title: Ovarian masses in children and adolescents - an analysis of 521 clinical cases.
abstract: OBJECTIVE
  To analyze the clinical characteristics of ovarian masses in children and adolescents.
  
  
  METHODS
  We performed a retrospective analysis of patients less than 20 years of age who were treated at the Obstetrics and Gynecology Hospital of Fudan University between March 2003 and January 2012. Medical records were reviewed for age at operation, including presentation of symptoms and signs; the levels of tumor markers; imaging examinations; pathologic findings; the size of masses; treatment; and outcome. Data management and descriptive analyses were performed using SPSS 16.0.
  
  
  RESULTS
  A total of 521 patients were included in this study. Among them, 92 had non-neoplastic lesions, 382 had benign neoplasms, and 47 had malignant tumors. The mean age of the patients was 16.3 ± 2.2 years. The primary presenting symptoms and signs were abdominal pain (39.5%), menstrual disorder (31.1%), abdominal swelling (5.4%), and an enlarged abdominal perimeter (3.3%). Malignant tumors tended to be larger than benign neoplasms (17.3 ± 8.6 cm vs 9.0 ± 5.7 cm; P = .000). There was no age difference between patients with benign neoplasms (16.3 ± 2.1 y) and those with malignant tumors (15.7 ± 2.5 y). The operations included salpingo-oophorectomy, ovarian cystectomy, and oophorectomy. Two patients with malignant tumors had bilateral salpingo-oophorectomy, and 2 patients who had tumor metastasis underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Forty-one cases of malignant tumors received postoperative chemotherapy.
  
  
  CONCLUSIONS
  Germ cell tumors are the most common malignancy, and mature teratomas are the most common benign neoplasms in children and adolescents. Abdominal pain and menstrual disorder are the main reasons for doctor's visit. Although examination by ultrasound is the preferred auxiliary in the diagnosis of ovarian pathology, it could not distinguish between benign and malignant tumors. However, tumor size and tumor markers are helpful to identify the properties of masses. Surgery is usually better for treatment, and it is preferable to attempt conservative, fertility-sparing surgery in adolescents. Postoperative chemotherapy is necessary for malignant tumors.
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China.
authors.forename: Mingxing
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China. Electronic address: guilingli@fudan.edu.cn.
authors.forename: Guiling
authors.initials: G
authors.lastname: Li
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China. Electronic address: xucongjian@gmail.com.
authors.forename: Congjian
authors.initials: C
authors.lastname: Xu
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D002277:Carcinoma / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D008599:Menstruation Disturbances / Q000209:etiology; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D010048:Ovarian Cysts / Q000175:diagnosis / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D010052:Ovariectomy; D012189:Retrospective Studies; D058994:Salpingectomy; D018312:Sex Cord-Gonadal Stromal Tumors / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins
keywords: Adolescents; Children; Ovarian masses