Treatment of Ovarian Lesions in Children and Adolescents: A Retrospective Study of 130 Cases

Abstract

In this study, we analyze the management of ovarian masses in a total of 130 children surgically treated for 137 ovarian lesions (7 bilateral). The most frequent symptoms were chronic (52.3%) and acute (25.4%) abdominal pain. Histological examination revealed 64 (46.7%) functional lesions, 59 (43.1%) benign neoplasms, 5 (3.7%) malignant ones, and 7 (6.6%) torsed normal ovaries. Ovarian torsion occurred in 36 cases (26.27%). A conservative treatment was performed in 81 (59.1%) girls: 61 (75.3%) treated in nonemergency and 20 (24.7%) in emergency surgery; laparoscopic approach in 35 cases (43.2%); and open surgery in 46 (56.8%). The remaining 56 (40.9%) ovarian masses underwent nonconservative surgery: 40 cases (71.4%) nonemergency and 16 (28.6%) emergency; laparoscopy in 20 patients (35.7%); and open surgery in 36 (64.3%). Fertility preservation should be a goal in the surgical treatment. The management of ovarian torsion should include adnexal detorsion and recovery of the ovarian tissue. In case of benign neoplasms, laparoscopic tumorectomy should be the gold standard; in early stage malignant tumors, fertility-sparing surgery with accurate staging is preferred.

Laparoscopic approach to ovarian masses

“…Özellikle, AFP ve B-HCG çocukluk çağı over tümörlerinin tanı ve postoperatif takibinde önemli iki belirteçdir (4,16,17,20,21) . …”

“…Matür teratomlarda da eksizyon yeterliyken, immatür teratomlarda ooferektomi yapılmalıdır (Resim 7). Bu nedenle preoperatif AFP, B-HCG, LDH gibi tümör markerlarının, hormon salgılayan tümörleri ekarte edebilmek için de Makroskopik rezidü veya yalnızca biyopsi, lenf bezinde tümör tutulumu (>2 cm) var, komşu organlara (omentum, barsaklar, mesane) yayılım, karın içi yıkama sıvısında tü-mör hücresi var, tümör belirteçleri normal veya yüksek Uzak organlara yayılım östrojen, progesteron gibi hormon düzeylerinin bilinmesi son derece önemlidir (20,21,35) .…”

Ovarian masses in infant-juvenile age

“…The surgeon have to choose two routes: emergencey surgey for patients with acute abdominal pain and with a mass associated complications(torsion, rupture, hemorrages) and elective surgery for endocrine disturbance, ovarian cysts and mass without abdominal pain. 2,3 Ovarian surgery in childhood can result in compromised future fertility, either from the removal of normal ovarian tissue or from adhesion formation. Therefore, preservation of ovarian tissue as well as minimization of adhesion formation should be surgical goals.…”

Tumores ováricos en niñas y adolescentes

“…El cirujano debía elegir una de dos opciones: cirugía de urgencia para pacientes con dolor abdominal agudo y con complicaciones asociadas con el tumor (torsión, ruptura, hemorragias), y cirugía programada para trastornos endocrinos, quistes ováricos y tumores sin dolor abdominal. 2,3 La cirugía de ovarios en la niñez puede poner en riesgo la futura fertilidad, ya sea por la extracción de tejido ovárico normal o por la formación de adherencias. Por lo tanto, los objetivos quirúrgicos deben consistir en conservar el tejido ovárico y en reducir al mínimo la formación de adherencias.…”