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Fertility Preservation in Patients with Severe Ovarian Dysfunction
Published on: March 25, 2021
[Diagnosis and management in pediatric patients with ovarian masses]
C C Cabrera Chamorro1, C A Caicedo Paredes1, E A Portillo Bastidas1
1Servicio de Cirugía Pediátrica. Fundación Hospital Infantil Los Ángeles. Pasto, Colombia.
Insights
In pediatric ovarian masses, large size, solid components, and positive tumor markers predict malignancy. Ovarian preservation is recommended for low-risk masses, while oophorectomy is for high-risk cases.
Area of Science:
- Pediatric Surgery
- Gynecologic Oncology
- Pediatric Oncology
Background:
- Ovarian masses are common in children, requiring careful diagnosis and management.
- Distinguishing benign from malignant ovarian masses preoperatively is crucial for appropriate treatment planning.
Purpose of the Study:
- To review the diagnosis and management of pediatric ovarian masses.
- Identify preoperative risk factors for malignancy.
- Evaluate surgical management strategies and outcomes.
Main Methods:
- Retrospective study of pediatric patients (<18 years) surgically managed for ovarian masses.
- Analysis of symptoms, imaging, tumor markers, treatment, outcomes, and pathology.
- Primary endpoint: ovarian malignancy.
Main Results:
- 54 patients identified (2014-2017); 49 benign, 5 malignant.
- Malignant masses were larger (19.4 cm vs. 6.49 cm), had more solid components, and positive tumor markers.
- Benign masses (43 patients) underwent ovarian preservation; malignant masses underwent oophorectomy and staging.
Conclusions:
- Large size, solid components, and positive tumor markers predict malignancy in pediatric ovarian masses.
- Ovarian preservation surgery is suitable for low-risk masses.
- Oophorectomy with tumor staging is indicated for high-risk malignant ovarian tumors.
Objective:
Review of the diagnosis and management of ovarian masses in children, through the identification of preoperative risk factors of malignancy, the evaluation of surgical management and its results.
Methods:
Retrospective study in pediatric patients under 18 years old, managed surgically by ovarian masses. Analyzed data were symptoms, imagining, tumor markers, treatment, outcomes and pathology. The primary endpoint was ovarian malignancy.
Results:
We identified 54 patients with ovarian masses between 2014 and 2017, of which 49 were benign and 5 malignant; The malignant ovarian masses were significantly larger than the benign, with an average of 19.4 cm vs 6.49 cm (p = 0.0001); had greater solid component in the imaging and positive tumor markers (p = 0.001) and were treated with oophorectomy plus tumor staging surgery. Forty-three patients with benign tumors underwent ovarian preservation surgery. The postoperative follow-up of all the patients was on average 3.4 months (1-25 months) and 20.3% presented pelvic pain associated with alterations of the menstrual cycle in their postoperative control. There are no reports of recurrence or contralateral ovarian tumor.
Conclusions:
Large masses with solid components and positive tumor markers were significant predictors of malignancy. Minimally invasive ovarian preserving surgery should be considered as the first treatment option in masses with low risk of malignancy. On the other hand, oophorectomy plus tumor staging surgery should be considered for ovarian tumors with a high risk of malignancy.
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