Ovarian Masses in Adolescent Girls

Ergende adneksiyal kitleye yaklaşım

“…Baflka bir aç›dan bak›ld›¤›nda overin kötü huylu tümörlerinin %5'den az› ergen ve çocuklarda görülmektedir (2). Over tümörleri çocuklarda menarfl öncesi ortaya ç›kan tüm kanserlerin sadece %1'ini oluflturur (2,4). Ergende en s›k rastlanan over tümörü germ hücreli tümör olup, 20 yafl alt›nda yumurtal›kta bulunan tümörlerin yaklafl›k üçte ikisi germ hücreli tiptir.…”

Gonadal germ cell tumors in children and adolescents

“…The procedure often requires the ovariectomy, due to the size of the mass or uncertainty of diagnosis, however in selected cases with small tumors the enucleation of the lesion can be feasible and many authors advocate ovary-sparing operations with unilateral appearing lesions. [ 13 14 ] On the other hand, every effort should be made to preserve hormonal and reproductive functions in patients with bilateral benign GCTs. Since most GCTs have a mixed structure, immature and malignant elements may coexist also without high levels of serum markers and it is sometime impossible to know whether the lesion is malignant or not before surgery; for this reason the surgical approach should always be very cautious and if any doubt arises on the nature of the mass, intraoperative staging procedures are recommended.…”

“…If the diagnostic suspicion for malignancy is low and the pediatric surgeon is expert in minimally invasive surgery, a laparoscopic approach may be considered in cases with small or cystic masses. [ 12 13 14 15 16 ] Avoidance of tumor spill can be assured utilizing different techniques: The cystic mass can be placed in a retrieval bag, firstly punctured and then removed without spill within the bag;…”

“…The incidence of malignancy in children with ovarian torsion is low; most solid ovarian masses associated with torsion are benign. [ 13 ] Ovarian torsions require an emergent procedure and usually a laparoscopic procedure is preferred. The ovary can be excised or detorsed depending on the intraoperative findings.…”

“…[ 18 19 ] If a malignant GCT is proven by frozen section examination of a biopsy of the mass, en bloc resection of testis and spermatic structures with ligation of the cord at the internal inguinal ring is required. [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ] A complete removal of the tumor is feasible in most cases and the postoperative decrease of αFP will confirm the absence of disease in localized GCTs. Patients with scrotal skin involvement and those operated or biopsied through a scrotal approach should undergo hemiscrotectomy to ensure the local control; some authors state that when a scrotal orchiectomy has been performed without violation of the tumor capsule and the tumor markers decrease after the operation, hemiscrotectomy can be avoided assuming negative margins; however, the proximal cord structures should be resected up to the internal ring with an inguinal approach.…”