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Ovarian Tumors in Children and Young Adults.

El-Said Abdel-Hady,

PhD, FRCOG,

former Dean of Medicine, Mansoura University,

President of

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Objectives

Epidemiology,
Clinical Presentation,
Diagnosis and Treatment,
Follow up and prognosis,
Mansoura Experience.

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Ovarian cancer in children and young adults in the United States, 1992-1997.�

Ovarian cancer in children and young adults is rare, and consequently, little research concerning this disease has been conducted in this age group.

John L Young Jr, et al. Cancer. 2003 May 15;97(10 Suppl):2694-700.

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New era of Fertility preservation in gynecologic cancers

Gynecologic cancers affect a significant proportion of young-age women who wish to preserve fertility for a future chance of childbearing.

TaylanTaylan E, Oktay K. Gynecol Oncol. 2019 Dec;155(3):522-529

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Pediatric ovarian tumors, a challenge for pediatricians and gynecologists�

The incidence increases with age,
0.43 in 100,000 cases at 1 year,
152 in 100,000 at 35-years.

Under the age of 18 years,

Most cases are benign functional cysts,
10% of adnexal tumors are malignant.

Marginean CO, et al. Medicine (Baltimore). 2019 Apr; 98(16): e15242.

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Clinical presentation

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Clinical presentation

Abdominal pain is the main presenting symptom. Acute pain due to torsion is rare.

Abdominal enlargement: may be huge.

Menstrual irregularity is rare (in sex cord stromal tumours).

Some tumours are accidentally discovered.

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Diagnosis (clinical, imaging and tumor markers)

Pelvi-abdominal swelling on examination.

Ultrasound scan is the first indication of an ovarian swelling.

CT and MRI with any suspicious findings.

Tumor markers.

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Jeong YY. Imaging evaluation of ovarian masses. RadioGraphics 2000;20(5): 1445–1470.

It is often difficult to distinguish between benign and malignant ovarian tumors by USS.

Malignant tumors will appear predominantly solid or heterogeneous and tend to be larger than benign tumors.

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Tumor Markers �J Pediatr Surg 2010; 45(1):130–134.

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Tumour markers

Negative tumor markers do not exclude the possibility of malignancy because the markers are positive in only 54% of cases.

Oltmann SC. Can we preoperatively risk stratify ovarian masses for malignancy? J Pediatr Surg 2010; 45(1):130–134.

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Schultz KA. Pediatric ovarian tumors: a review of 67 cases. Pediatr Blood Cancer 2005;44(2):167–173.�

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Germ cell tumors

The most commonly diagnosed ovarian tumor in the age group below 20 years.

Tend to be of low grade and low stage,

(70-75% of patients present in Stage I disease).

This not only enables but also necessitates preserving the fertility in women who have not completed their family.

Ayhan A, Celik H, Taskiran C, Bozdag G, Aksu T. Oncologic and reproductive outcome after fertility-saving surgery in ovarian cancer. Eur J Gynaecol Oncol. 2003;24(3-4):223-32

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Treatment

When to treat?
When Not to treat?
Where to treat?
Who should treat?
What form of treatment?

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Where to treat?

Tertiary care centers with expertise in gynaecological oncology and availability of frozen section pathology.

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Fertility sparing surgery

Cytology or washings,
Frozen section,
Ovarian cystectomy,
Unilateral ovariectomy,
Unilateral salpingo-oophrectomy,
Unilateral salpingo-oophorectomy plus contralateral cystectomy.

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Malignant tumours

Consider stage and tumor grade

Stage 1c (tumor invading the capsule with ascites containing malignant cells)

Needs postoperative chemotherapy according to histological subtype.

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Advanced stages

Fertility sparing surgery is confined to early-stage and low-grade disease.

Conflicting results with unilateral ovarian carcinoma with extra-pelvic disease (up to Stage III).

Candidates for those procedures were selected according to the FIGO stage, grade, ploidy state, histological subtypes and patients' desire.