Gynecologic tumors and symptoms in childhood and adolescence; 10-years' experience

The advancement of diagnostic imaging evaluations and the earlier occurrence of secondary sexual development prompted us to review our recent experience with genital tract tumors in children.

We analyzed data for 1938 patients aged less than 18 years who were referred to Gifu University School of Medicine-affiliated Hospitals for the years 1984 through 1993.

Of the patients, 145 underwent surgical treatment. Vaginal tumor was seen in 5 patients; 1 endodermal sinus tumor, 1 sarcoma botyroides and 3 Gartner's duct cysts. Two patients with malignant tumor presented only with bloody vaginal discharge; recurrent abdominal pain due to vaginal obstruction was noted in 1 patient with the cyst. Ten had benign tumors in the vulva, presenting with a genital mass. Of 114 ovarian tumors, 3 were diagnosed by antenatal ultrasonographic examinations. Fifty-five had germ cell tumors, 33 had epithelial tumors, and 18 had stromal tumors. The most common symptom was abdominal pain and approximately one-third of girls who complained of abdominal pain had an ovarian tumor. Precocious puberty was noted in 4 girls with stromal tumor. Two of the 23 malignant tumors developed in the vagina and the others originated in the ovary. In 19 patients unilateral salpingo-oophorectomy or local excision was done in an attempt for reproductive organ conservation; 4 cases of advanced stage disease were treated with hysterectomy and/or bilateral salpingo-oophorectomy. Only 3 of the 23 patients with malignant tumor died within 4 years and others are free from disease.

Genital symptoms, even common, alert us to the possibility of a genital tract tumor. The prompt and precise detection of either benign or malignant tumors in children may lead to cure and preservation of fertility with conservative surgery.