Laparoscopic adnexectomy of a persistent ovarian tumor in a girl with acute lymphoblastic leukemia relapse

The management of children with acute lymphoblastic leukemia (ALL) relapse and an ovarian tumor remains controversial. The authors report about a 4-year-old girl who developed a late bone marrow and cutaneous relapse of her pre-B-cell ALL and revealed an enlargement of her left ovary (4 x 3 x 2 cm). Chemotherapy (ALL-REZ-BFM pilot-protocol 2002) achieved effective remission, but the ovarian mass depicted no regression. Laparoscopic adnexectomy was performed and the tumor could be extracted in a specimen-bag through a 12-mm umbilical incision. Histology detected no viable lymphoblasts, but a fibrotic enlargement due to previous cellular infiltration. The authors conclude that in children with ALL relapse and an ovarian tumor, malignant infiltration as well as local response to chemotherapy can be judged only by surgical excision and histopathologic examination. Laparoscopic oophoradnexectomy is a valuable management option in these children.