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Ovarian Masses in Children: Surgical Experience and Outcomes
Rohit Kapoor1, Ankur Mandelia1, Basant Kumar1
1Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
This study reviewed pediatric ovarian masses, finding that imaging and tumor markers can help distinguish benign from malignant types. All patients treated experienced favorable outcomes, indicating a good prognosis for childhood ovarian tumors.
Area of Science:
- Pediatric Oncology
- Gynecologic Oncology
- Surgical Pathology
Background:
- Ovarian masses in children are uncommon but require careful evaluation.
- Distinguishing between neoplastic and non-neoplastic ovarian masses is crucial for appropriate management.
- Understanding clinical presentation, diagnostic features, and treatment outcomes is vital for improving pediatric care.
Purpose of the Study:
- To review the experience of treating ovarian masses in pediatric patients.
- To emphasize clinical presentation, diagnostic methods, treatment strategies, and patient outcomes.
- To identify factors aiding in the differentiation of benign and malignant ovarian pathologies in children.
Main Methods:
- Retrospective review of electronic medical records for patients under 18 years old treated for ovarian masses between 2009 and 2023.
- Analysis of demographic data, clinical symptoms, physical examination findings, tumor markers, and radiological features.
- Evaluation of operative details, histopathological diagnoses, follow-up status, and overall survival.
Main Results:
- Out of 30 pediatric patients, 83.3% had neoplastic ovarian masses (benign, borderline, or malignant).
- Clinical presentation varied, with abdominal pain more common in benign cases and painless masses in malignant cases.
- Imaging characteristics (size, cystic vs. solid components) and elevated tumor markers (AFP, hCG, LDH) aided in differentiating mass types, with a significant difference observed in tumor size and component composition between benign and malignant lesions (P < 0.05).
Conclusions:
- Preoperative imaging and tumor marker analysis are valuable tools for differentiating benign from malignant ovarian pathologies in children.
- The overall prognosis for pediatric ovarian tumors is favorable, with all patients in this study alive and disease-free post-treatment.
Aims:
This study aims to review our experience of treating ovarian masses in children with an emphasis on clinical presentation, diagnosis, treatment, and outcome.
Methods:
We retrospectively reviewed the electronic medical records of all patients below 18 years of age who underwent surgical treatment for ovarian masses at our institute between 2009 and 2023. Study variables included demography, clinical presentation, physical findings, tumor markers, radiologic features, operative details, histopathology, follow-up status, and overall survival.
Results:
During the study period, 30 patients with a mean age of 10.07 years (range: 15 days-18 years) underwent surgical treatment for ovarian masses. Nonneoplastic ovarian masses were seen in 5 (16.7%) patients, whereas 25 (83.3%) patients had benign (10 [33.3%], borderline 3 [10%], or malignant 12 [40%]) ovarian neoplasms. The most common clinical presentation in the benign group was abdominal pain (n = 6), whereas painless abdominal mass (n = 6) was the predominant complaint in children with malignant tumors. A functional ovarian mass presenting with precocious puberty or virilization was seen in 5 (16.7%) patients. On imaging, nonneoplastic and benign lesions had a mean size of 4.33 (range: 3.1-6) cm and 12.63 (range: 2.8-28) cm, respectively, whereas borderline and malignant masses had a mean tumor size of 22.5 (range: 6.5-32) cm and 12.55 (range: 3.5-18.7) cm, respectively (P < 0.05). The cystic component was identified in all nonneoplastic and benign tumors, whereas the solid component was present in all borderline and malignant lesions (P < 0.05). Tumor markers such as serum alpha-fetoprotein and beta-human chorionic gonadotropin were raised in 8 (66.67%) of malignant tumors, whereas markers were normal in all benign lesions and borderline malignant lesions and 4 (33.33%) of malignant tumors. Lactate dehydrogenase (LDH) was also raised in all malignant masses (n = 12), whereas it was normal in all benign and borderline malignant masses (n = 18). In 6 (20%) patients with nonneoplastic and benign masses with maximum tumor size <6 cm, the laparoscopic approach was adopted, whereas open surgery was preferred in the rest of the patients. At a mean follow-up of 53.5 (range: 4-117) months, all patients are alive and disease free.
Conclusions:
Preoperative imaging characteristics (tumor size and solid component) and raised tumor markers may help us to differentiate between benign and malignant ovarian pathologies. The overall prognosis of pediatric ovarian tumors seems to be favorable.
