Surgical Ovary Masses in Children: A Single Center Experience of 11 Years

Abstract

Objective: The majority of childhood ovarian masses are benign. However, malignant tumors encountered in adulthood may also be seen in childhood. There is still no ovarian tumor management protocol for children. We shared our experiences with ovarian mass cases operated in our clinic.

Material and Methods: Patients aged 0-18 years and had surgery in our hospital between 2010 and 2020 due to ovarian masses were included in the study. The ages of the patients, the maximum diameter and structure of the mass on ultrasonography (USG) and other imaging modalities, symptoms on presentation, tumor markers, operation data, and histopathology results were recorded. The patients were divided into three groups in relation with tumor histopathology, and the demographic data were compared among groups.

Results: In 11-year period, 107 surgical operations were performed on 106 patients due to ovarian masses. The ages of the patients were between 2 days and 17 years, with a mean age of 13.4±14.1 years. Of the masses, 9 (8.4%) were malignant (3 (2.8%) borderline), 44 (41.1%) were benign, and 54 (50.5) were non-neoplastic. Histopathology results of 53 surgical operations performed for neoplastic ovarian masses were germ cell tumor in 31 (29%), epithelial tumor in 19 (17.8%), sex cord stromal tumor in 2 (1.9%), and leiomyoma 1 (0.9%) patient.

Conclusion: Adult protocols should be used when necessary in rare childhood ovarian malignant tumors, and large multi-center patient series should be constituted in order to establish pediatric protocols related to the subject. A multidisciplinary approach is necessary in childhood ovarian masses.

Keywords

• Children
• Masses
• Ovary
• Surgery

Çocuklarda Cerrahi Over Kitleleri: 11 Yıllık Deneyim

Abstract

Amaç: Çocukluk çağı over kitlelerinin çoğunluğu benigndir. Ancak yetişkinlik döneminde görülen malign tümörlerde çocukluk çağında görülebilmektedir. Bu tümörlerel ilgili çocukluk çağına ait bir protokol hala yoktur. Bizde kliniğimizde opere edilen over kitleleri ile ilgi deneyimimizi paylaştık.

Gereç ve Yöntemler: Hastanemizde 2010 ile 2020 yılları arasında over kitlesi nedeniyle opere edilen 0 ila 18 yaş arası olgular çalışmaya dahil edildi. Hastaların yaşları, ultrasonografi (USG) ve diğer yapılan görüntüleme yöntemlerinde kitlenin maksimum çapı ve yapısı, başvuru semptomları, tümör belirteçleri, operasyon verileri, patoloji sonuçları kaydedildi. Patolojiye göre 3 gruba ayrılarak demografik veriler karşılaştırıldı.

Bulgular: Çalışmanın yapıldığı 11 yıllık süreçte 106 olguya over kitlesi nedeniyle 107 ameliyat yapılmıştır. Olguların yaşları 2 gün ile 17 yaş arasında değişmekle birlikte ortalaması 13.4±14.1’dir. Bu ameliyatlardan 9 (%8.4)’ü malign (3’ü (%2.8) borderline), ve 44 (%41.1)’i benign neoplastik over kitlesi, 54 (50.5)’i nonneoplastik over kitlesiydi. Neoplastik over kitlesi nedeniyle yapılan 53 ameliyatta patoloji sonuçları; olgulardan 31 (%29)’u germ hücreli tümör, 19 (%17.8)’i epitelyal tümörler, 2 (%1.9)’u seks kord stromal tümör, 1 (%0.9) leomiyom olarak değerlendirildi.

Sonuç: Çocukluk çağı over kitlelerinde multidisipliner yaklaşım unutulmamalıdır. Çocukluk çağında az görülen over tümörlerinde gerektiğinde yetişkin protokollerinden yararlanılırken, çok merkezli çalışmalarla seriler oluşturulmalı ve böylece konu ile ilgili çocuk protokolleri oluşturulmalıdır.

Keywords

• Çocuk
• Kitleler
• Over
• Cerrahi

References

1. Referans1 How JA, Marino JL, Grover SR, et al. Surgically Managed Ovarian Masses at the Royal Children's Hospital, Melbourne -19 Year Experience. J Pediatr Surg. 2019;54:1913-20. doi: 10.1016/j.jpedsurg.2019.05.005. 
2. Referans2 Liu H, Wang X, Lu D, et al. Ovarian masses in children and adolescents in China: analysis of 203 cases. Journal of Ovarian Research  2013;6:47. doi: 10.1186/1757-2215-6-47.
3. Referans3 Kirkham YA, Lacy JA, Kives S, et al. Characteristics and Management of Adnexal Masses in a Canadian Pediatric and Adolescent Population. J Obstet Gynaecol Canada 2011;33:935-43. doi: 10.1016/s1701-2163(16)35019-8.
4. Referans4 Grapsa D, Kairi-Vassilatou E, Kleanthis C, et al. Epithelial Ovarian Tumors in Adolescents: A Retrospective Pathologic Study and a Critical Review of the Literature. Journal of Pediatric and Adolescent Gynecology, 2011;24:386–88. doi: 10.1016/j.jpag.2011.07.011
5. Referans5 Xac MC, Jetelina KK, Jarin J, et al. Benign, Borderline, and Malignant Pediatric Adnexal Masses: A 10-Year Review. J Pediatr Adolesc Gynecol. 2021;S1083-3188(21)00002-4. doi: 10.1016/j.jpag.2021.01.002.
6. Referans6 Wong YS, Tam YH, Pang KK, et al. Oophorectomy in children. Who and why: 13-year experience in a single centre. J Paediatr Child Health. 2012;48:600-3. doi: 10.1111/j.1440-1754.2012.02427.x.
7. Referans7 Hermans AJ, Kluivers KB, Wijnen MH, et al. Diagnosis and treatment of adnexal masses in children and adolescents. Obstet Gynecol. 2015;125:611-15. doi: 10.1097/AOG.0000000000000665.
8. Referans8 Hembram M, Sagili H, Dasari P. A retrospective analysis of surgically managed adnexal masses in children and adolescents in a tertiary centre. Front Womens Healt, 2016;1:52-4 doi: 10.15761/FWH.1000112.

9. Referans9 Cass DL, Hawkins E, Brandt ML, et al. Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period. J Pediatr Surg. 2001 May;36(5):693-9. doi: 10.1053/jpsu.2001.22939.
10. Referans10 "Article 1 of the Convention on the Rights of the Child". Website of the Office of the United Nations High Commissioner for Human Rights (OHCHR). United Nations. 20 November 1989. http://www.ohchr.org/en/professionalinterest/pages/crc.aspx. [accessed 13 April 2021].
11. Referans11 Nasioudis D, Alevizakos M, Holcomb K, et al. Malignant and borderline epithelial ovarian tumors in the pediatric and adolescent population. Maturitas, 2017;96:45–50. doi: 10.1016/j.maturitas.2016.11.011.
12. Referans12 Sadeghian N, Sadeghian I, Mirshemirani A, et al. Types and frequency of ovarian masses in children over a 10-year period. Caspian J Intern Med 2015;6:220-223.
13. Referans13 User İR, Karakuş SC, Özokutan BH, et al. Can preoperative findings help to interpret neoplastic and non-neoplastic lesions of ovary and affect surgical decisions in children and adolescents?. Arch Argent Pediatr 2019;117:294-400. doi: 10.5546/aap.2019.eng.294.
14. Referans14 Qazi SH, Jeelani SM, Dogar SA, et al. Approaches to the management of pdiatric ovaian masses in 21st century: Systematic review and meta-analysis. J Pediatr Surg. 2020;55:357-368. doi: 10.1016/j.jpedsurg.2019.09.003.
15. Referans15 Coleman RL, Ramirez PT, Gershenson DM. Neoplastic Diseases of the Ovary Screening, Benign and Malignant Epithelial and Germ Cell Neoplasms, Sex-Cord Stromal Tumors. In: Roger A, Gershenson DM, Lentz GM,  Valea FA, editors. Germ Cell Tumors, Philadelphia: Comprehensive Gynecology Lobo; 2017, p.733-80.
16. Referans16 Sola R, Wormer BA, Walters AL, et al. National trends in the surgical treatment of ovarian torsion in children: an analysis of 2041 pediatric patients utilizing the Nationwide Inpatient Sample. Am Surg 2015;81:844–8.
17. Referans17 Lipsett SC, Haines L, Monuteaux MC, et al. Variation in Oophorectomy Rates for Children with Ovarian Torsion across US Children's Hospitals. 2021;231:269-272. doi.org/10.1016/j.jpeds.2020.12.019.
18. Referans18 Oltmann SC, Fischer A, Barber R, et al. Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance. J Pediatr Surg 2010;45:135–9.
19. Referans19 Virgone C, Alaggio R, Dall’Igna P, et al. Epithelial Tumors of the Ovary in Children and Teenagers: A Prospective Study from the Italian TREP Project. Journal of Pediatric and Adolescent Gynecology, 2015;28:441–6.
20. Referans20 Childress KJ, Patil NM, Muscal JA, et al. Borderline Ovarian Tumor in the Pediatric and Adolescent Population: A Case Series and Literature Review. Journal of Pediatric and Adolescent Gynecology. 2018;31:48–54.
21. Referans21 Baert T, Storme N, Van Nieuwenhuysen E, et al. Ovarian cancer in children and adolescents: A rare disease that needs more attention. Maturitas, 2016;(88) 3–8.
22. Referans22 F. Tomao, F. Peccatori, L. Del Pup, et al. Special issues in fertility preservation for gynecologic malignancies, Crit. Rev. Oncol. Hematol. 2016; 97: 206–19.
23. Referans23 Roett MA. Ovarian cancer. In: Rakel D,  Kellerman RD editors. Philedalphia: Conn's Current Therapy 2020; 2019,1166-9.
24. Referans24 Fotopoulou C, Braicu I, Sehouli J. Fertility-Sparing Surgery in Early Epithelial Ovarian Cancer: A Viable Option? Obstetrics and Gynecology International, 2012;2012:1–8. doi: 10.1155/2012/238061.