Role of reticular network in determination of an underlying lesion in pediatric torsed ovary

Abstract

Introduction/ Purpose: The aim of this study is to review the pediatric ovarian torsions and to determine causing lesions, as well as the role of reticulum network to discern underlying tumor in a fully necrotic material. Material and methods: This study included 22 females who underwent unilateral salpingo-oophorectomy procedure because of ovarian torsion in a children’s research hospital between 1989- 2003. The hematoxylin-eosin stained slides (mean 4 slides) and one Gomori’s reticulum stained slide of each case were retrospectively reviewed. The reticulum network was evaluated as rich, poor or absent. Results: The mean age of 22 cases was 8 years (1 month- 14 years). Twelve were right ovary and 10 were left. The mean macroscopic diameter of the torsed ovary was 7.5 cm. Three cases had underlying solid tumor: dysgerminoma, endodermal sinus tumor and mixed germ cell tumor. In 10 cases cysts were detected and in 5 cases mature cystic teratoma was diagnosed. And in the other 4 cases no underlying lesion was detected. Conclusion: Torsion and hemorrhagic necrosis of ovary occurring from ovarian mass is very rare. The main reason of this is prior pelvic surgery in adults. But in pediatric age group, ovarian torsion is the most frequent cause of an ovarian mass requiring surgery. Because of reticulum rich parenchyma of ovary, reticulum network detection is useful of the differential diagnosis of torsion’s reason. We found that the reticulum network was rich in torsed ovarian parenchyma without solid tumors or mature cystic teratoma. In pediatric patients with torsed ovary underlying a solid tumor reticulum network was poor or absent. Finally we conclude that an underlying lesion more commonly occurs in children than adults in torsed ovary and reticulum network might help in differential diagnosis

Keywords

• Ovary, torsion, pediatric

Pediatrik ovaryum torsiyonlarında retiküler çatının değerlendirilmesinin ayırıcı tanıdaki önemi

Öz

Giriş ve amaç: Çalışmamızın amacı pediatrik olgularda, torsiyone ovaryuma ait tümüyle nekrotik örneklerde; altta yatan hazırlayıcı etkenin belirlenmesi için retiküler çatıyı incelemenin yararını irdelemektir. Olgular ve yöntem: Hastanemizde 1989- 2003 yılları arasında unilateral salpingo-ooforektomi yapılmış 22 olgu yeniden değerlendirildi. Demonstratif bloklardan yapılan kesitlere Gomori retikulum boyası uygulandı ve örnekler retikulumdan zengin, fakir ve damar duvarı dışında retikulum ağı yok şeklinde semi-kantitatif olarak sınıflandırıldı. Bulgular: Ortalama yaş 8 (1 ay-14 yıl), ortalama çap 7.5 cm bulundu. Materyal 12 olguda sağ, 10 olguda sol ovaryuma aitti. 3 olguda solid tümör varlığı (disgerminom, mikst germ hücreli tümör ve endodermal sinus tumörü), 5 olguda ise matür kistik teratom saptandı. 10 olguda folikül kistleri belirlendi. 4 olguda ise hazırlayıcı bir etken bulunamadı. Sonuçlar: Erişkinde ovaryum tümörüne bağlı torsiyon ve hemorajik nekroz oldukça ender olup; hazırlayıcı başlıca etken daha önce uygulanmış cerrahi girişimlerdir. Çocuklarda ise jinekolojik cerrahi girişim gerektiren en sık neden ovaryumda kitle varlığıdır. Çalışmamızda tümördışı torsiyonların, olağan ovaryum stroması gibi retikulumdan zengin olduğunu; solid tümör ve matür kistik teratom bulunan olgularda bu zengin retikuler çatının yok olduğunu gözledik. Sonuç olarak çocuklarda altta yatan bir lezyona bağlı ovaryum torsiyonlarının erişkine göre daha sık olduğunu; bu nedenle özellikle pediatrik olgularda nekroz nedeniyle dokunun doğası seçilemediği zaman retikulum boyamanın yardımcı olabileceği sonucuna ulaştık

Anahtar Kelimeler

• Ovaryum, torsiyon, pediatrik

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