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Pre-operative differentiation of pediatric ovarian tumors: morphological scoring system and tumor markers
Zoran B Stankovic1, Milan K Djukic, Djordje Savic
1Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia, Serbia. zodar@eunet.yu
Insights
Morphological scoring systems like DePriest's index are crucial for differentiating benign from malignant childhood ovarian tumors. This aids in accurate diagnosis and appropriate treatment planning for pediatric patients.
Area of Science:
- Pediatric Oncology
- Gynecologic Pathology
- Medical Imaging
Background:
- Childhood ovarian tumors require accurate differentiation between benign and malignant types.
- Morphological assessment plays a key role in preoperative evaluation.
Purpose of the Study:
- To evaluate the effectiveness of morphological scoring systems in distinguishing benign from malignant ovarian tumors in children.
- To assess the utility of tumor markers and endocrinological investigations in preoperative diagnosis.
Main Methods:
- Histopathological confirmation of ovarian tumors in pediatric patients.
- Morphological assessment using DePriest's index and Ueland's index.
- Evaluation of tumor markers and ultrasonographic findings.
Main Results:
- Ultrasonography accurately predicted benign cystic tumors.
- DePriest's and Ueland's indexes demonstrated high sensitivity and accuracy in differentiating benign tumors (score <7).
- Elevated tumor markers were noted in 17 patients, with some exhibiting endocrine manifestations.
Conclusions:
- Ultrasonographic assessment combined with morphological analysis (DePriest and Ueland) is highly effective for differentiating pediatric ovarian tumors.
- Tumor markers and endocrinological investigations provide valuable preoperative diagnostic information.
Objective:
To investigate the importance of morphological scoring systems in differentiation of ovarian tumors in childhood.
Methods:
Morphological assessment using DePriest's index was performed for all patients with histopathological confirmation of ovarian tumor, with evaluation of tumor markers, from January 1997.
Results:
Fifty-three girls (age range 13 months to 19 years) were surgically treated for 59 ovarian tumors, including six bilateral. All lesions with cystic appearance on ultrasonography were benign, 23 of 35 semisolid, and four of ten solid tumors were also benign. Stage of malignant disease was as follows: stage I, ten; stage II, two; stage III, six. Sensitivity, positive predictive value and accuracy by DePriest's and Ueland's indexes for benign tumors (score <7) were: 0.88, 0.79; 0.89; and 0.94, 0.84; 0.93; respectively. Elevated levels of tumor markers were observed in 17 patients, including four patients with endocrine manifestations. In 24 patients ovaries were successfully preserved, including two patients with foci of immature teratoma in a dermoid cyst.
Conclusion:
Ultrasonographic assessment with morphological analysis recommended by DePriest and Ueland is a very useful procedure for differentiating benign from malignant ovarian tumors in children. Tumor markers and endocrinological investigation are also useful for preoperative evaluation.
