Background and Aims

Pediatric adnexal tumor is rare and pre-operative risk assessment of ovarian masses is important in improving fertility preservation, guiding clinical decision in surgical approach, as well as optimal oncological management. We report our experience using Pediatric Risk of Malignancy Index (PRMI) and tumor markers to guide surgical decision in pediatric adnexal masses.

Methods

PRMI score and tumor markers were performed routinely for all pediatric patients with adnexal masses treated in our institution from August 2016 – February 2020 and the results were presented to primary surgeons. PRMI score < 7 predicted a benign histology for pediatric adnexal masses. Prospective study on surgical decisions of the primary surgeons were performed and analyzed.

Results

Fifty patients were treated for pediatric adnexal masses in our institution during the study period. Ten patients (20%) had non-benign pathology. Thirteen patients had PRMI score > 7 (26%). At least one tumor markers were elevated in 18 patients (36%). A PRMI score > 7 and abnormal tumor markers were significantly associated with non-benign histology (P<0.01). PRMI score was significantly associated with surgical approach, where 92% (n=34) cases were performed via Minimally Invasive Surgery (MIS) and 86% (n=32) had an ovarian sparing surgery in patients with PRMI < 7 (P<0.01). Compared to the historical data, more surgeons performed MIS and ovarian sparing surgeries for patients with PRMI score < 7, which predicted benign histology. Tumor markers found to have no associated with surgical approach.

Conclusions

PRMI and tumor markers are useful predictor tools to guide surgical decision for pediatric adnexal masses. More patients with low PRMI score and normal tumor markers underwent minimally invasive and fertility preserving surgeries.

Background and Aims

Ovarian mature teratoma (OMT) can be presented as synchronous or metachronous multiple forms (10 to 20% of cases) in the ipsi or contralateral ovary. Surgical management can be restricted to partial oophorectomy (PO) considering the potential fertility risk after total oophorectomy (TO). This study reviews clinical data of OMT to analyze risk factors of second events.

Methods

A retrospective French analyze was performed of all children (<18 years) with histologically confirmed OMT treated between 2007 and 2016. Were recorded clinical features, surgical approaches, post-operative follow-up; and analysed second events and their management.

Results

Overall, 350 children were identified (median age: 11 years, ranges: 0-17). At diagnosis, bilateral forms were present in 5.1% of cases. Considering the surgical management, after mini-laparotomy (53%), explorative laparoscopy with mini-laparotomy approach (32%) or laparoscopy (15%), PO were more practiced than TO (59%). Per-operative rupture occurred in 23 cases (6.6%).

Twenty-nine cases presented a second event (overall incidence of 8.3%: homolateral recurrence 7 cases, contralateral recurrence 18 cases, on both ovaries 3 cases, malignant form 1 case) after a median follow-up of 25.5 months (ranges 0-88). It was managed by surgery (PO 19 cases, TO 4 cases) or strict surveillance (6 cases). In multivariate risk factors analysis, palpable mass, bilateral forms at diagnosis and per-operative rupture have a statistical impact on the risk of second events (P<5%). The type of initial surgical approach does not impact the outcome (laparotomy p=0.35, laparoscopy p=1.0, PO p=0.56, TO p=0.61).

Conclusions

The risk of second event promotes PO as the first choice of surgical procedure to preserve the ovarian tissue. The post-operative follow-up has to be defined and strengthened after per-operative tumour rupture and in the case of palpable mass or bilateral forms at diagnosis. Information to patients and their family to early consult in case of recurrence of pelvic symptoms are necessary.

Background and Aims

To investigate the current management of ovarian tumors in children by the Egyptian pediatric surgical association (EPSA) consultants.

Methods

Following approval of the EPSA executive board, an online questionnaire was sent via e-mails on EPSA online group mail to all registered consultants. Repeated reminders were sent biweekly for 6 weeks.

Results

Responses were received from 82 consultants (response rate: 82/111, 73.8%) [25 pediatric surgeons with an interest in oncology, 55 pediatric surgeons with other interests and two oncology surgeons with a specialty in childhood tumors]. Diagnosis: 74.4% of respondents indicated abdomino-pelvic mass as the commonest presenting symptom. Concerning imaging, US and CT were reported by 61%. AFP and HCG were requested by 84% as serum tumor markers. Surgery: Approximately 50% of respondents perform 1–3 cases per year. Diagnostic laparoscopy (when indicated) was performed by 70.7%. Transverse abdominal incision was the commonest surgical approach (81.7%). Of all respondents; 66% never encountered intraoperative complications, whereas the remaining 34% had different complications (mainly tumor rupture). Minimally invasive surgery (MIS) was attempted by 53.6% in small-sized benign looking tumors. A total of 69.5% perform ovarian sparing surgery (OSS) in benign masses whenever possible. Follow-up: benign tumors were the most prevalent type observed by 86.6% of respondents. In benign lesions, 28% of surgeons never ask for follow-up and the remaining 72% monitor patients with different schedules.

Conclusions

There is a paradigm shift toward MIS and OSS in the current practice of EPSA consultants. No actual standard protocol of management is present for ovarian tumors in Egypt, and they still fall at the edge between many subspecialties. This survey indicates that national uniform guidelines with international reference are needed to be adopted in our country, and to commence a prospective registration system for such neoplasms which is currently lacking.