Ovary-sparing Surgery Research Articles

Вроджені кісти яєчника: діагностика та лікування в неонатальному періоді

The indications and method of surgery in newborns with prenatally diagnosed ovarian cysts remain under discussion. Purpose - to summarize own experience in the treatment of newborns with congenital ovarian cysts. Materials and methods. This study based on the results of treatment of 15 newborns that were operated in I surgical department of Lviv Regional Children’s Clinical Hospital «OKHMATDYT» at 2010-2021 years. For the diagnose confirming, the US was applied in all newborns after birth. The urgent hospitalization, immediately after birth, required 7 (46.7%) newborns and 4 (26.7%) newborns - during of the first month of life, by that 4 (26.7%) infants were hospitalized for elective surgery during six months after birth. The open surgery was applied in 9 (60%) patients and laparoscopic - in 6 (40%) patients. The postoperative mortality was 6.7%. Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8). Results. Among of 54 fetuses, after the birth the presence of cyst was confirmed in 15 (27.8%) of newborns, which were operated. Indications for urgent surgery immediately after birth (46.7% of newborns) was the presence of huge (>6 cm) cyst in abdomen, which in 2 newborns determined with respiratory disorders and in 2 newborns - intestinal obstruction. Increasing of the cyst’s size with the pain syndrome was the indication for the urgent surgery during of the first month of life (26.7% of infants) and the presence of cyst without tendency to decreasing of its size was the indication for elective surgery (26.7% of infants). Ovary-sparing surgery was succeeded only in 20% of patients and in 80% of patients performed adnexectomy. Conclusions. By the antenatally revealing of ovarian cyst, the scheduled US control is required with the aim to monitoring of the dynamic of cyst size. The indications for the surgery in neonatal period are: 1) cysts with the diameter >4 cm; 2) clear suspicions for the complications (torsion, self-amputation, compression of abdominal organs); 3) enlargement of cyst size after the born. The choice of method of surgery determined by size and the character of cystic formation. The research was carried out in accordance with principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of clinical hospital «OKHMATDYT». The informed agreement of parents was obtained for conducting the study. No conflict of interests was declared by the authors.

Validation of a low-cost model for training laparoscopic ovary-sparing surgery (LOSS) in ovarian mature teratomas

BackgroundMature ovarian teratoma is the most common ovarian neoplasm in pediatrics. Laparoscopic ovary sparing surgery (LOSS) is effective and safe. Due to the expansion of this technique in recent years, education-based surgical simulation is a useful tool for skills development. AimTo validate a low-cost model for training LOSS in pediatric ovarian teratomas. MethodsWe developed a low-cost model, incorporated into Hands-On courses since 2018. After academic lectures, and surgical strategies video demonstration, all participants performed the procedure in pairs, in our pediatric gruyer-like-training-box, under supervision. Time and critical maneuvers were assessed. A Likert-type scale was used to evaluate: previous experience, anatomical appearance of the model, surgical anatomy compared to a real patient and utility as a training method. Statistical analysis was performed with R-Studio®. Results75 % considered the model as good or high degree of similarity in relation to the anatomical characteristics; and 91.3 % in relation to surgical anatomy. 78.8 % believe the model improves the majority of skills. Correlation in time assessment for 81 participants with different levels of experience was statistically significative (p<0.01*). Emphasis was placed on preserving the capsule and ovarian tissue without causing any injury to adjacent tissues, resulting in a homogeneous performance. ConclusionWe saw a correlation between the previous experience of the surgeon and their performance in the model. Introducing this model in a simulation curricula would improve the learning curve. A decrease in surgical technique complications is to be expected, and should be demonstrated in future studies.

Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients

Although most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health. To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies. Pre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children's hospitals in the United States between August 2018 and January 2021, with 1-year follow-up. Implementation of a consensus-based, preoperative risk stratification algorithm with 6 months of preintervention assessment, 6 months of intervention adoption, and 18 months of intervention. The intervention adoption cohort was excluded from statistical comparisons. Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution. A total of 519 patients with a median age of 15.1 (IQR, 13.0-16.8) years were included in 3 phases: 96 in the preintervention phase (median age, 15.4 [IQR, 13.4-17.2] years; 11.5% non-Hispanic Black; 68.8% non-Hispanic White); 105 in the adoption phase; and 318 in the intervention phase (median age, 15.0 [IQR, 12.9-16.6)] years; 13.8% non-Hispanic Black; 53.5% non-Hispanic White). Benign disease was present in 93 (96.9%) in the preintervention cohort and 298 (93.7%) in the intervention cohort. The percentage of unnecessary oophorectomies decreased from 16.1% (15/93) preintervention to 8.4% (25/298) during the intervention (absolute reduction, 7.7% [95% CI, 0.4%-15.9%]; P = .03). Algorithm test performance for identifying benign lesions in the intervention cohort resulted in a sensitivity of 91.6% (95% CI, 88.5%-94.8%), a specificity of 90.0% (95% CI, 76.9%-100%), a positive predictive value of 99.3% (95% CI, 98.3%-100%), and a negative predictive value of 41.9% (95% CI, 27.1%-56.6%). The proportion of misclassification in the intervention phase (malignant disease treated with ovary-sparing surgery) was 0.7%. Algorithm adherence during the intervention phase was 95.0%, with fidelity of 81.8%. Unnecessary oophorectomies decreased with use of a preoperative risk stratification algorithm to identify lesions with a high likelihood of benign pathology that are appropriate for ovary-sparing surgery. Adoption of this algorithm might prevent unnecessary oophorectomy during adolescence and its lifelong consequences. Further studies are needed to determine barriers to algorithm adherence.

Ovary-Sparing Surgery for Ovarian Dermoid Cysts in Children: A Report of Two Cases and Literature Revıew

Ovarian lesions in during childhood and adolescence are rare and most of these are benign. Mature teratomas are frequently seen in these cases. The most common of these masses in children are the mature cystic teratoma which are also known as dermoid cysts. The management of children with ovarian dermoids has evolved over recent years in a manner of ovary preservation. In this review article two cases of ovarian dermoids are presented. The tumoral mass was totally excised in both of these cases preserving the effected ovary in an ovary sparing manner. The medical history of the patients, radiological and histopathological findings are also given together with a brief literature review on this issue.

Ovary-Sparing Surgery for Ovarian Dermoid Cysts in Children: A Report of Two Cases and Literature Review

Ovary-Sparing Surgery for Ovarian Dermoid Cysts in Children: A Report of Two Cases and Literature Review

Лікування дітей з перекрутом придатків матки

The diagnosis of adnexal torsion is challenging due to the absence of specific symptoms that can determine the postponing of surgery, and, as the consequence, the development of necrotic changes at adnexa. Today, the surgical treatment of patients with this pathology shifting to the ovary-sparing surgery (detorsion) despite to the presence of necrotic changes during surgery. By that, the question of the choice of the method of treatment in case of adnexal torsion still under debate between pediatric surgeons and gynecologists. Purpose - to summarize the own experience in the treatment of patients with adnexal torsion. Materials and methods. This study based on the results of the treatment of 73 patients with adnexal torsion, which were operated at 2010-2022 years. Diagnosis was established on the results of clinical investigation and ultrasonographic (US) data. It was performed 74 surgical procedures (one patient was operated on twice), among them 57 (77%) by laparoscopic and 17 (23%) open approach (laparotomy). It was 49 (66.2%) ovary-sparing procedures (detorsion with or without cystectomy) and 25 (33.8%) - adnexectomy. Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8). Results. Mean age of patients was 11.50.5 years. Abdominal pain syndrome (in 100%) and vomiting (in 49.3%) were the main clinical appearances. Unilateral ovaria enlargement and peripheral displacement of follicles were the most frequent US findings. The absence of the blood flow was revealed in 39.5% and the whirlpool sign in 11.6% of patients. Among of all patients, simple torsion confirmed in 24.3%, while the torsion caused by cyst or dermoid tumors, revealed in 75.7% of patients. Detorsion only was performed in 24.3% of patients and in 42.5% of patients it was supplemented by cystectomy. Adnexectomy was performed in 32.2% of patients. Conclusions. The diagnosis of adnexal torsion should be considered in all females with acute abdominal pain syndrome. Ultrasonography with or without Doppler is the first-line imaging modality. Laparoscopic detorsion, simple or supplemented by cystectomy, is the method of choice in the treatment of patients with adnexal torsion. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Recurrence Rates for Pediatric Benign Ovarian Neoplasms

Study ObjectiveTo examine the recurrence rates of pediatric benign ovarian neoplasms MethodsA retrospective review of females up to 21 years of age who underwent surgery for a benign ovarian neoplasm at 8 pediatric hospitals from January 2010 through December 2016 was conducted. Data include primary operation details, follow-up imaging, and reoperation details. ResultsFour hundred and twenty-six females were included in our cohort, with a median age of 15 years at the time of the primary operation. Of the patients, 69% had a mature teratoma, 18% had a serous cystadenoma, and 8% had a mucinous cystadenoma. Two-thirds of patients underwent ovarian-sparing surgery. There were 11 pathologically confirmed recurrences (2.6%) at a median follow-up of 12.8 months. The pathologically confirmed recurrence was 10.5 per 100 person-months at 12 months (SE = 5.7) for mucinous cystadenomas and 0.4 months (SE = 0.4) for mature teratomas (P = .001). For half of the patients, the pathologically confirmed recurrences occurred by 12.8 months, and for 75%, they occurred by 23.3 months. There were no differences in reoperation or recurrence on the basis of initial procedure (ovary-sparing surgery vs oophorectomy). ConclusionWe measured the pathologically confirmed recurrence rate for pediatric benign ovarian neoplasms in a large cohort. Oophorectomy was not protective against recurrence. Mucinous cystadenomas were at a greater risk of pathologically confirmed recurrence.

Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents

Describe the current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian masses DESIGN: Prospective cohort study from 2018 to 2021 SETTING: Eleven children's hospitals PARTICIPANTS: Females age 6-21 years undergoing surgical management of an ovarian mass INTERVENTIONS: Obtaining intraoperative FS pathology MAIN OUTCOME MEASURE: Diagnostic accuracy of FS pathology RESULTS: Of 691 patients who underwent surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology. Among FS patients, 12 of 27 (44.4%) underwent ovary-sparing surgery, and 15 of 27 (55.5%) underwent oophorectomy with or without other procedures. FS results were disparate from final pathology in 7 of 27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for identifying malignancy, with a c-statistic of 0.69. Malignant diagnoses missed on FS included serous borderline tumor (n=1), mucinous borderline tumor (n=2), mucinous carcinoma (n=1), and immature teratoma (n=1). FS did not guide intervention in 10 of 27 (37.0%) patients: 9 with benign FS underwent oophorectomy, and 1 with malignant FS did not undergo oophorectomy. Of the 9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%) had malignant final pathology. FSs are infrequently utilized for pediatric and adolescent ovarian masses and could be inaccurate for predicting malignancy and guiding operative decision-making. We recommend continued assessment and refinement of guidance before any standardization of use of FS to assist with intraoperative decision-making for surgical resection and staging in children and adolescents with ovarian masses.

Long-term surgical outcomes in pediatric ovarian neoplasms: 20-year single-center experience.

The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON. A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence. Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group. The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue.

Single port laparoscopic-assisted ovarian cystectomy using optical forceps in neonates: a brief technical report

BackgroundThe management of neonatal ovarian cysts is often demanding. However, offering surgery as a definitive treatment for patients who lack easy access to healthcare for follow-up is reasonable. Minimally invasive, ovary-sparing surgery provides benefits, including shorter operative times, hospital stay, and superior cosmesis. The novel modification described here renders added value because it utilizes readily available and reusable instruments, averts the need for multiple ports and large incisions, and is essentially time-saving.So, the aim of the study is to evaluate the safety and feasibility and describe the use of optical forceps during single-port laparoscopic-assisted (SPLA) ovarian cystectomy in a specific cohort of neonates with simple/complicated ovarian cysts.ResultsNeonates who required ovarian cystectomy/salpingo-oophorectomy, admitted from January 2015 to December 2019 and fulfilled the inclusion criteria, were treated with optical forceps during SPLA. After the surgery, we put in place a follow-up protocol to monitor complications and recurrences.Twenty-one neonates were included. The average gestational age was 37.2 ± 1.6 weeks, operative time was 43.2 ± 2.4 min, and length of hospital stay was 2.4 ± 0.5 days. In our experiment, there was no encounter with complications, recurrences, or ones that required conversion to laparotomy, nor did we require the use of extra ports.ConclusionSPLA procedures using optical forceps for managing neonatal cysts requiring surgery appear to be a safe and achievable option by allowing complete visualization of the cyst/lesion. It also has an excellent cosmetic result with a near-normal umbilicus scar. Further research is required to compare this method to open and laparoscopic standards.

110 The ultrasound and MRI findings in a young girl with an ovarian mass

Objective: We report a case of a 12-year-old girl with foci of immature teratoma G2 who was treated with the ovary-sparing surgery. Study design: A 12-year-old premenarchal girl complained about mild lower abdominal pain of one-month duration three years after she underwent laparoscopy because of the dermoid cyst in the left ovary (with a volume of 350 ml). On ultrasound a large right ovarian tumor 165 ml in volume was seen, containing fatty and fluid contents, and multiple septations up to 3 mm. The normal ovarian tissue or ovarian crescent sign was present and reported. Pelvis MRI scan confirmed ultrasonography findings, but exclusively emphasized the absence of normal ovarian tissue of the right ovary. Laparoscopic right ovarian cystectomy and reconstruction without suturing was performed. The final pathological diagnosis was mature teratoma with foci of immature teratoma of the right ovary, grade 2. Results: The treatment of immature teratomas has gone through an evolution from aggressive treatment with surgery followed by multidrug chemotherapy to conservative surgical approaches with no adjuvant therapy. To preserve fertility as much as possible, ovarian cystectomy is undoubtedly better than excising the whole ovary as this practice would minimize loss of normal cortex tissue. Preservation of ovarian tissue depends on the presence of the normal ovarian tissue with follicles and can be visualized using ultrasonography or MRI. A positive ultrasonographic ovarian crescent sign should be taken into account when deciding the surgical approach, whether the ovary-sparing cystectomy should be attempted. There is little to no data on ovarian crescent sign seen and reported on MRI examinations of the ovary. Conclusion: A movement toward standardized imaging, specific criteria for the diagnosis and optimal therapeutic approach should be done to benefit children and adolescents' recovery and future fertility.

112 Ovarian cysts and masses in childhood and adolescence

Objective: To determine the presentation, diagnosis and management of ovarian cysts and masses in children and adolescents. Study design: A retrospective cohort study of children and adolescents with ovarian cysts and masses aged 18 years or younger, presenting to a tertiary referral reproductive medicine unit between 2013 and 2018 was performed. Data were primarily collected using computerized medical notes. The following were noted: age at presentation, diagnostic outcomes, types of management and post-intervention follow up. Results: 60 children or adolescents with ovarian cysts or masses were identified. The median age of diagnosis was 14 years. Seventy-one per cent of patients were post-menarche at presentation. The most common presentation was abdominal pain or discomfort with 49 (82%) patients presenting in this way. Imaging identified 41 (65%) simple cysts, 20 (32%) complex cysts and 2 (3%) ovarian torsions. Three (5%) patients had bilateral cysts. Diagnostic laparoscopy was performed in 10 (17%) patients. Ovarian surgery was performed in 27 (45%) patients, with 9 (33%) patients having an oophorectomy and 20 (74%) being laparoscopic. The commonest diagnoses were mature cystic teratoma and hemorrhagic cyst. Two (3%) malignancies were diagnosed. Follow up within a Pediatric and adolescent gynecology clinic occurred in 30 (50 %) patients. Conclusion(s): This retrospective cohort study demonstrates that the majority of children or adolescents presenting with an ovarian cyst or mass present post-menarche. Most patients had a benign cyst, commonly a mature cystic teratoma or hemorrhagic cyst, and were treated conservatively or with minimal access ovary-sparing surgery.

Differential-diagnostic and therapeutic challenges in the management of ruptured corpus luteum cyst with undiagnosed intrauterine pregnancy in the early first trimester and ruptured ovarian pregnancy

Background: The similarities in clinical features between ruptured corpus luteum cyst (RCLC) with undiagnosed intrauterine pregnancy in the early first trimester (RCLC-P) and ruptured ovarian pregnancy are well established. However, the identification of differences between these two morbid conditions is important to determine the causes and manage the hemoperitoneum without devastation of pregnancy in RCLC-P. Furthermore, the pregnancy outcomes after laparoscopic surgery in women with RCLC-P are not recognized. Methods: Retrospective observational study of six women with RCLC-P and seven women with ruptured ovarian pregnancy. Results: All cases were referred under strong suspicion of ruptured ectopic pregnancy due to lower abdominal pain and positive urinary pregnancy test after spontaneous conception. The estimated median number of gestational weeks in RCLC-P (5 weeks) was significantly lower than that for ruptured ovarian pregnancy (7 weeks). At triage, the median serum levels of beta-human chorionic gonadotropin (β-hCG) were significantly lower in RCLC-P (592 IU/L) than ruptured ovarian pregnancy (3723 IU/L) (p = 0.01). In all six cases with RCLC-P, laparoscopic ovary-sparing surgery was performed. Among the four women who received postoperative supplementation of progesterone, uneventful vaginal delivery occurred at term in three cases. Conclusions: Early gestational age and lower serum β-hCG levels at triage, as well as non-declining levels of serum β-hCG on the day after surgery, were significant predictors of RCLC-P rather than ruptured ovarian pregnancy. Laparoscopic surgery was a feasible option for the management of RCLC-P with appropriate postoperative luteal support to achieve successful obstetric outcomes.

Морфофункциональное состояние эндометрия у пациенток до и после органосохраняющих операций по поводу доброкачественных опухолей яичников

Benign ovarian tumors (BOT) have a significant impact on fertility and are associated with infertility, which, in turn, relates to endometrial receptivity and depends on the ovarian status, forming the so-called endometriopathy. Objective. To study the morphological and functional features of the endometrium in patients of reproductive age before and after ovary-sparing surgery for BOT according to 2D and 3D ultrasounds. Patients and methods. The study included 145 patients who underwent surgery for BOT. Patients were divided into two groups. Group 1 included 75 patients with diminished ovarian reserve (OR), group 2 included 70 patients with normal OR. Diminished OR was defined as serum Anti-Müllerian hormone (AMH) level &lt;1.1 ng/mL. Pelvic ultrasound (US) was performed in the mid-secretory phase before and 6–12 months after surgery. We measured endometrial thickness, endometrial pattern, visualization of basal and spiral arteries by 2D ultrasound, volume and volumetric blood flow in the endometrial and subendometrial regions by 3D ultrasound. Results. The analysis revealed endometrial dysfunction in patients with diminished OR before and after surgery, however there was a trend towards improvement in all the examined parameters after 12 months. In patients with normal OR before surgery, endometrial parameters did not differ from the population, but more persistent abnormalities were noted in the postoperative period. Conclusion. The 3D ultrasound technique provides an objective assessment of morphological and functional features of the endometrium and allows to identify markers of endometrial dysfunction. Key words: benign ovarian tumors, volumetric blood flow, ovarian reserve, 3D ultrasound, endometrium

Ovary-Sparing Surgery for Ovarian Teratoma in an Infant with Nonbilious Vomiting.

Ovarian teratoma is the most common ovarian tumor in children with an overall incidence of 2.6 cases per 100,000 girls per year. Diagnosis and management are challenging due to its nonspecific presentation, malignancy determination, and need to conserve fertility. A previously healthy 5-month-old female infant presented with fever, abdominal distension, and nonbilious emesis, and an 8.2 × 6.8 × 6.1-centimeter pelvic mass originating from the left adnexa was found on imaging. Due to concern for malignancy and torsion, exploratory laparotomy and ovarian-sparing surgery (OSS) with resection of the mass were performed. Histology showed a grade 1 teratoma. This case illustrates a challenging diagnosis and its symptom overlap with other etiologies in infants. The keys to diagnosing and managing this entity are including ovarian pathology in the differential diagnosis and performing OSS whenever possible. Furthermore, ultrasound follow-up is needed to monitor for ipsilateral and contralateral ovarian tumors later in life.

Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre

IntroductionThe aetiology and management of ovarian pathology in children differs between antenatal and postnatal lesions. However, all lesions may present acutely due to adnexal torsion. In this setting, opportunities to preserve fertility with ovary-sparing surgery (OSS) may be missed. Some studies suggest that pediatric and adolescent gynaecology (PAG) input in care is associated with OSS.MethodsA retrospective cohort study of children undergoing surgery for ovarian pathology at a tertiary pediatric surgery centre over an 8-year period (2011–2018). Patient factors, lesion characteristics and PAG involvement were examined for association with OSS using multivariate logistic regression.ResultsThirty-five patients with ovarian pathology managed surgically were included. Ten were infants with lesions detected antenatally; all were managed by pediatric surgeons (PS) alone at median age 2 weeks (1 day–25 weeks). Twenty-five patients presented postnatally at median age 11 (0.75–15) years. In total, there were 16 cases of adnexal torsion, each managed primarily by PS. Twelve underwent oophorectomy and six (50%) of these cases had viable ovarian tissue on histology. Furthermore, two infants with large simple cysts were similarly managed by unnecessary oophorectomy based on histology. Overall rate of OSS was 46% and PAG involvement was the only factor associated with ovarian salvage.ConclusionDifferences in surgical management between PAGs and PS may be attributable to the different patient populations they serve. We recommend improving the knowledge of PS trainees in OSS approaches for adnexal torsion and large benign lesions.

Operative management of pediatric ovarian tumors and the challenge of fertility-preservation: Results from the UK CCLG Surgeons Cancer Group Nationwide Study

BackgroundOvarian tumors in the pediatric age group are rare. A significant number of children with ovarian mass lesions present “out of hours “as surgical emergencies, and surgical management does not always involve a surgical oncologist. This multicenter study reports how the mode of clinical presentation may influence (i) operation (conventional open vs minimally invasive surgery (MIS)) and (ii) examines if young females presenting as surgical emergency(s) are more likely to undergo total oophorectomy or ovarian sparing surgery. MethodsRetrospective multicenter study amongst UK pediatric surgical oncology centers. Females <16 years with diagnosis of ovarian tumor from 2006 to 2016 were included. Functional/neonatal ovarian cysts were excluded. ResultsThree hundred ten patients with ovarian tumors treated at 12 surgical oncology centers were identified. Mean age at surgery was 11 years [IQR 8–14]. Most common diagnosis were mature teratoma (57%, 177 cases), immature teratoma (10.9%, 34 cases) and cystadenoma (12%, 36 cases). Seventy percent (217) of cases were performed as open procedures. Thirty percent (94) of children underwent MIS.Tumors were significantly smaller in children who underwent MIS. Median tumor size in the laparoscopic group was 6 cm compared to 11 cm in the open group (p < 0.00001). Children who underwent MIS were significantly more likely to have ovary sparing surgery. ConclusionThis UK nationwide study demonstrates that ovary-sparing surgery and minimally invasive surgery are still infrequently deployed by pediatric surgeons in the UK. Patients with smaller tumors were more likely to undergo MIS, and more frequently underwent ovary-sparing surgery. In view of the implications on fertility and hormonal health caused by unilateral oophorectomy, it is time to review this current practise and agree consensus guidelines to reduce rates of unnecessary oophorectomy. Level of evidence statementThis is a level II evidence study. It is a retrospective multicentre collaborative study, which summarizes data from a national cohort of children.

Endocervical adenocarcinoma in situ with ovarian metastasis: a case report

Background: Ovarian metastases, which may simulate primary ovarian neoplasms, can occur in advanced stage primary cervical adenocarcinoma (AC). However, such tumors are very rarely observed in cases of endocervical adenocarcinoma in situ (AIS) with early or even no obvious signs of tumor invasion. Case: We present a case of ovarian metastasis occurring in a 37-year-old triparous premenopausal woman with a diagnosed case of endocervical AIS. The patient presented with a rapidly growing and painful abdominal mass 22 months after a cold knife cone biopsy and 19 months after a simple extrafascial hysterectomy. She was subsequently treated with a combination of surgery and chemotherapy and is currently free of disease seven years after the initial diagnosis of endocervical AIS lacking unequivocally recognizable stromal invasion. Conclusion: Endocervical AIS with early or even no obvious detectable invasion may spread to the ovaries, but this situation is exceptionally rare. We propose that, in such cases, ovary sparing surgery is justifiable for initial treatment. Medical care strategies for patients affected by rare diseases largely depend on experience gained from reported cases in published literature, this is what compelled us to report this particular case.

Factors Associated With Management of Pediatric Ovarian Neoplasms

Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.

Pediatric ovarian immature teratoma: Histological grading and clinical characteristics

BackgroundOvarian immature teratomas (ITs) are relatively rare among all pediatric ovarian tumors. The histological grading for ovarian ITs, which ranges from 1 to 3, is based on the proportion of immature neuroepithelial component. Higher-grade ITs in adults are treated as malignant neoplasms and require adjuvant chemotherapy. However, there is no consensus on the therapeutic management of pediatric ovarian ITs. The aim of our study was to analyze the histological grades and clinical characteristics of ovarian ITs in pediatric patients. MethodsThis retrospective chart review consisted of seven patients, including one, three, and three patients with histological grade 1, 2, and 3 pediatric ovarian ITs, respectively, who were treated at our institute between 2000 and 2016. Collected data comprised age, alpha-fetoprotein (AFP) level, clinical stage, tumor size, treatment, and prognosis. ResultsThe median age and AFP levels of patients with grade 1, 2, and 3 ovarian ITs were 8, 7, and 10 years and 37, 112, and 221 ng/ml, respectively. All cases were Children Oncology Group (COG) stage I and International Federation of Gynecology and Obstetrics (FIGO) stage IA. All patients had unilateral tumors in the right ovary. The median tumor sizes of the grade 1, 2, and 3 IT patients were 104, 160, and 100 cm2, respectively. All patients underwent primary open surgery alone. Two patients, including one patient each with grade 2 and 3 ITs, underwent tumor enucleation as ovary-sparing surgery, whereas the remaining five patients underwent unilateral salpingo-oophorectomy. The median follow-up was seven years, and all cases achieved event-free survival. ConclusionsClinical characteristics of patients with grade 3 ovarian ITs were relatively older and had higher AFP levels than those with lower-grade ITs. According to our patient’s clinical course and prognosis, COG stage I pediatric ITs should be treated by surgery alone and that postoperative chemotherapy is unnecessary even for those with grade 3 ITs as well as patients with rather low AFP levels. Level of evidenceIV