Diagnosis. SCTs should be completely excised

Ovarian Teratoma

Treatment

SCTs should be completely excised. Surgery (which has been undertaken in utero as fetal surgery) is the cornerstone of successful therapy and cure rates exceed 95%. Type I and II lesions can be approached posteriorly through either an inverted chevron or sagittal incision. Type III and IV lesions require an additional transverse lower abdominal incision. Essential components of the procedure include complete removal of the intact tumor, ligation of the middle sacral artery and excision of the coccyx with the tumor (a 37% recurrence rate if it was not removed).

If the lesion is benign (97%), no further therapy is indicated. These children should be evaluated every 3 months for the first 2 years with emphasis on rectal examination and AFP levels. If the lesion is malignant, adjuvant chemotherapy with cisplatin, bleomycin and vinblastine is indicated.

Ovarian tumors are one of the more common germ cell tumors in female children and adolescents. Of all ovarian masses, most (80%) are benign (epithelial cysts, teratomas, immature teratomas) often with predominantly cystic components.

Ovarian and sacrococcygeal teratomas occur with near equal frequency in infants. In older children, however, ovarian teratomas are more common and account for 50% of all pediatric ovarian tumors.

Abdominal pain, mass and vomiting are the most common presenting complaints. With the child supine, the mass is often visible and movable. If torsion (1-3%) has occurred, the abdomen may be tender with 1-3% of the torsion group spontaneously rupturing.

The differential diagnosis includes pregnancy, ovarian torsion, omental or mesenteric cyst, lymphangioma and lymphoma.

Children's Oncology Group ovarian staging system

Stage I: Limited to ovary (ovaries) peritoneal washings negative;

Stage II: Microscopic residual; peritoneal washings negative for malignant cells, tumor markers positive or negative.

Stage III: Lymph node involvement; gross residual or biopsy only; contiguous visceral involvement (omentum, intestine, bladder); peritoneal washings positive for malignant cells; tumor markers positive or negative.

Stage IV: Distant metastases, including liver.

Abdominal x-rays may show displacement of the normal gas pattern and/or calcifications within the tumor. Ultrasonography and CT can determine the organ of origin, assess the contralateral ovary, and determine whether the lesion is solid or cystic. Serum AFP and beta-hCG levels should be measured.

Дата добавления: 2014-10-15