title: Laparoscopic adnexectomy of a persistent ovarian tumor in a girl with acute lymphoblastic leukemia relapse.
abstract: The management of children with acute lymphoblastic leukemia (ALL) relapse and an ovarian tumor remains controversial. The authors report about a 4-year-old girl who developed a late bone marrow and cutaneous relapse of her pre-B-cell ALL and revealed an enlargement of her left ovary (4 x 3 x 2 cm). Chemotherapy (ALL-REZ-BFM pilot-protocol 2002) achieved effective remission, but the ovarian mass depicted no regression. Laparoscopic adnexectomy was performed and the tumor could be extracted in a specimen-bag through a 12-mm umbilical incision. Histology detected no viable lymphoblasts, but a fibrotic enlargement due to previous cellular infiltration. The authors conclude that in children with ALL relapse and an ovarian tumor, malignant infiltration as well as local response to chemotherapy can be judged only by surgical excision and histopathologic examination. Laparoscopic oophoradnexectomy is a valuable management option in these children.
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany. holger.till@kk-i.med.uni-muenchen.de
authors.forename: Holger
authors.initials: H
authors.lastname: Till
authors.forename: Oliver
authors.initials: O
authors.lastname: Muensterer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Graubner
mesh_terms: D000290:Adnexa Uteri / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001856:Bone Marrow Examination; D019046:Bone Marrow Neoplasms / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D010051:Ovarian Neoplasms / Q000556:secondary / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012878:Skin Neoplasms / Q000473:pathology; D016896:Treatment Outcome