Original StudyOvarian Tumors in Children and Adolescents—A Clinical Study of 52 Patients in a University Hospital
Introduction
Ovarian tumors are uncommon lesions in children and adolescents.1, 2 The actual incidence of ovarian lesions in young girls is unknown. An approximate incidence has been estimated as 2.6 cases annually/100,000 girls, and malignant ovarian tumors comprise about 1% of all childhood cancers.1, 3 Benign and functional cysts (follicular, corpus luteum, and theca lutein cysts) are the most common ovarian lesions in childhood and adolescence. The majority of the ovarian tumors diagnosed in girls from birth to 19 years are of non-epithelial origin.4 Ovarian tumors may present with acute abdominal pain or referred with a large pelvic or abdominal mass and concerns of malignancy. Although benign neoplasms greatly outnumber malignant ones in this age group and their clinical symptoms and signs are nonspecific, it is critical to determine the possibility of malignancy at an early stage by currently available multimodal diagnostic methods. After a complete diagnostic work-up, it is possible to decide optional management plan for the patient. Historically, all ovarian masses discovered in infants, children and adolescents were removed surgically. However, the identification of tumor markers and advances in radiological imaging allow a more conservative approach to the management of these neoplasms, with ovarian preservation as the standard, except in cases of cancer. Operative procedures involving the ovary in young patients can result in compromise of future fertility, due either to removal of the ovary or to formation of adhesions. Laparoscopic approaches are used to adequately assess and resect ovarian tumors that are benign.5, 6 However, the use of laparoscopy or minimally invasive techniques remains controversial in children with ovarian tumors.7
This retrospective study reviews the clinical practice and outcome of the operative treatment of ovarian tumors in girls and adolescents in the authors’ hospital department during the past 25 years.
Section snippets
Materials and Methods
The patients in the study included all girls between 6 and 20 years of age referred from the peripheral hospital and clinics for confirmation and management of an ovarian mass, to the department of Ob/Gyn, King Fahad Hospital of the University, Al-Khobar between January, 1985 and December, 2009. This hospital is a tertiary referral center for the whole Eastern Province of Saudi Arabia. Data collected retrospectively from the hospital medical records included age at the time of surgery,
Results
In the 25-year study period, 52 patients were operated upon for ovarian tumors at our hospital. Functional cysts were excluded from the study. The mean age of the patients at presentation was 14.2 years (range, 6–20 years). The most common presenting complaint was abdominal pain in 30 (58%) patients, abdominal swelling 18 (35%) and menstrual disorders 4 (8%) patients. There was no statistically significant difference in the age and presenting symptoms between patients with benign and malignant
Discussion
Ovarian tumors generally have been considered rare in children and adolescents,1, 2, 3 as a result operation for these lesions are uncommon. As a group, these lesions maybe cystic, solid, or both and range over a wide spectrum of pathology from non-neoplastic, benign up to highly aggressive malignant tumors. Approximately one third of all childhood ovarian neoplasms are reported to be malignant. The vast majority of ovarian masses encountered in children and adolescents were non-neoplastic.8, 9
Conclusion
The majority of ovarian tumors in young girls are benign. Nonetheless, it is important for an early diagnosis to be established in order to reduce the risk of ovarian torsion with possible loss of the ovary and to improve the prognosis in patients with malignant tumors.
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Recurrence Rates for Pediatric Benign Ovarian Neoplasms
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