Ovarian Tumors In Children Research Articles

Transumbilical 1-port laparoscopic resection of benign ovarian tumor

Background/PurposeWe evaluated the effectiveness of transumbilical 1-port laparoscopic resection of benign ovarian tumors in children with limited working space. MethodsThis study involved 15 children and adolescents with benign ovarian tumors treated from January 2006 to December 2010. Preoperative evaluation included physical findings, tumor markers, and imaging studies. A single surgeon performed the procedure using a 10-mm 0° operative laparoscope with a 5-mm working channel. The fallopian tube was suspended with transabdominal suspensory sutures passing through the mesosalpinx to expose the tumor and remove it after aspiration of the contents. The tumor was contained in the endobag and chopped into pieces before removal through the small umbilical wound. ResultsThe patients' age ranged from 2 to 17 years (mean, 9.7 years). Tumor size ranged from 3.6 to 23 cm. Tumor markers including α-fetoprotein, β-human chorionic gonadotropin, cancer antigen 125, and carcinoembryonic antigen were negative. The average operating time was 134 minutes. Except for 1 patient with associated encephalomyelitis, all patients were discharged within 3 days after surgery. Pathologic examination and follow-up studies revealed benign tumors, with no residual lesions in the abdomen or recurrence. ConclusionsTransumbilical 1-port laparoscopic resection is effective for resection of benign ovarian tumors in children, with a satisfactory cosmetic outcome. However, to prevent inadequate resection of a potential malignant lesion, thorough preoperative evaluation with physical signs, tumor markers, and imaging studies, as well as flexible intraoperative tactics, should be adopted.

Ovarian tumours in children : A review of 18 cases

To review the experience of Children's Hospital of Rabat in managing ovarian tumours in children. There were 18 patients between 2 and 15 years of age who presented with an ovarian tumour at Children's Hospital of Rabat between January 2000 and December 2008. Data collected from the hospital medical records included age at diagnosis, patient's history, presenting complaints, radiological examination, tumour markers, management, operative procedure, histopathological examination and outcome of the patients. The most common presenting complaint was abdominal pain in 10 (55%) patient. 77% of ovarian tumours were germ cell tumours; 71% of these were teratomas which were benign in 66% of cases. Unilateral salpingo-oophorectomy was the most common surgical procedure performed in 15 patients (83%) through laparotomy. Laparoscopic ovarian cystectomy was carried out in 2 (11%) patients with benign cystic teratoma. Of the 7 (39%) patients with malignant tumours, three received postoperative chemotherapy. Outcome was good in most cases. There were no cases of resistance to treatment, or death. Early diagnosis of ovarian tumours in children and adolescents is important. Since most of these tumours are benign, surgical treatment should be conservative to minimise the risk of subsequent infertility, while the treatment of malignant tumours should include complete staging, resection of the tumour, postoperative chemotherapy when indicated, to give the patient a chance for future childbearing.

Pediatric risk of malignancy index for preoperative evaluation of childhood ovarian tumors

This study aimed to develop and provisionally validate a novel scoring index for preoperative cancer-risk prediction in childhood ovarian tumors. Fifty-five girls aged 18 and below underwent surgery for ovarian masses between 2004 and 2009. Benign or non-benign histological diagnoses (the latter including all malignant and borderline tumors and tumors containing immature components) were correlated with clinical and biochemical parameters, and blinded scores of ultrasound and computed-tomography using multivariate logistic regression. Regression coefficients were used as weighting factors to create an additive index. This index was validated prospectively against 23 consecutive adnexal masses operated in 2010. In total, 67 tumors were benign and 11 non-benign. Non-benign diagnosis was independently associated with the maximum diameter of the largest solid component (score = value in cm), the presence of sex hormone-related symptoms (score = +6), and enhancement or flow in a septum or solid papillary projection (score = +4). The novel scoring index was calculated as the total score of these three parameters. A cutoff score of 7 gave a specificity of 97.9% and sensitivity of 87.5% for the training data set, and specificity and sensitivity of 100% for the pilot testing set. The novel pediatric risk-of-malignancy index is able to accurately discriminate between benign and non-benign ovarian tumors in children and adolescents. Its preoperative application may guide surgical management decisions before the availability of histological confirmation.

Fertility sparing surgery for ovarian tumors in children and young adults

To study the outcome of fertility conserving surgery for ovarian tumors in children and young adults (≤ 20 years) over 6 years (2003-2009). This prospective study included 183 patients diagnosed with ovarian cysts or tumors requiring surgical excision. Ovarian cystectomy/ovariectomy was carried out followed by frozen section histopathology. Malignant cases were subjected to staging laparotomy and fertility sparing surgery. The median age at diagnosis was 17 years (range 7-20 years). 160/183 (87.4%) were non-neoplastic ovarian cysts or benign tumors. In 131/160 (81.8%) of non-neoplastic and benign tumors, it was possible to preserve the affected ovary. Twenty cases (11%) were diagnosed as primary malignant ovarian tumors, 2/183 (1.1%) were borderline tumors and 1 case (0.55%) was metastatic colonic carcinoma. The median follow up of cases with primary malignant ovarian tumors was 36 months. During this period, two recurrences (9.1%) were detected, both of the germ cell type (immature teratoma and yolk sac tumor). Recurrent cases were managed by local excision and lymph node sampling followed by chemotherapy. Fertility sparing surgery for malignant ovarian tumors in children and young adults has excellent prognosis and should be attempted whenever possible.

Imaging of pediatric ovarian neoplasms

We review the clinical and imaging characteristics of the most common ovarian neoplasms in children and adolescents. Because of the widespread use of diagnostic imaging, incidental ovarian neoplasms might be encountered during the evaluation of abdominal pain, trauma or other indications and might pose a diagnostic dilemma. Conducting adequate imaging studies under these conditions is important, as management strategies differ according to the size and appearance of the lesion as well as the age of the patient. US dominates in gynecological imaging because of its excellent visualization, absence of ionizing radiation and sedation risks and comparatively low cost. For further examination of indeterminate lesions found using US, MRI is being used more progressively in this field, particularly for the evaluation of complex pelvic masses with the aim of distinguishing benign and malignant conditions and conditions requiring surgical intervention. CT is reserved primarily for tumor staging and follow-up and for emergency situations.

Pediatric Malignant Ovarian Tumors: 15 Years of Experience at a Single Institution

Malignant ovarian tumors in children are relatively rare. We reviewed our 15-year experience to understand their clinical presentations, managements, and prognoses. There were 15 children who were diagnosed to have malignant ovarian tumors from January 1994 to June 2009 in our hospital. The presenting symptoms, treatments, and outcomes were obtained retrospectively from the medical records. The median age at presentation was 13 years. The most common presenting symptom was abdominal pain, occurring in 10 patients (66.7%). The tumors were in the left side in 10 patients (66.7%). The pathologic diagnoses were yolk sac tumors in four patients, immature teratomas in four, dysgerminomas in three, malignant mixed germ cell tumors in three, and carcinosarcoma in one patient. According to the Federation Internationale de Gynecologie Oncologique classification, seven girls had Stage I, one had Stage II, and seven had Stage III disease. Thirteen patients received chemotherapy with platinum-based regimens. Three patients died of their disease: one of yolk sac tumor, one of malignant mixed germ cell tumor, and one of carcinosarcoma. They all had Stage III disease at diagnosis. The 10-year overall survival and disease-free survival rates were 77% and 69%, respectively. Pediatric malignant ovarian tumors were highly curable disease if they were not in the advanced stage at presentation. Earlier consideration of malignant ovarian tumor in the differential diagnosis of young girls with abdominal pain is important.

Ovarian Torsion Caused by Teratoma Masquerading as Perforated Appendicitis in a 5-Year-Old Girl

Ovarian torsion is a well-known but poorly recognized disease. Although ovarian torsion is the most common complication of ovarian tumors in children, it is an uncommon cause of abdominal pain in pediatric patients. Ovaries can be only salvaged by prompt diagnosis and timely surgical intervention. Acute ovarian torsion without appropriate treatment may result in loss of ovarian function, tissue necrosis, and death. The objective of this article is to present a case of pediatric ovarian torsion and describe the difficulty of distinguishing it from perforated appendicitis in the emergency department (ED). We report a 5-year-old girl who presented to the ED with nausea, tenderness over the right lower guardant of her abdomen, fever, and anorexia. She was initially diagnosed with appendicitis based on physical examination and abdominal computed tomography scan and was sent to the operating room for surgical exploration. The definite diagnosis of the patient was acute ovarian torsion complicated with cystic teratoma. Primary clinicians in the ED should pay more attention to acute ovarian torsion in young children because it is difficult to diagnose in time to salvage the gynecological function when the clinical presentations masquerade as perforated appendicitis.

Letters to the Editor

11 November 2009 Dear Editor, BENIGN OVARIAN TUMOUR PRESENTING AS HUGE ABDOMINAL MASS The annual incidence of ovarian neoplasms in the paediatric and adolescent population is estimated to be 2.6 cases per 100 000, with germ cell tumours being the most common ones.1 We presented a girl with a huge abdominal mass without any discomfort or pain. In this paper, we emphasised the diagnosis of serous cystadenoma in children who present with asymptomatic abdominal mass. A 12-year-old pre-menarchal girl presented with a history of increasing abdominal distension, without discomfort, pain or any other urinary and gastrointestinal symptoms (Fig. 1a). The patient's weight was 60 kg, and height was 163 cm. No pain or abdominal masses were noted upon examination. The other physical and systemic examinations were unremarkable. The first ultrasonographic examination of the abdomen was performed by a paediatrician in an effort to reveal the cause of frequent micturition, and a cyst of the left ovary was an incidental finding. Pelvic ultrasonographic examination revealed a large cystic mass (56 cm) arising from the left ovary, reaching to the level of the xiphoid. Magnetic resonance imaging showed a huge mass arising from the left ovary with no signs of organ invasion (Fig. 1b,c). Laboratory results including endocrinological tests (follicle-stimulating hormone (FSH)-immunochemiluminometric assays (ICMA) 25.08 mIU/mL, LH-ICMA 5.06 mIU/mL, oestradiol 58 pg/mL), as well as thyroid-stimulating hormone [TSH] and T4, were normal for the age and pubertal stage of the patient. The ovarian tumour marker values (alfa feto protein [AFP], beta human chorionic gonadotropin [βHCG], carcinoembryonic antigen [CEA], cancer antigen-125 [CA125] and lactate dehydrogenase [LDH]) were also normal. The cyst was surgically removed with preservation of normal ovarian tissue, and histopathology revealed a serous cystadenoma. The huge cyst was unilocular, with a thin wall and clear content. Both of the ovaries were visible by pelvic magnetic resonance imaging, and their volumes were found within normal limits (Fig. 1d). The patient was followed up regularly, and there was no evidence of recurrence 30 months after surgery. (a) The patient with minimal abdominal distension at admission. (b,c) Magnetic resonance imaging demonstrated an enormous mass occupying almost the entire abdomen. (d) Cyst was surgically removed, with preservation of normal ovarian tissue. Although there are numerous classes of epithelial ovarian cancer in adults, the histological subtypes of epithelial ovarian tumours in children include only serous and mucinous tumours.2 Benign serous cystadenomas are rare benign neoplasms in the paediatric age group.3 Although this tumour is rare, this diagnosis should be considered in 11–15-year-old girls presenting with a huge abdominal mass. Malignant transformation is possible in 5–10% of cases, in particular, the adenomatose shapes that can induce transformation into adenocarcinoma.4 However, serous cyst tumour of the ovary in our patient occurred prior to menarche, and these tumours tend to present with abdominal distension. The FSH levels were measured by new ICMA. The normal ranges were calculated by age and Tanner stage (premenopausal: 5–30 IU/L). The patient was a pre-menarchal pubertal girl at Tanner stage 4. She exhibited an elevated basal FSH level; however, the menses had not started, and the mid-follicular oestradiol levels were normal. FSH serum levels were high during spontaneous puberty and slowly normalised thereafter in our patient. The differential diagnosis of ovarian masses in pre-menarchal girls includes cysts, torsion with subsequent oedema, benign or malignant ovarian neoplasm, and, rarely, involvement of the ovary by lymphoma, leukaemia, or metastatic disease.5 Ovarian causes of cysts in adolescents include follicular and corpus luteum cysts, haemorrhagic functional cysts, endometriomas, or benign and malignant neoplasms. Disorders of the fallopian tube such as hydrosalpinx, pyosalpinx, paratubal cyst or ectopic pregnancy can mimic an ovarian cyst. Peritoneal cysts or peri-appendiceal abscesses are occasionally mistaken as adnexal pathology.6 Patients with a serous cyst might present late, and this may lead to renal insufficiency secondary to urinary outflow obstruction. A mass may also be totally asymptomatic and revealed by ultrasonography incidentally. Benign cystadenomas are the most common cysts and are effectively treated by unilateral cystectomy.7 Conservative surgery is adequate for benign lesions and early-stage ovarian tumours of borderline malignancy. Early detection of adnexal masses and surgical techniques makes it possible to remove the tumour and preserve the underlying ovary and subsequent fertility. Surgical treatment of our case was successful, and the patient adjusted well to her post-operative body image.

Laparoscopic surgery of ovarian tumors in children: Report of 4 cases and literature review

In this study, we evaluated the feasibility and curative effects of laparoscopic surgery of ovarian benign tumors in children. The clinical data of four children with ovarian tumors who underwent laparoscopic surgery in the Second People’s Hospital of Shenzhen from January, 2008 to February, 2010 were retrospectively reviewed. Among these 4 children, laparoscopic ovarian cystectomy was performed in 3 cases and laparascopic ovarian adnexectomy in one case. Mean operation time was 61.25 ± 32.24 min, mean intraoperative loss of blood was 5 - 100 ml, and mean length of postoperative hospital stay was 3 - 5 days. No postoperative complications or tumor recurrence was observed within the follow-up periods from 6 - 24 months. Laparoscopic surgery is the preferred treatment for ovarian benign tumors in children due to its safety and effectiveness. Key words: Laparoscopic surgery, ovarian tumor, child.

Ovarian Tumors in Children and Adolescents—A Clinical Study of 52 Patients in a University Hospital

Study Objective To review the clinical presentation of ovarian tumors in children and adolescents treated at the University of Dammam and King Fahad University Hospital. Design Data of the patients was noted retrospectively from the hospital medical records regarding age, presentation, diagnosis, treatment, and outcome. Setting The study was carried out in the Ob/Gyn department at King Fahad Hospital of Dammam University, Saudi Arabia between January 1985 and December 2009. Participants There were 52 patients between 6 and 20 years of age who presented with an ovarian tumor during the study period. Intervention Preoperative diagnostic approach included history, physical examination, ultrasonography, radiological examination, tumor markers, operative treatment, and histopathological examination of the tumor. Chemotherapy was given to patients where indicated. Results The main presenting symptom was abdominal pain in 30 (58%) patients. Of the neoplastic tumors, 87% were germ cell tumors, of which 73% were benign while 13% were malignant. Operative procedures included 48 (92%) exploratory laparotomies and 4 (8%) laparoscopic resections. Ovarian cystectomy was done in 23 (44%) patients and salpingoophorectomy in 28 (54%) patients. Of the 7 (13%) patients with malignant tumors, five received postoperative chemotherapy. Three patients with malignancy died in the series. Conclusion Early diagnosis of ovarian masses in young girls is important. Since most of these masses are benign, operation should be designed to optimize future fertility, while the treatment of malignant tumors would involve complete staging, resection of the tumor, postoperative chemotherapy when indicated, to give the patient a chance for future childbearing.

A histopathological study of ovarian neoplasms in children in a tertiary hospital of northern Nigeria

Information concerning the frequency and pattern of ovarian tumours in children is scant, more so in northern Nigeria. In view of this, we reviewed ovarian biopsies obtained from children in Zaria over a 25-year period. Ovarian tumours occurring in 48 patients of age 15 years and below were reviewed and classified using the current World Health Organization (WHO) histological classification of ovarian tumours. Ovarian tumours in children accounted for 8.6% of all cases of tumours seen in all age groups over the period. Among all the malignant tumours seen in this period, 32% occurred in children, and Burkitt's lymphoma accounted for 31.2% of these. Germ cell tumours accounted for 58.0% while epithelial tumours had a frequency of 2.1%. Burkitt's lymphoma is the most common childhood ovarian tumour in Zaria, northern Nigeria.

Sclerosing Stromal Tumor: An Important Differential Diagnosis of Ovarian Neoplasms in Childhood and Adolescence

Sclerosing stromal tumors are an uncommon type of benign ovarian sex cord-stromal tumor. Histologically, they are characterized by a cellular pseudolobular pattern, composed of fibroblasts and round cells separated by densely collagenous or markedly edematous hypocellular tissue and prominent vascularity. Although the usual age of presentation is in the 2nd and 3rd decades, sclerosing stromal tumor can occur in adolescence or premenarchal girls. Clinical symptoms include premature menarche, menstrual irregularities, abdominal discomfort, and rarely, ascites. Imaging studies frequently reveal solid or complex cystic adnexal masses with marked vascularity raising concern for germ cell tumors and, especially in the absence of elevated tumor markers, surface epithelial neoplasms. The differential diagnosis of a benign sclerosing stromal tumor is seldom entertained. We present the clinicopathological findings in 4 adolescent patients, presenting with unilateral adnexal masses, in which the preoperative clinical suspicion for malignancy was very high. We stress the importance of being familiar with sclerosing stromal tumors when evaluating ovarian neoplasms in children and adolescents in order to contribute to the appropriate clinical management preventing extensive and unnecessary surgery, and preserving fertility.

Laparoscopic resection of benign ovarian tumours in children with gonadal preservation

Ovarian tumours are often regarded as an indication for open oophorectomy, especially following torsion. We wish to report our results of laparoscopic ovarian cystectomy with ovarian preservation. Retrospective review of clinical records of patients who where managed with laparoscopic ovarian cystectomy with ovarian preservation. Twelve records were identified over a 3-year period. The average age was 11.8 years (9-15). Presentation was of a mass in nine patients and torsion in three patients. Average size of the mass was 8.2 cm (5-18). Two patients had bilateral lesions. All patients were noted to have normal tumour markers. Successful cystectomy with ovarian preservation was accomplished in all cases using 3-port laparoscopy. The bilateral lesions were addressed at the same surgery with no increased length of stay or morbidity. In the three patients with acute torsion, an initial laparoscopic detorsion was performed with delayed laparoscopic cystectomy and ovarian preservation 7-10 days later. There was one complication of a minor umbilical port site infection. Histology was of a mature teratoma in ten cases and simple cyst in two. Six patients underwent routine ultrasonographic follow-up at 2-5 months at which time the involved ovary assumed a size and shape and blood flow comparable to the contra-lateral ovary in five patients. In one patient the affected side was smaller, 8.6 ml compared to 10 ml on the contra-lateral ovary. The remaining patients have been followed up clinically and remain asymptomatic. Laparoscopic cystectomy with ovarian preservation can be successfully applied to benign ovarian tumours. Acute ovarian torsion is not a contraindication to this technique where a two stage procedure still enables us to offer ovarian preservation.

A 9-Year Review Of Ovarian Masses in Children and Adolescents

Objective: This retrospective study was planned to determine the distribution and treatment of various types of ovarian tumors in children and adolescents under 16 years of age presenting with ovar...

Torsion of Malignant Ovarian Tumors in Childhood and Adolescence

To investigate the frequency of torsion of malignant ovarian tumors in children and adolescents. We evaluated all patients treated for adnexal torsion in a tertiary care referral pediatric institution during the last 20 years. Presentation, tumor markers and pathology reports were evaluated. We reviewed the literature on torsion of malignant ovarian tumors. Ninety-two girls (age 6 months to 19 years), 41 of them premenarchal, were surgically treated for adnexal torsion. Symptoms and signs that led to clinical investigation and subsequent surgery were not specific. Histological findings of torsioned masses showed 69 non-neoplasms and 23 tumors, including five malignant. Origin of the malignant disease included four germ cell tumors and one sex-cord stromal tumor. The morphology index score for malignant tumors was > or = 7 in all five patients. Tumor markers were elevated in 12 patients, including four of the patients with malignant tumors. Complete staging was performed in three adolescents with stage Ia, IIa and IIIa of disease. We found tumor origin for 11 previous reported patients with torsion of malignant ovarian tumor, including seven germ cell and four granulosa cell tumors. Torsion of malignant ovarian tumors in pediatric and adolescent patients occurs very rarely, but it is nevertheless possible at any stage of disease. The most common torsioned malignant ovarian tumors were of germ cell origin, in both premenarchal and postmenarchal girls. A torsioned adnexal mass with index > or = 7 needs to be considered as a potential malignant tumor.

Juvenile Granulosa Cell Tumour (JGCT) of the Ovary in a 6-Year-Old Girl: Laparoscopic Resection Achieves Long-Term Oncological Success

Juvenile granulosa cell tumours (JGCT) represent a rare malignancy in childhood and their laparoscopic resection has not been advocated yet. We report on a 6-year-old girl with signs of precocious pseudo-puberty and an abdominal tumour. Work-up revealed premature thelarche, vaginal discharge, elevated estrogen levels, and a solid tumour in the lower pelvis (6 x 4 x 3 cm in MRI). The girl underwent laparoscopy (3 ports, 5-mm instruments), during which a non-invasive, mobile tumour of the left ovary was found. Since all margins of resection could be clearly identified, salpingo-oophrectomy was performed, using the harmonic scalpel for dissection and 5-mm clips to ligate the fallopian tube. Histopathology revealed a JGCT with an intact capsule (FIGO 1 a) which required no further chemotherapy. Within 3 months postoperatively the girl's signs of precocious puberty had resolved and at present, after a follow-up of more than 3 years, there is no evidence of tumour recurrence. Minimally invasive surgery of solid ovarian tumours in children remains controversial. However in the present case, laparoscopic resection did not compromise the surgical and oncological safety.

Pseudo-puberté précoce isosexuelle révélant une tumeur de la granulosa juvénile chez une petite fille de six ans

Juvenile granulosa cell tumors of the ovary are a rare form of neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. About 90% are diagnosed in stage I (FIGO) with a favorable prognosis, whereas those at higher stages have a less favorable outcome. The authors describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 6-year old child. Clinically, an endocrine syndrome was associated with a pelvic mass. Hyperoestrogenia and serum alphafoetoprotein level were biologically detected. Tumor was localized strictly to the ovary, so conservative surgery was applied and proved sufficient to remove all tumor tissue. Histological examination showed typical microscopic aspect of a juvenile granulosa cell tumor. The patient is well 14 years after surgery with normal growth and mental development.

Laparoscopy for Giant Cystic Ovarian Tumors in Children

Objective: We describe our experience with the laparoscopic removal of giant cystic ovarian tumors in four pediatric patients. Methods: Patients with giant ovarian tumors removed laparoscopically between 1998 and 2002 were reviewed retrospectively. Results: Four girls between the ages of 14 and 17 years (average, 15.5) had giant cystic ovarian masses that were successfully removed laparoscopically. The average maximum diameter of the ovarian cysts of the patients was 16.75 cm (range, 9-20 cm). Three patients had benign ovarian cysts, and one had a teratoma. The duration of the operation ranged from 76 to 210 minutes. The postoperative hospital stays were 1 to 2 days after cyst removal and 3 days after teratoma excision. No intraoperative complications occurred, and the hospital course of all patients was uncomplicated. The morbid obesity of one patient did not negatively affect her surgery. The patients did not report any problems during follow-up, and the clinical examination findings were normal in all ...

Epithelial ovarian tumors in children: A retrospective analysis

Background/Purpose: Epithelial tumors of the ovary account for about 15% of pediatric ovarian masses. The authors reviewed a 14-year experience with ovarian masses to understand the spectrum of pathology, presentation, and outcome of children with epithelial lesions. Methods: All ovarian masses resected or biopsied at the authors' institution from 1988 to the present were reviewed retrospectively. Patient age, presenting symptoms, operative procedures, postoperative treatment, and outcome were obtained from the medical record. Results: A total of 240 cases were identified. A total of 123 (51.2%) were nonneoplastic in nature. Of the 117 neoplastic masses, 79 (67.5%) were germ cell tumors and nineteen (16.2%) were epithelial-derived tumors. Patients with epithelial tumors had a mean age of 13.9 ± 4 years. Ten patients (52.6%) presented with abdominal pain, and 9 (47.4%) presented with an asymptomatic mass. Eleven underwent oophorectomy, 6 underwent cystectomy, and 2 had biopsy alone. Four patients (21%) had ascites, and 1 (5.3%) had a pleural effusion. The histopathologic diagnoses for the epithelial tumors included 9 serous cystadenomas (47%) and 3 mucinous cystadenomas (16%), 3 mucinous cystadenocarcinomas (16%), and 4 serous tumors of borderline malignancy (21%). Two patients (11%) had bilateral disease. Four patients (21%) underwent a subsequent laparotomy for either staging or recurrence, and 2 patients (11%) required chemotherapy. One patient (5.3%) died of ovarian adenocarcinoma. Conclusions: Epithelial tumors comprise a small but significant proportion of pediatric ovarian masses. The pediatric surgeon must understand the biologic characteristics, operative management, and follow-up treatment of these tumors, and how these differ from germ cell lesions. J Pediatr Surg 38:331-335. Copyright 2003, Elsevier Science (USA). All rights reserved.

Secondary ovarian neoplasms in children: imaging features with histopathologic correlation.

Although the pathologic features and imaging appearance of childhood primary ovarian neoplasms have been well described, little information is available about the malignancies that may secondarily involve the ovary. To determine the relationship between the imaging features and the histopathology of secondary ovarian neoplasms in children treated at our institution. We searched our institutional database for codes indicating metastatic ovarian disease. Of the 35 patients with such codes, 18 had pathologically proven secondary ovarian disease. From their medical records we recorded demographic data, presenting symptoms, and evidence of endocrine dysfunction. We reviewed the pre-oophorectomy imaging and the subsequent pathologic specimens. One-third of the patients had bilateral pelvic masses; another third had large masses indistinguishable from the ovaries. Twelve (67%) had either ascites, peritoneal implants, matted bowel, adenopathy, pleural effusions, or some combination of these. Five (28%) had other metastatic disease. Primary tumors included colon adenocarcinoma (9), Burkitt's lymphoma (3), alveolar rhabdomyosarcoma (3), Wilms' tumor (1), neuroblastoma (1), and retinoblastoma (1). Although rare, secondary ovarian tumors should be considered in the differential diagnosis of children with ovarian masses. Bilateral ovarian masses or large masses indistinguishable from the ovaries, particularly in the presence of other metastatic foci, may help distinguish primary from secondary ovarian malignancies.