Benign ovarian masses

doi:10.1053/j.sempedsurg.2005.01.004

Seminars in Pediatric Surgery

Volume 14, Issue 2, May 2005, Pages 93-99

https://doi.org/10.1053/j.sempedsurg.2005.01.004 Get rights and content

Primary tumors of the ovary are uncommon in children and the majority of these masses are not malignant. As newer diagnostic imaging techniques have increased the detection of all ovarian masses, the frequency of ovarian cancer has actually decreased. Clinical symptoms are generally not helpful in distinguishing benign from malignant masses, but radiographic criteria have been developed. Surgical treatment is aimed at ovarian preservation if the lesion proves benign.

Section snippets

Presentation

Benign ovarian neoplasms may be asymptomatic and recognized only on routine pelvic examination or ultrasound. They will become acutely symptomatic if they undergo torsion, rupture or hemorrhage.3, 4 Abdominal pain is the most common symptom. A chronic pattern of pain, increasing abdominal girth and distention over several weeks to months, and secondary symptoms such as anorexia, nausea, vomiting and urinary frequency and urgency may also occur.

Ovarian masses in the neonatal age group are

Investigation

Useful tests including laboratory work that may assist in the investigation of an ovarian mass are detailed in Table 3. Imaging of any suspected pelvic mass is essential. Plain abdominal films may show pelvic calcifications suggestive of a benign teratoma (Figure 1). Ultrasound is the diagnostic study of choice for initial evaluation of potential ovarian pathology in all age groups. Transvaginal pelvic ultrasound is widely used in nonvirginal patients since it provides excellent resolution 2 to

Mature cystic teratomas

Traditional management of children with mature cystic teratomas (MCT) has been oophorectomy via laparotomy.19, 20, 21 This is due to concern about occult germ cell malignancy along with the viability of ovarian tissue and potential for MCT recurrence after cystectomy. Additional concerns include intraoperative MCT spill with the subsequent risk of chemical peritonitis and adhesion formation. These risks are minimized with complete cyst excision and copious intraperitoneal irrigation if there is

Summary

The overwhelming majority of adnexal masses are benign. Some will be discovered incidentally on routine examination or radiographs done for another reason. Symptoms are generally due to a complication related to the mass such as torsion, rupture or hemorrhage, or due to a large mass compressing or displacing adjacent structures. Ultrasound is the radiographic study of choice, with CT scan and MR scan as needed for specific indications. Resection of a benign mass with ovarian preservation is the

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Cited by (35)

Ovarian torsion in a two-year-old
2022, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
Image 1Image 2 Serum Markers and Radiologic Characteristics of Ovarian Tumors [6-8]Image 3 Best practice recommendations occasionally seem counterintuitive.
Ovarian torsion occurs infrequently; and usually another diagnosis, such as appendicitis or intussusception, is initially suspected. Torsion of ovary and testis occurs with equal frequency, yet oophorectomy exceeds orchidectomy by a factor of two. This disparity is attributed to delay in diagnosis and misapprehension of operative findings.
A two-years-old girl presented with abdominal pain and vomiting. Torsion of the right ovary was diagnosed by ultrasound (Fig. 1, Fig. 2, Fig. 3, Fig. 4). The ovary was untwisted laparoscopically and preserved, despite its grossly abnormal appearance (Fig. 5). Two follow-up ultrasounds were performed; both studies showed normal ovaries bilaterally (Fig. 6, Fig. 7).
Torsion has these prerequisites:
• the mass has bulk and is lopsided.
• the mass has no surface adhesions.
• the mass has a narrow tether.
The ovaries of a two-year-old are tiny and unlikely candidates to twist. Ovarian cysts and tumors may elicit torsion, but these are rare during childhood; their estimated incidence is 5/100,000.
These considerations and the appearance of the ovary argued for oophorectomy, especially since malignancy, though rare in pediatrics, occurs most frequently in girls who are 2 years-old or less. Nevertheless, the best practice recommendation is preservation of the ovary; and this decision proved correct.
Evaluation and Treatment Results of Ovarian Cysts in Childhood and Adolescence: A Multicenter, Retrospective Study of 100 Patients
2017, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
Adnexal masses are uncommon during childhood, but their recognition is increasing perhaps as a result of the increasing availability of advanced diagnostic technologies. Finding a mass in a child always raises concern for malignancy, but the most adnexal masses in children are thought to be benign ovarian cysts.1 Up to 98% of female newborns have small ovarian cysts on ultrasonography (USG), but the prevalence of clinically significant ovarian cysts in this age group is approximately 1 in 2500 live births.
To investigate the characteristics of children with ovarian cysts and evaluate treatment strategies.
Retrospective study.
Eight pediatric endocrinology clinics, Turkey.
A total of 100 children and adolescents with ovarian cysts.
Patient data collected via retrospective chart review. Patients were stratified according to age into 4 groups (newborns, 1-12 months, 1-8 years, and 8-18 years).
Special emphasis was given to torsion and tumor cases, concomitant diseases, treatment modalities, and problems during follow-up.
Most newborns and infants were asymptomatic with the cysts being discovered incidentally; in girls ages 1-8, symptoms were common, including breast budding (47.1%, 16 of 34) and vaginal bleeding (29.4%, 10 of 34). Girls older than 8 years mostly presented with abdominal pain (31.6%, 12 of 38) and menstrual irregularity (21.1%, 8 of 38). Most of our patients were diagnosed with a simple ovarian cyst, but 9 patients were found to have ovarian tumors. Ovarian torsion was detected in 7 patients; 5 with large and 2 with small cysts (<20 mm). Two patients had central precocious puberty (CPP) at presentation and 5 patients developed CPP during follow-up. The surgical intervention rate was high (38%, 38 of 100), but was associated with earlier treatment year, and this association remained significant after adjusting for confounders (P = .035).
Most girls have simple cysts, which have a favorable prognosis without intervention; however, there might be coexisting pathologies or complications such as tumors, torsion, and CPP; hence these patients should be evaluated accordingly and treated with a multidisciplinary approach.
Specificities of carcinomas in adolescents and young adults
2017, Bulletin du Cancer
Les carcinomes sont des tumeurs rares de l’adolescent–jeune adulte (AJA) au spectre différent de ceux de l’adulte. Les localisations les plus fréquentes en dehors de la thyroïde sont le nasopharynx, les glandes salivaires, le côlon-rectum et les ovaires. Si les carcinomes du nasopharynx ou des glandes salivaires sont des tumeurs de bon pronostic, d’autres sont de pronostic plus réservé, comme les carcinomes digestifs, gynécologiques ou de la ligne médiane. Les modes de révélation sont aspécifiques et dépendent de la localisation : masse, syndrome tumoral, douleur, altération de l’état général. Le caractère inhabituel des carcinomes à l’âge pédiatrique conduit à proposer une exploration oncogénétique systématique. La généalogie, les signes cliniques associés et le type de carcinome doivent guider les analyses. En l’absence d’orientation, l’analyse du gène TP53 et, pour les carcinomes du spectre élargi du syndrome hereditary non-polyposis colorectal cancer (HNPCC), la recherche de mutation des gènes MMR (mismatch repair) semble essentielle. En raison de la rareté de ces maladies et de l’absence de recommandations homogènes, les membres du comité tumeurs rares de la SFCE recommandent pour la prise en charge de ces AJA, une relecture histologique par un pathologiste habitué aux carcinomes de l’adulte, un double avis en oncologie pédiatrique et adulte, une analyse des référentiels adultes avec adaptation au caractère pédiatrique de la maladie, en particulier en termes de risque d’effets secondaires. Un recours à un avis national (par un membre du groupe FRACTURE) ou européen (groupe EXPERT) est parfois nécessaire dans les situations les plus complexes.
Carcinomas are rare tumors of the adolescent–young adult (AYA) with a different spectrum from those of adults. The most common sites outside of the thyroid is the nasopharynx, salivary gland, colon-rectum and ovaries. If nasopharyngeal carcinoma or salivary gland tumors are good prognosis, others are more reserved prognosis, such as digestive carcinomas, gynecological or midline. The revelation modes are non-specific and depend on the location: mass, tumor syndrome, pain, impaired general condition. The unusual of pediatric carcinomas led to propose a systematic oncogenetic exploration. The medical history of the family, the symptoms and the type of the carcinoma should guide the analysis. In the absence of guidance, analysis of TP53 gene and, for carcinomas of the expanded spectrum of the hereditary non-polyposis colorectal cancer (HNPCC) syndrome, the search for mutation of MMR genes (mismatch repair) seems essential. Because of the rarity of these diseases and the absence of homogeneous recommendations, members of the rare tumors committee of the SFCE recommended for the management of these AJA, an histological review by a pathologist familiar with carcinomas of the adult, a double discussion between pediatric and adult oncologists, analysis of adult standards with adaptation to pediatric data, especially in terms of risk of side effects. An advice to a national opinion (by a member of FRACTURE group) or European (group EXPERT) is sometimes necessary in the most complex situations.
Epithelial Tumors of the Ovary in Children and Teenagers: A Prospective Study from the Italian TREP Project
2015, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
In the literature, only 14 and 11 cases, respectively, of borderline epithelial tumors and benign epithelial tumors are described in premenarchal or perimenarchal girls.16–18 Benign serous cystadenoma is the most common subtype.6,9 These findings has been previously explained with the hypothesis that ovarian epithelial tumors could be stimulated by hormones19,20 or arise from repeatedly disrupted and repaired ovarian surface epithelium (with subsequent higher risk of spontaneous mutations) during ovulation processes, which are more numerous in this age group.21
To report the clinical findings and treatment results of a series of patients with epithelial tumors of the ovary, registered and treated prospectively in a multi-institutional Italian network (TREP project) on rare tumors in children and adolescent between 2000 and 2014.
Data on 16 patients, aged 22 to 206 months, from 7 centers were reviewed. All patients were grouped on the basis of the results of the first surgical approach, according to the Children Oncology Group staging system.
The most frequent symptom was abdominal pain; 3 patients were hospitalized for acute pain after ovarian torsion. Initial surgical treatment was complete in 15 of 16, and a biopsy was performed in 1 of 16. The histology examination revealed 8 benign tumors (7 mucinous cystadenomas and 1 serous cystadenoma) and 8 borderline tumors (2 serous and 6 mucinous). Fifteen of 16 patients maintained the complete remission after surgical treatment alone; 1 affected by Proteus syndrome died consequent to the progression of a synchronous Wilms tumor, after a delayed incomplete surgery.
Our analysis documented the rarity of these tumors in children and adolescents. No malignant histologies were found. Surgery alone was effective to cure the majority of patients. Considering the rarity of malignant entities, ovary-sparing surgery may be planned when an epithelial tumor is suspected on the basis of the preoperative work-up and intraoperative findings.
Ovarian tumors in children and adolescents: A series of 41 cases
2015, Diagnostic and Interventional Imaging
Revue iconographique avec analyse sémiologique fine des tumeurs ovariennes de l’enfant et l’adolescente afin de proposer une orientation diagnostique pertinente.
Étude rétrospective (2001–2011) de 41 patientes âgées de moins de 15 ans et opérées d’une masse ovarienne avec étude anatomo-pathologique.
Soixante-deux pour cent des lésions étaient bénignes, 33 % étaient malignes et 5 % étaient borderline. Les tumeurs germinales étaient les plus fréquentes (77,5 %) suivies des tumeurs des cordons sexuels et du stroma (12,5 %) et des tumeurs épithéliales (7,5 %). Les tumeurs malignes étaient plus fréquemment observées entre 0 et 2 ans. En imagerie, les calcifications et la graisse étaient spécifiques des tumeurs germinales ; le nodule mural était évocateur de tératome mature (p < 0,001). Les critères prédictifs de malignité étaient cliniques : augmentation de volume de l’abdomen (p < 0,01), masse palpable (p = 0,05), biologiques : augmentation du taux d’hCG et/ou d’AFP (p < 0,001) et en imagerie : taille supérieure à 12 cm (p < 0,05), vascularisation lésionnelle (p < 0,01) et ascite abondante (p < 0,01).
Cette analyse sémiologique permet de mieux appréhender le diagnostic étiologique des tumeurs ovariennes en pédiatrie et souligne, en particulier, à côté des critères classiques, l’importance de la mise en évidence d’une vascularisation tumorale hautement prédictive de malignité.
Ovarian tumors in children and adolescents: A series of 41 cases
2015, Diagnostic and Interventional Imaging
Pictorial review with a detailed semiological analysis of ovarian tumors in children and adolescents to provide a relevant diagnostic approach.
Retrospective study (2001–2011) of 41 patients under the age of 15 who underwent surgery for an ovarian mass with a definite pathological diagnosis.
Sixty-two percent of the lesions were benign, 33% were malignant and 5% were borderline. Germ cell tumors were most frequent (77.5%), followed by sex cord stromal tumors (12.5%) and epithelial tumors (7.5%). Malignant tumors were more frequent in children between 0 and 2 years old. On imaging, calcifications and fat were specific for germ cell tumors; the presence of a mural nodule was predictive of a mature teratoma (P < 0.001). Predictive factors for malignancy were clinical, including abdominal distension (P < 0.01) or a palpable mass (P = 0.05), biological, including increased hCG and/or AFP levels (P < 0.001) and radiological, including tumors larger than 12 cm (P < 0.05), tumoral hypervascularity (P < 0.01) and voluminous ascites (P < 0.01).
This semiological analysis confirms the role of imaging in diagnosing the etiology of ovarian lesions in children and adolescents and emphasizes the importance identifying tumoral hypervascularity, which, in addition to classic criteria, is highly predictive of malignancy.

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Benign ovarian masses

Section snippets

Presentation

Investigation

Mature cystic teratomas

Summary

Semin Pediatr Surg

Obstet Gynecol

J Pediatr Surg

Int J Gynecol Obstet

Clin Imaging

J Adolesc Health Care

Adolesc Pediatr Gynecol

Magn Reson Imaging

J Am Assoc Gynecol Laparosc

J Pediatr Surg

Int J Obstet Gynecol

J Pediatr Surg

Gynecol Oncol

Fertil Steril

Fertil Steril

Ovarian cancer in children

Semin Surg Oncol

Ovarian cancer in children and young adults in the United States 1992–1997

Cancer

Ovarian masses in young adolescentsimaging findings with surgical confirmation

Eur J Gynaecol Oncol

Imaging of pediatric ovarian masses

Radiographics