Management of Ovarian Tumors and Adnexal Torsion in Children; How to Save?

Yıl 2019, Cilt: 9 Sayı: 2, 140 - 144, 30.06.2019

Beytullah Yağız Ayşe Karaman Derya Erdoğan

https://doi.org/10.16899/jcm.577708

Cited By: 1

Öz

Abstract

Background/Aims: Although rare, torsion and malignancy of the uterine adnexa, are a common concern of differential diagnosis while dealing with abdominal pain in girls

Methods:Forty-seven patients  who were
operated for adnexal torsion or ovarian tumor between March 2004 and December
2010 are enrolled in the study. 

Results:Twenty one patients had torsion of the uterine adnexa, 18 had ovarian
tumors and 8 had an ovarian tumor with torsion. The rate of radical surgery was
47% in torsion which was elevated to 72% in tumor and 100% in tumors with
torsion. In ovarian torsion, the rate of radical surgery and adnexal sparing
were not different between early versus late presenting cases. 

Conclusions: Despite encouraging data in the literature favor ovarian sparing,
radical surgery still seems to remain high in girls with adnexal torsion and
tumors. Ovarian sparing seems possible in tumors but further studies are needed
to determine the best management strategy. 

Anahtar Kelimeler

ovary, tumor, torsion, child

Çocuklarda Over Tümörlerinin Ve Adneks Torsiyonlarının Sağaltımı; Nasıl Kurtarabiliriz?

Öz

Öz

Amaç:Nadir görülmekle birlikte, uterin adnekslerin malignite ve torsiyonları,
karın ağrısı ile başvuran kız çocuklarının değerlendirilmesinde önemli bir
sorun oluşturmaktadır

Gereç ve Yöntem: Kliniğimizde, Mart 2004 ile Aralık 2010 tarihleri arasında adneks
torsiyonu veya tümörü tanısı almış 47 hasta çalışmaya dahil edildi.

Bulgular:Yirmi bir hasta uterin adnekslerin torsiyonu, 18 hasta over tümörü ve 8
hastanın ise tümör ile birlikte torsiyon nedeniyle ameliyat edilmişti. Radikal
cerrahi oranı torsiyonlarda %47, tümörlerde %72 iken, hem torsiyon hemde tümör
varlığında %100’e ulaşmaktaydı. Over torsiyonlarında radikal cerrahi ve over
kurtarılma oranları açısından, erken ve geç başvuran vakalar arasında fark
yoktu.

Tartışma:Overlerin korunabileceğini destekleyen verilerin
giderek artmasına rağmen, kız çocuklarında adneks torsiyonu ve tümörlerinin
tedavisinde radikal cerrahi oranları halen yüksek gözükmektedir. Over
tümörlerinde koruyucu cerrahi mümkün gözükmekle beraber en uygun yolunu bulmak
için daha ileri çalışmalara ihtiyaç vardır. 

Anahtar Kelimeler

over, tümör, torsiyon, çocuk

Kaynakça

• 1. Adeyemi-Fowode, O., K.A. McCracken, and N.J. Todd, Adnexal Torsion. Journal of Pediatric and Adolescent Gynecology, 2018. 31(4): 333-338.
• 2. Braungart, S., R.J. Craigie, and P.D. Losty, Controversies in the management of ovarian tumours in prepubertal children — A BAPS and UK CCLG Surgeons Cancer Group National Survey. Journal of Pediatric Surgery, 2018. 53(11): 2231-2234.
• 3. Oltmann, S.C., et al., Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance. J Pediatr Surg, 2010. 45(1): 135-9.
• 4. Santos, X.M., D.L. Cass, and J.E. Dietrich, Outcome Following Detorsion of Torsed Adnexa in Children. J Pediatr Adolesc Gynecol, 2015. 28(3): 136-8.
• 5. Guthrie, B.D., M.D. Adler, and E.C. Powell, Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000-2006. Pediatrics, 2010. 125(3): 532-8.
• 6. Dasgupta, R., et al., Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg, 2018. 53(7): 1387-1391.
• 7. Piper, H.G., et al., Ovarian torsion: diagnosis of inclusion mandates earlier intervention. Journal of Pediatric Surgery, 2012. 47(11): 2071-2076.
• 8. Gonzalez, D.O., P.C. Minneci, and K.J. Deans, Management of benign ovarian lesions in girls: a trend toward fewer oophorectomies. Curr Opin Obstet Gynecol, 2017. 29(5): 289-294.
• 9. Rosendahl, M., M.K. Simonsen, and J.J. Kjer, The influence of unilateral oophorectomy on the age of menopause. Climacteric, 2017. 20(6): 540-544.
• 10. Geimanaite, L. and K. Trainavicius, Ovarian torsion in children: management and outcomes. J Pediatr Surg, 2013. 48(9): 1946-53.
• 11. Bjelland, E.K., et al., Is unilateral oophorectomy associated with age at menopause? A population study (the HUNT2 Survey). Hum Reprod, 2014. 29(4): 835-41.
• 12. Rousseau, V., et al., Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases. J Pediatr Adolesc Gynecol, 2008. 21(4): 201-6.
• 13. Billmire, D., et al., Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: an intergroup study. J Pediatr Surg, 2004. 39(3): 424-9; discussion 424-9.
• 14. Madenci, A.L., et al., Preoperative risk stratification of children with ovarian tumors. J Pediatr Surg, 2016. 51(9): 1507-12.
• 15. Al Jama, F.E., et al., Ovarian tumors in children and adolescents--a clinical study of 52 patients in a university hospital. J Pediatr Adolesc Gynecol, 2011. 24(1): 25-8.
• 16. Kim, M.J., et al., Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases. Am J Obstet Gynecol, 2011. 205(1): 32.e1-4.
• 17. Renaud, E.J., et al., Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review. J Pediatr Surg, 2018.