1
|
Stefanopol IA, Baroiu L, Chirila S, Miulescu M, Anghel L, Nechita L, Dinu CA, Stefanescu V, Bobeica C, Nechifor A, Tatu AL. The Influence of Living in Rural Areas on the Evolution and Management of Pediatric Ovarian Cystic Lesions: A Retrospective Study on a Cohort from South Eastern Romania. Int J Gen Med 2022; 15:5273-5284. [PMID: 35655655 PMCID: PMC9153997 DOI: 10.2147/ijgm.s368202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Department of Pediatric Surgery and Orthopedy, “Sf Ioan” Clinical Emergency Hospital for Children, Galati, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Infectious Diseases Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Correspondence: Liliana Baroiu, Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 47 Domnească Street, Galati, 800010, Romania, Tel +40723201241, Email
| | - Sergiu Chirila
- Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, Constanta, Romania
- Sergiu Chirila, Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, 1 University Alee, Campus B, Constanta, 900470, Romania, Tel +407213320668, Email
| | - Magdalena Miulescu
- Research Center in the Functional Cardiorespiratory and Neuromotor Exploration, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Lucreţia Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Internal Medicine Department, “sf Andrew the Apostle” County Emergency Clinical Hospital, Galati, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Ciprian Adrian Dinu
- Dental Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Victorita Stefanescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alin Laurenţiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, Reform-UDJ, Galati, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC DIR, Galati, Romania
| |
Collapse
|
2
|
Approaches to the management of pediatric ovarian masses in the 21st century: Systematic review and meta-analysis. J Pediatr Surg 2020; 55:357-368. [PMID: 31706611 DOI: 10.1016/j.jpedsurg.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/24/2019] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopy is increasingly being adopted for the treatment of ovarian pathologies in adults. However, its implementation for the management of pediatric ovarian masses varies and the evidence, to date, has not been comprehensively analyzed. This review aims to compare laparoscopic and open surgical management of pediatric ovarian masses. METHODS We searched PubMed, Cochrane Library and Google Scholar from the year 2000 till April 2017. Studies selected for this included those on epidemiological trends of pediatric ovarian lesions, assessing outcomes of laparoscopic management and comparison of laparoscopic and open surgical techniques for pediatric ovarian masses. A meta-analysis comparing outcomes of both modalities was performed using standard methodology. RESULTS A total of 44 studies met the inclusion criteria of which 15 were on histological types of ovarian lesions, 24 assessed laparoscopic management only and five compared laparoscopy with open surgery for pediatric ovarian masses. Nonneoplastic lesions were the most common ranging from 36.5% to 73.7%, with cystic lesions being the most prevalent. Neoplastic lesions ranged between 26.3% and 63.5%, with germ cell tumors being the most common, while malignancy ranged between 3.5% and 10.8%. Laparoscopic management was generally advocated for managing benign lesions with a cautious approach for suspicion of malignant lesions. In comparison to open surgery, laparoscopic surgery had shorter operating time (MD = -33.24 min, 95% CI = -34.29 to -32.19, p < 0.0001), less intraop bleeding (MD = - 61.46 ml, 95% CI = -62.69 to -60.24, p < 0.0001), and reduced length of hospital stay (MD = -2.78 days, 95% CI= -2.82 to -2.74, p<0.0001). Complication rates were equivocal between the two approaches. Spillage rates could not be assessed. CONCLUSION Limited evidence suggests that laparoscopic approach to presumptively benign ovarian masses have better outcomes when compared to open surgery with regards to operating time, blood loss and hospital stay. However, complication rates were similar between the two approaches. Studies with rigorous scientific methods are needed for a definitive recommendation, especially in resource limiting settings. However malignant lesions should still be managed with an open surgical approach to avoid upstaging of disease status. LEVEL OF EVIDENCE II.
Collapse
|
3
|
How JA, Marino JL, Grover SR, Heloury Y, Sullivan M, Mellor A, McNally O, Jayasinghe Y. Surgically Managed Ovarian Masses at the Royal Children's Hospital, Melbourne -19 Year Experience. J Pediatr Surg 2019; 54:1913-1920. [PMID: 31160084 DOI: 10.1016/j.jpedsurg.2019.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 04/07/2019] [Accepted: 05/11/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND/PURPOSE To describe the clinicopathological characteristics and management of surgically removed ovarian masses at the Royal Children's Hospital, Melbourne from 1993 to 2012. METHODS Medical records were reviewed retrospectively. Data regarding clinical findings, imaging and surgical management were evaluated. RESULTS There were 266 ovarian masses found in 258 surgeries (eight had bilateral masses). Most were benign (246/266, 92.5%), 2.3% (6/266) were borderline, and 5.3% (14/266) were malignant. The most common presenting symptom was abdominal pain for benign masses (169/246, 68.7%), and a palpable mass for borderline and malignant masses (12/20, 60.0%). Sensitivity and specificity of ultrasound for detection of malignancy was 64.7% and 52.9% respectively. Ovarian torsion occurred in 22.1% (n=57), none with malignancy, with seven cases diagnosed under one year of age. Sensitivity and specificity of ultrasound for ovarian torsion was 22.0% and 91.9%, respectively. The proportion undergoing ovarian cystectomy rather than oophorectomy has increased from 56.3% during 1993-1997 to 93.8% during 2008-2012 (p<0.005). Ovarian torsion was managed with ovarian conservation in 82.6% of cases between 2008-2012. CONCLUSION The majority of pediatric and adolescent ovarian masses were benign. Sensitivity of ultrasound was fair for detection of malignancy, and poor for ovarian torsion. Conservative surgeries are increasingly common. LEVEL OF EVIDENCE Level IV - case series with no comparison group TYPE OF STUDY: Retrospective Study.
Collapse
Affiliation(s)
- J A How
- Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia.
| | - J L Marino
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, Australia
| | - S R Grover
- Department of Pediatric & Adolescent Gynecology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Y Heloury
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Pediatric Surgery, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia
| | - M Sullivan
- Children's Cancer Centre, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia
| | - A Mellor
- Mater Adolescent and Young Adult Health Centre, Raymond Terrace, South Brisbane, Queensland, Australia
| | - O McNally
- Department of Gynecological Oncology, Royal Women's Hospital, Melbourne, 20 Flemington Road, Parkville, Victoria, Australia
| | - Y Jayasinghe
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, Australia; Department of Pediatric & Adolescent Gynecology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
| |
Collapse
|
4
|
Rathore R, Sharma S, Arora D. Spectrum of Childhood and Adolescent Ovarian Tumors in India: 25 Years Experience at a Single Institution. Open Access Maced J Med Sci 2016; 4:551-555. [PMID: 28028390 PMCID: PMC5175498 DOI: 10.3889/oamjms.2016.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Ovarian tumour in children and adolescent girls form an uncommon but important part of gynaecological malignancies. They account for 1% of all the childhood malignancies and 8% of all abdominal tumours in children. Since the ovarian cysts are thought to arise from mature follicles, these tumours were considered to be infrequent in the paediatric population. AIM: The rarity of this condition prompted us to conduct this study and share our experience on the incidence and clinicopathological features of different ovarian tumours in girls up to 20 years of age observed in last 25 years at a single tertiary care hospital. MATERIAL AND METHODS: This was a retrospective study conducted in the Department of Pathology at a tertiary hospital, Delhi. All ovarian tumours up to the age of 20 years in the past 25 years (1990-2014) were included for the purpose of studying the clinicopathological aspects of ovarian tumours in this age group. Descriptive statistics for prevalence and age-wise prevalence was done. Chi-square test, to find an association between the age, laterality and size with malignancy was performed. RESULTS: We received a total of 1102 cases of ovarian tumours over the period of 25 years (1990 to 2014), of which 112 (10%) cases were seen in girls up to 20 years of age. The mean age of the patients was 15.3 ± 4 years. The most common presenting complaint was pain abdomen (46.4 %) There was a statistically significant correlation found between size and malignancy status of tumours in our study (p = 0.00). Of 112 cases of ovarian tumours, 39/112 (34.8%) were malignant and 73/112 (65.2%) were benign. Mature cystic teratoma (27.6%) was the most common type of benign tumour in this age group and immature teratomas were the most common type of malignant ovarian neoplasms. CONCLUSION: Premenarchal girls with ovarian masses may have varied presentations. Abdominal pain is the most common presenting complaint of young adolescent girls with adnexal masses. So the index of suspicion should be kept high and prompt investigations like ultrasound must be performed early to rule out such adnexal masses. Immature Teratoma was the most common malignant and mature cystic teratoma was the most common benign tumour in our study.
Collapse
Affiliation(s)
- Ruchi Rathore
- Department of Pathology, NDMC Medical College and Hindu Rao Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences, Delhi University, New Delhi, India
| | - Deepshikha Arora
- Department of Pathology, University College of Medical Sciences, Delhi University, New Delhi, India
| |
Collapse
|
5
|
Mandiwa C, Shen LJ, Tian YH, Song LL, Xu GQ, Yang SY, Liang Y, Yuan J, Wang YJ. Parity and risk of ovarian cysts: Cross-sectional evidence from the Dongfeng-Tongji cohort study. ACTA ACUST UNITED AC 2016; 36:767-771. [PMID: 27752898 DOI: 10.1007/s11596-016-1659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/20/2016] [Indexed: 10/20/2022]
Abstract
Little is known about the association between parity and the risk of ovarian cysts. The aim of this study was to examine the association between parity and the risk of ovarian cysts among a population of Chinese women. A total of 20 502 women aged 45-86 years from the Dongfeng-Tongji Cohort study completed baseline questionnaires, medical examination and provided baseline blood samples. Participants were categorized into four groups according to parity (one, two, three, and four or more live births). Logistic regression models were used to investigate the association between parity and the risk of ovarian cysts. The prevalence of ovarian cysts in the study population was 4.0% (816/20 502). Increasing parity was associated with decreasing risk of ovarian cysts without adjustment for any covariates and after age-adjusted model (P<0.001). After adjusting for potential confounders, women who had had four or more live births had lower risk of ovarian cysts (OR: 0.51; 95% CI: 0.27-0.96) compared with women who had had one live birth. There was a consistent but non-significant decreased risk of ovarian cysts for women who had had two, and three live births (OR: 0.85; 95% CI: 0.68-1.05) and (OR: 0.84; 95% CI: 0.59-1.20) respectively compared with women who had had one live birth. It was concluded that higher parity was associated with decreasing risk of ovarian cysts in this population of Chinese women. These findings could be helpful in decision making in clinical practice for gynecologists when evaluating women suspected to have ovarian cysts.
Collapse
Affiliation(s)
- Chrispin Mandiwa
- MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China.,Ministry of Health, Lilongwe, 265, Malawi
| | - Li-Jun Shen
- MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China.,Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Yao-Hua Tian
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Lu-Lu Song
- MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China.,Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Gui-Qiang Xu
- MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China.,Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Si-Yi Yang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Yuan Liang
- Department of Social Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Jing Yuan
- MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - You-Jie Wang
- MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China. .,Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China.
| |
Collapse
|
6
|
Abstract
OBJECTIVE To evaluate the diagnosis and treatment decisions made in children and adolescents with an adnexal mass. METHODS This was a retrospective cohort study among patients younger than age 18 years who were diagnosed with or treated for an adnexal mass at the Radboud University Medical Center, Nijmegen, the Netherlands, between January 1999 and October 2013. Age, signs and symptoms, laboratory results, imaging data, type of surgery including surgeon specialty, and histologic diagnosis were analyzed. Published criteria for characterizing a mass as benign (Papic et al) were applied to the present data set. RESULTS One hundred eleven patients were included. The mean age of the patients was 10.2±5.6 years, ranging between 0 and 17 years. Ovarian masses were malignant in 28 patients (25.2%). Surgical therapy was applied in 83.1% of the benign masses and in 100% of the malignant masses. Oophorectomy was performed in 46.4% of the benign masses. The presence of a gynecologist was the only factor that significantly lowered the chance of oophorectomy in benign masses (odds ratio 0.14, 95% confidence interval 0.04-0.47). Papic et al's model had a sensitivity of 40.91% and a specificity of 100%. CONCLUSION The malignancy rate among patients with adnexal masses in our cohort was one in four patients. Most patients with an adnexal mass were treated surgically, and oophorectomy was performed in almost half of the benign masses. The presence of a gynecologic surgeon protected against oophorectomy in benign cases. LEVEL OF EVIDENCE II.
Collapse
|