Diagnosis Difficulties and Minimally Invasive Treatment for Ovarian Masses in Adolescents

Abstract

About 1% of childhood tumors can be malignant ovarian tumors and differential diagnosis with benign ones is sometimes difficult before surgery. Concerning the management of such tumors in adolescents for which future fertility is a concern, there is specific interest in their malignant potential and the possible use of ovarian-sparing operative techniques, as well the suitability of chemotherapy. To exemplify the difficulties of preoperative differential diagnosis, personalized approach and the difficulties of deciding to preserve the affected ovary, we report a rare case of a 14-year-old female adolescent with a growing abdominal painless mass and without any other chronic diseases. After physical examination and imaging investigations, laparoscopic surgical procedure is performed, the peritoneal cavity is explored and the well-delimited gigantic tumor is removed. Considering the normally looking pelvis and absence of adenopathy, as well as the patient’s age and wish to have children, both ovaries are preserved. Laparoscopy has become the gold standard in the management of this condition, although there are few studies that report this approach in children; the differential diagnosis between a benign and a malignant tumor cannot be established exactly until after the histological examination, which revealed in our case a cystic teratoma with mature tissues. A better understanding of clinical features and evolution of giant ovarian masses in adolescents could help clinicians better diagnose and treat such lesions.

Doppler Ultrasound versus Pelvic Magnetic Resonance Imaging in diagnosis of ovarian mass in teenagers: A Prospective study

“…Adolescent gynecologic pathology is dominated by adnexal tumours [11] . Functional cysts, ovarian torsion and benign masses have been considered the commonest tumours detected in adolescence periods, however approximately 1% of childhood tumours could be malignant ovarian tumours and differential diagnosis with benign tumours is often difficult prior to surgical interference [12] .…”

Ovarian Masses in Children and Adolescents: A Review of the Literature with Emphasis on the Diagnostic Approach

“…Ovarian Neoplasm AFP 1 Immature teratoma Yolk sac tumor Embryonal carcinoma Sertoli-Leydig cell tumor (rare) LDH 2 Dysgerminoma…”

“…Ovarian masses, including both non-neoplastic lesions and neoplastic tumors, can occur in all age groups. The incidence, clinical presentation and histological distribution of such lesions in children and adolescents are distinct from those in adults and require a particularized therapeutic approach [2]. Masses of the ovary range from simple functional cysts to malignant neoplasms.…”

“…The diagnostic value of tumor markers is higher when the results are combined with clinical and radiological information. In any case, the definite diagnosis of an ovarian mass is established only after its surgical removal and histopathological examination [2]. Monitoring of serum tumor markers is helpful for postoperative follow-up as it may provide evidence of disease relapse [15].…”

Therapeutic Management and Prognostic Factors for Ovarian Malignant Tumours in Adolescents: A Comprehensive Review of Current Guidelines

“…The diagnosis of ovarian cancer in the adolescent population can pose challenges in clinical practice, considering the low suspicion of the disease due to young age, the heterogenous and often subtle clinical presentation and the potential limitations in diagnostic imaging in an effort to reduce radiation exposure [ 15 , 16 ]. Ovarian-mass related symptoms are usually non-specific, such as diffuse subacute abdominal and pelvic pain, feeling of pelvic pressure, distended abdomen, rapid increase in abdominal volume, urinary or bowel transit disorders, nausea, vomiting and, much rarer in early puberty, vaginal bleeding and menstrual irregularities [ 17 , 18 ].…”