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