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01-06-2012 | Healthcare Policy and Outcomes

The Role of Tumor Markers in the Surgical Approach of Ovarian Masses in Pediatric Age: A 10-Year Study and a Literature Review

Authors: Claudio Spinelli, MD, Valentina Pucci, Irene Buti, MD, Josephine Liserre, MD, Antonio Messineo, MD, Francesco Bianco, Clara Ugolini, MD

Published in: Annals of Surgical Oncology | Issue 6/2012

Abstract

Purpose

The purpose of this study was to detect the role of serum tumor markers in the differential diagnosis and in the choice of the surgical treatment of ovarian lesions in pediatric age.

Methods

We retrospectively reviewed medical charts of all pediatric girls operated in two pediatric centers during a 10-year period. The following features were analyzed: age at the moment of presentation, symptoms, diagnostic studies, surgical approach, pathological findings, and, in particular, serum tumor markers. Also, a literature review and statistical analysis (χ² test) concerning the increase of different tumor markers in benign and malignant ovarian lesions were related to the study.

Results

A total of 120 children with 127 ovarian masses (7 with bilateral pathologies) were reviewed. Pathology showed 61 nonneoplastic lesions (48%), 54 benign tumors (42.5%), 5 malignant tumors (4%), and 7 torsed normal ovaries (5.5%). The evaluation of serum tumor markers was performed in 106 cases and was positive in 16 (15.1%): in all of the 5 cases (100%) of malignant neoplastic lesions and in 11 (20.4%) benign neoplastic ones. The literature review confirmed these data, and statistical analysis highlighted them as significant values.

Conclusions

The role of tumor markers is still controversial. This is the reason why, before considering a radical treatment, we suggest caution to optimize future fertility.

Oltman SC, Garcia N, Barber R, Huang R, Hicks B, Fischer A. Can we preoperatively risk stratify ovarian masses for malignancy? J Pediatr Surg. 2010;45(1):130–4.CrossRef

Al Jama FE, Al Ghamdi AA, Gasim T, Al Dakhiel SA, Rahman J, Rahman MS. Ovarian tumors in children and adolescents: a clinical study of 52 patients in a university hospital. J Pediatr Adolesc Gynecol. 2011;24(1):25–8.PubMedCrossRef

Ruttenstock EM, Saxena AK, Schwinger W, Sorantin E, Hoellwarth ME. Pediatric Ovarian Tumors-Dilemmas in diagnosis and management. Eur J Pediatr Surg. 2010;20(2):116–20.PubMedCrossRef

Spinelli C, Di Giacomo M, Cei M, Mucci N. Functional ovarian lesions in children and adolescents: when to remove them. Gynecol Endocrinol. 2009;25(5):294–8.PubMedCrossRef

Hatzipantelis ES, Dinas K. Ovarian tumors in childhood and adolescence. Eur J Gynaecol Oncol. 2010;31(6):616–20.PubMed

Sarnacki S, Brisse H. Surgery of ovarian tumors in children. Horm Res Paediatr. 2011;75(3):220–4.PubMedCrossRef

Morowitz M, Huff D, von Allmen D. Epithelial ovarian tumors in children. A retrospective analysis. J Pediatr Surg. 2003;38(3):331–5.PubMedCrossRef

Cass DL, Hawkins E, Brandt ML, et al. Surgery for ovarian masses in infants, children and adolescents: 102 consecutive patients treated in a 15-year period. J Pediatr Surg. 2001;36(5):693–9.PubMedCrossRef

Spinelli C, Mucci N, Di Giacomo M, Pistolesi F, Cei M, Vergnani S. Evaluation, management and outcome of paediatric ovarian lesions: 67 consecutive patients surgically treated in a 7-year period. Rev de Cir Infantil. 2008;18(3):35–42.

10.

Brookfield KF, Cheung MC, Koniaris LG, Sola JE, Fischer AC. A population-based analysis of 1037 malignant ovarian tumors in the pediatric population. J Surg Res. 2009;156(1):45–9.PubMedCrossRef

11.

Von Allmen D. Malignant lesions of the ovary in childhood. Semin Pediatr Surg. 2005;14(2):100–5.CrossRef

12.

Hayes-Jordan A. Surgical management of the incidentally identified ovarian mass. Semin Pediatr Surg. 2005;14(2):106–11.PubMedCrossRef

13.

Stankovic ZB, Djukic MK, Savic D, Lukac BJ, Djuricic S, Sedlecki K, Zdravkovic D. Preoperative differentiation of pediatric ovarian tumors: morphological scoring system and tumor markers. J Pediatr Endocrinol Metab. 2006;19(10):1231–8.PubMedCrossRef

14.

Pectasides D, Pectasides E, Kassanos D. Germ cell tumors of the ovary. Cancer Treat Rev. 2008;34(5):427–41.PubMedCrossRef

15.

Kalfa N, Philibert P, Patte C, et al. Juvenile-granulosa cell tumor: clinical and molecular expression. Gynecol Obstet Fertil. 2009;37(1):33–44.PubMedCrossRef

16.

Balan P. Ultrasonography, computed tomography and magnetic resonance imaging in the assessment of pelvic pathology. Eur J Radiol. 2006;58(1):147–55.PubMedCrossRef

17.

Spinelli C, Di Giacomo M, Mucci N, Massart F. Hemorrhagic corpus luteum cysts: an unusual problem for pediatric surgeons. J Pediatr Adolesc Gynecol. 2009;22(3):163–7.PubMedCrossRef

18.

Scully R. International histological classification of tumors: histological typing of ovarian tumors. World Health Organization, Geneva, 1999.CrossRef

19.

FIGO Committee on Gynecologic Oncology. Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynecol Obstet. 2009;105:3–4.CrossRef

20.

Pantelli C, Curry J, Kiely E, et al. Ovarian germ cell tumors: a 17-year study in a single unit. Eur J Pediatr Surg. 2009;19(2):96–100.CrossRef

21.

Stankovic Z, Djuricic S, Djukic M, Jovanovic D, Vasiljevic M. Epithelial ovarian tumors and Ca-125 in premenarchal girls. Eur J Gynaecol Oncol. 2006;27(6):597–9.PubMed

22.

Schultz KA, Sencer SF, Messinger Y, Neglia JP, Steiner ME. Pediatric ovarian tumors: a review of 67 cases. Pediatr Blood Cancer. 2005;44(2):167–73.PubMedCrossRef

23.

De Backer A, Madern GC, Oosterhuis JV, Hakvoort-Cammel FG, Hazebroek FW. Ovarian germ cell tumors in children: a clinical study of 66 patients. Pediatr Blood Cancer. 2006;46(4):459–64.PubMedCrossRef

24.

Kong B, Tian YJ, Zhu WW, Qin YJ. A pure non-gestational ovarian choriocarcinoma in a 10-year-old girl: case report and literature review. J Obstet Gynaecol Res. 2009;35(3):574–8.PubMedCrossRef

25.

Takekawa Y, Kemmotsu H, Mouri T, Joe K, Ohkawa H. A case of pediatric ovarian dysgerminoma associated with high serum levels and positive immunohistochemical staining of neuron-specific enolase. J Pediatr Surg. 2004;39(9):1437–9.CrossRef

26.

Aggarwal A, Lucco KL, Lacy J, Kives S, Gerstle JS, Allen L. Ovarian epithelial tumors of low malignant potential: a case series of 5 adolescent patients. J Pediatr Surg. 2009;44(10):2023–7.PubMedCrossRef

27.

Schneider DT, Jänig U, Calaminus G, Göbel U, Harms D. Ovarian sex cord-stromal tumors: a clinicopathological study of 72 cases from the Kiel Pediatric Tumor Registry. Virchows Arch. 2003;443(4):549–60.PubMedCrossRef

28.

Oltmann SC, Garcia NM, Barber R, Hicks B, Fischer AC. Pediatric ovarian malignancies: how efficacious are current staging practices? J Pediatr Surg. 2010;45(6):1096–102.PubMedCrossRef

29.

Ball A, Wenning J, Van Eyk N. Ovarian fibromas in pediatric patients with basal cell nevus (Gorlin) syndrome. J Pediatr Adolesc Gynecol. 2011;24(1):e5–7.PubMedCrossRef

30.

Wang Y, Wang W, Xu C, et al. Childhood Ovarian Juvenile Granulosa Cell tumor: a retrospective study with 3 cases including clinical features, pathological results, and therapies. J Pediatr Hematol Oncol. 2011;33(3):241–5.PubMedCrossRef

31.

Ghaemmaghami F, Karimi Zarchi M, Hamedi B. High levels of Ca 125 (over 1,000 IU/ml) in patients with gynecologic disease and no malignant conditions: three cases and literature review. Arch Gynecol Obstet. 2007;276(5):559–61.PubMedCrossRef

32.

Ryoo U, Lee DY, Bae DS, Yoon BK, Choi D. Clinical characteristics of adenxal masses in Korean children and adolescents. J Minim Invasive Gynecol. 2010;17(2):209–13.PubMedCrossRef

33.

Galinier P, Carfagna L, Delsol M, et al. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg. 2009;44(9):1759–65.PubMedCrossRef

34.

Savic D, Stankovic ZB, Djukic M, Mikovic Z, Djuricic S. Torsion of malignant ovarian tumors in childhood and adolescence. J Pediatr Endocrinol Metab. 2008;21(11):1073–8.PubMedCrossRef

35.

Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol. 2010;150(1):8–12.PubMedCrossRef

36.

Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States. Pediatrics. 2010;125(3):532–8.PubMedCrossRef

37.

Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance. J Pediatr Surg. 2010;45(1):135–9.PubMedCrossRef

38.

McCarthy JD, Erickson KM, Smith YR, Quint EH. Premenarchal ovarian torsion and elevated Ca-125. J Pediatr Adolesc Gynecol. 2010;23(1):e47–50.PubMedCrossRef

39.

Epelman M, Chikwava KR, Chauvin N, Servaes S. Imaging of pediatric ovarian neoplasms. Pediatr Radiol. 2011;41:1085–99.PubMedCrossRef

40.

Tsay JY, Saigo PE, Brown C, La Quaglia MP. Diagnosis, pathology, staging, treatment, and outcome of epithelial ovarian neoplasia in patients age <21 years. Cancer. 2001;91(11):2065–70.CrossRef

41.

Billmire D, Vinocur C, Rescoria F, et al. Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: an intergroup study. J Pediatr Surg. 2004;39(3):424–9.PubMedCrossRef

42.

Bristow RE, Nugent AC, Zahurak ML, Khouzhami V, Fox HE. Impact of surgeon specialty on ovarian-conserving surgery in young females with an adnexal mass. J Adolesc Health. 2006;39(3):411–6.PubMedCrossRef

43.

Vaysse C, Delsol M, Carfagna L, et al. Ovarian germ cell tumors in children. Management, survival and ovarian prognosis. A report of 75 cases. J Pediatr Surg. 2010;45(7):1484–90.PubMedCrossRef

44.

Abdel-Hady ES, Abdel-Hady Hemira R, Gamal A, El-Shamey M. Fertility sparing surgery for ovarian tumors in children and young adults. Arch Gynecol Obstet. 2011; epub ahead of print.

45.

Medeiros LR, Rosa DD, Edelweiss MI, et al. Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review. Int J Gynecol Cancer. 2005;15:192–202.PubMedCrossRef

46.

Marina NM, Cushing B, Giller R, et al. Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: a Pediatric Oncology Group/Children’s Cancer Group Intergroup Study. J Clin Oncol. 1999;17(7):2137–43.PubMed

47.

Cushing B, Giller R, Ablin A, et al. Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: a report of the pediatric oncology group and the children’s cancer group. Am J Obstet Gynecol. 1999;181(2):353–8.PubMedCrossRef

Title: The Role of Tumor Markers in the Surgical Approach of Ovarian Masses in Pediatric Age: A 10-Year Study and a Literature Review
Authors: Claudio Spinelli, MD
Valentina Pucci
Irene Buti, MD
Josephine Liserre, MD
Antonio Messineo, MD
Francesco Bianco
Clara Ugolini, MD
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2249-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Role of Tumor Markers in the Surgical Approach of Ovarian Masses in Pediatric Age: A 10-Year Study and a Literature Review

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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