57. Pediatric and Adolescent Gynecologic Pathology, Manitoban Experience – an 11-year Audit of Gynecologic Surgical Procedures and Diagnoses at Health Sciences Centre, Winnipeg, Manitoba, Canada

Abstract

<h3>Background</h3> The gynecologic pathology indicating surgical management in the pediatric and adolescent population is diverse and involves both internal and external genitalia. As these procedures typically do not account for a large proportion of the surgery burden at any single institution, limited if any, literature characterizes the volume of procedures or the continuum of surgical gynecologic pathology. Therefore, the objective of this study was to determine the frequency and variety of gynecologic surgical procedures and pathological diagnoses in the pediatric population at a single centre site. <h3>Methods</h3> This was a retrospective chart review of patients ≤18 years of age who had gynecologic surgical specimens submitted for histopathological investigation to Health Sciences Centre, the largest tertiary care centre in the catchment area, between March 2007 and October 2018. A query of gynecologic keywords "cervix, fallopian tube, ovary, uterus, cervix, vagina, vulva, labia, hymen," in the Department of Pathology's laboratory information system was performed to locate patients. Electronic surgical pathology reports were retrospectively reviewed to extract demographic, surgical, and pathologic data. Data were described (n/N, %, mean ± standard deviation) using STATA software (StataCorp, Version 15.1, College Station, TX, USA). Research protocol was approved by the University of Manitoba's Health Research Ethics Board [(H2019:153)]. <h3>Results</h3> In total, 369 patients with a mean age of 14.9 ±3.2 (range 0-18) years were identified as having underwent surgical procedures during the 11.5-year study period. Of these, 90.2% of patients were from Manitoba and 8.4% were identified as being from out of province. 348 (94.3%) of patients had procedures at Winnipeg sites. Procedures addressed pathology in both internal and external genitalia, but most commonly involved the adnexa, including 45.4% (109/240) who had surgery for suspected adnexal pathology and underwent oophorectomies. Pathological diagnoses included 45.5% (168/369) benign neoplastic, 28.5% (105/369) non-neoplastic, 16.5% (61/369) developmental, 5.14% (19/369) pre-malignant, and 3.52% (13/369) malignant (12 were ovarian in origin, and 1 was a synovial sarcoma of the vulva). <h3>Conclusions</h3> Pediatric surgical gynecology represents a niche but diverse area of practise. In Manitoba, the majority of these procedures were performed by gynecologists at the largest tertiary care centre in the province. This study represents a broad overview of the frequencies and variety of gynecologic surgical procedures and pathological specimens of girls in Manitoba. Future research efforts should explore the subtleties of each anatomic site in terms of pathology, procedures, and patient outcomes.