Differenzialdiagnose von Ovarialtumoren in der Adoleszenz

Abstract

Introduction: Ovarian tumors diagnosed during puberty and adolescence mostly represent benign or functional tumors. Approximately 60% of ovarian neoplasias arise from germ cells and only 3 to 5% are malignant. Depending on the histopathological diagnosis of ovarian tumors treatment decisions have to include oncology, endocrinology and fertility related aspects and the individual situation of the young female patients. Patients and Methods: Between 2002 and 2003 four adolescent women (12 - 19 years) were treated because of symptomatic pelvic masses. Following clinical, physical and gynecological investigations imaging (ultrasonography, MRT) and laboratory analyses were indicated. Finally surgical exploration and therapy were performed leading to histopathological diagnosis. Results: Mucinous cystadenoma of the ovary was found in 3 cases. In one case a bilateral mixed germ cell tumor was diagnosed. Because of the absence of normal ovarian tissue due to extensive expansion of the benign tumors a unilateral ovarectomy was performed. The patient with the malignant mixed germ cell tumor and intraabdominal metastasis was treated with radical surgery followed by chemotherapy. The follow-up for 18 months showed complete remission. Conclusion: The incidence of ovarian tumors during puberty and adolescence is low. Often clinical symptoms are due to large tumor size, however malignancy of ovarian tumors is not predicted by tumor size. Therefore, surgical exploration only will lead to histopathological diagnosis allowing the most suitable and best therapy. Benign one-sided ovarian tumors favor preservation of the uterus and second ovary and subsequently fertility, and the tumor-bearing ovary is not always lost due to tumor size. Malignant disorders of the ovary require radical surgery followed by chemotherapy in that age group as well as in the elderly.