Pre-operative differentiation of pediatric ovarian tumors: morphological scoring system and tumor markers.
OBJECTIVE
To investigate the importance of morphological scoring systems in differentiation of ovarian tumors in childhood.


METHODS
Morphological assessment using DePriest's index was performed for all patients with histopathological confirmation of ovarian tumor, with evaluation of tumor markers, from January 1997.


RESULTS
Fifty-three girls (age range 13 months to 19 years) were surgically treated for 59 ovarian tumors, including six bilateral. All lesions with cystic appearance on ultrasonography were benign, 23 of 35 semisolid, and four of ten solid tumors were also benign. Stage of malignant disease was as follows: stage I, ten; stage II, two; stage III, six. Sensitivity, positive predictive value and accuracy by DePriest's and Ueland's indexes for benign tumors (score <7) were: 0.88, 0.79; 0.89; and 0.94, 0.84; 0.93; respectively. Elevated levels of tumor markers were observed in 17 patients, including four patients with endocrine manifestations. In 24 patients ovaries were successfully preserved, including two patients with foci of immature teratoma in a dermoid cyst.


CONCLUSIONS
Ultrasonographic assessment with morphological analysis recommended by DePriest and Ueland is a very useful procedure for differentiating benign from malignant ovarian tumors in children. Tumor markers and endocrinological investigation are also useful for preoperative evaluation.
Stankovic
Zoran B
ZB
Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia, Serbia. zodar@eunet.yu
Djukic
Milan K
MK
Savic
Djordje
D
Lukac
Branislav J
BJ
Djuricic
Slavisa
S
Sedlecki
Katarina
K
Zdravkovic
Dragan
D
D000293:Adolescent; D018394:CA-125 Antigen / Q000097:blood; D002454:Cell Differentiation / Q000502:physiology; D002648:Child; D006063:Chorionic Gonadotropin / Q000097:blood; D003537:Cystadenoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D005350:Fibroma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018238:Gonadoblastoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000097:blood; D010051:Ovarian Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D013724:Teratoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism
D018394:CA-125 Antigen; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D007770:L-Lactate Dehydrogenase