青少年附件包块的诊治策略

青少年附件包块是常见的生殖器官疾病，青春期发育阶段女性就诊妇科，影像学检查提示附件包块会涉及包块的进一步诊治，妇科医生会进一步检查以明确病理诊断，并提出后续治疗的建议。青少年常见的良性附件肿瘤是良性畸胎瘤（成熟性畸胎瘤），囊肿扭转是青少年常见的妇科急诊；常见附件恶性肿瘤是恶性生殖细胞肿瘤及性索间质肿瘤，这类肿瘤恶性程度高但经过规范化治疗预后良好。因此，重视青少年女性妇科肿瘤的问题、良性肿瘤的确诊、防止出现急诊情况、恶性肿瘤的早期诊断及治疗均是非常重要的。青少年属于特殊发育阶段，这个年龄的妇科附件肿瘤的诊治关系其一生的生长生育，需要有妇科内分泌理念，更要有肿瘤理念，需要及时治疗，更需要长期管理。     

附件包块的诊治策略

附件包块即卵巢、输卵管或周围结缔组织的肿块,是妇科临床实践中遇到的常见问题。并非所有的附件区肿块都起源于妇科,明确病因起源于妇科还是非妇科是至关重要的。常见的妇科附件包块包括：卵巢囊肿、卵巢或输卵管良恶性肿瘤、附件炎性包块、异位妊娠、输卵管阻塞性疾病、带蒂的子宫浆膜下肌瘤、来自胃肠道或乳腺癌的转移瘤等;附件区最常见的非妇科包块包括：阑尾黏液性肿瘤、肠系膜囊肿、胃肠道间质瘤等。由于附件包块的病因广泛,对其诊断是一个挑战,需要通过详细的病史、全面的体格检查,并通过影像学及肿瘤标志物检查来协助诊断。此外,评估附件包块还包括鉴别是良性的还是恶性的,是生理性的还是病理性的,这有利于决策治疗方式的选择。 浏览更多请关注本刊微信公众号及当期杂志。     

附件包块的诊治策略

        附件包块即卵巢、输卵管或周围结缔组织的肿块，是妇科临床实践中遇到的常见问题。并非所有的附件区肿块都起源于妇科，明确病因起源于妇科还是非妇科是至关重要的。常见的妇科附件包块包括：卵巢囊肿、卵巢或输卵管良恶性肿瘤、附件炎性包块、异位妊娠、输卵管阻塞性疾病、带蒂的子宫浆膜下肌瘤、来自胃肠道或乳腺癌的转移瘤等；附件区最常见的非妇科包块包括：阑尾黏液性肿瘤、肠系膜囊肿、胃肠道间质瘤等。由于附件包块的病因广泛，对其诊断是一个挑战，需要通过详细的病史、全面的体格检查，并通过影像学及肿瘤标志物检查来协助诊断。此外，评估附件包块还包括鉴别是良性的还是恶性的，是生理性的还是病理性的，这有利于决策治疗方式的选择。 浏览更多请关注本刊微信公众号及当期杂志。     

附件良恶性包块的鉴别诊断

附件包块是一种妇科常见病,早期诊断和治疗对患者的生存和预后有重要影响。附件包块良恶性的早期鉴别一直是临床关注的难题和焦点,需要依靠详细的病史,结合体征、年龄、家族史以及必要的辅助检查等综合评估。良性和恶性附件包块的预后和处理截然不同,因此准确判断附件包块良恶性具有重要的临床意义。     

附件良恶性包块的鉴别诊断

附件包块是一种妇科常见病，早期诊断和治疗对患者的生存和预后有重要影响。附件包块良恶性的早期鉴别一直是临床关注的难题和焦点，需要依靠详细的病史，结合体征、年龄、家族史以及必要的辅助检查等综合评估。良性和恶性附件包块的预后和处理截然不同，因此准确判断附件包块良恶性具有重要的临床意义。     

CT及MRI在附件包块中的诊断价值

CT和MRI能区分附件良恶性包块、炎性包块,但MRI更有优势。文章讨论了附件包块分类;常见卵巢良、恶性肿瘤及炎性包块的影像学特点和鉴别要点;CT和MRI在卵巢恶性肿瘤分期、附件扭转中的重要诊断价值。期待借助于CT和MRI,为附件包块的诊治提供精准的支持。     

CT及MRI在附件包块中的诊断价值

CT和MRI能区分附件良恶性包块、炎性包块，但MRI更有优势。文章讨论了附件包块分类；常见卵巢良、恶性肿瘤及炎性包块的影像学特点和鉴别要点；CT和MRI在卵巢恶性肿瘤分期、附件扭转中的重要诊断价值。期待借助于CT和MRI，为附件包块的诊治提供精准的支持。     

CA125、HE4、ROMA及RMI在附件包块诊断中的应用价值

附件包块病因复杂多样,相应的临床决策千差万别。因此,对附件包块性质的预判是临床诊断的首要任务,也是临床工作的难点和要点。CA125是鉴别附件包块良恶性的最常见指标,但影响因素多,不建议单独用于绝经前女性。人附睾蛋白4（HE4）特异度高,联合CA125可显著提高附件包块良恶性鉴别诊断的准确率。针对附件包块拟行手术的患者,推荐应用卵巢恶性肿瘤风险模型（ROMA）和恶性肿瘤风险指数（RMI）进行评估,高危者应转诊到妇科肿瘤专科。     

CA125、HE4、ROMA及RMI在附件包块诊断中的应用价值

附件包块病因复杂多样，相应的临床决策千差万别。因此，对附件包块性质的预判是临床诊断的首要任务，也是临床工作的难点和要点。CA125是鉴别附件包块良恶性的最常见指标，但影响因素多，不建议单独用于绝经前女性。人附睾蛋白4（HE4）特异度高，联合CA125可显著提高附件包块良恶性鉴别诊断的准确率。针对附件包块拟行手术的患者，推荐应用卵巢恶性肿瘤风险模型（ROMA）和恶性肿瘤风险指数（RMI）进行评估，高危者应转诊到妇科肿瘤专科。     

恶性附件包块的早期诊断和预示因素

卵巢癌是恶性妇科肿瘤的主要死因。大多数在确诊时已属进展期，因此其早期诊断及附件包块良恶性的鉴别备受关注。目前认为妇科检查、超声和系统的肿瘤标记物联合应用是较理想的方法。     

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia

Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46?±?4.87?years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p?p?=?.001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.     

Soft tissue sarcomas of infancy

Malignancy occurring during the neonatal period (defined as the first 28 days of life) is over 3 times the incidence of other pediatric age groups. Of all neoplasia occurring in infants, benign and malignant, 25% are soft tissue tumors. Differentiating the benign lesions from the 15% that are malignant can be difficult. This article discusses the epidemiology, differential diagnosis, evaluation, and treatment of infants with soft tissue sarcomas. Fibrosarcoma and rhabdomyosarcoma are also discussed at length. The authors review other rare tumors as well. The impact on diagnosis of molecular techniques is included when appropriate. A multidisciplinary team approach for treatment of these infants is recommended.     

Laparoscopic treatment of ovarian tumors in children: an experience of seven cases in Mansoura University Hospital

All ovarian tumors in children are rare. Laparoscopic ovary-sparing treatment of ovarian tumor would be the preferred surgical approach for children in order to preserve future fertility. The objective of this research is to study the experience of gynecology department in Mansoura University Hospital in laparoscopic treatment of ovarian tumors in children. This study included seven patients with age range of 7 to 11 years presented with ovarian tumors. The following items were fulfilled for all studied cases: age at diagnosis, presenting complaints, blood samples for detection of tumor markers, abdominal ultrasonography, abdominal magnetic resonance imaging (MRI), treatment by laparoscopy, histopathological examination, and the outcome of the patients. All ovarian tumors were benign. Three cases were found to be cystic teratomas, two cases were benign serous cystadenoma, only one case was cystadeno-fibroma and one case was solid tumor, and its histology did not give a clear diagnosis, but no malignant cells were found. Unilateral salpingo-oophorectomy was carried out in three patients, whereas the other four patients had unilateral ovarian cystectomy. In one case, intraoperative spillage during excision of the tumoroccurred. Recovery of all patients was good and without any complications. Laparoscopic conservative surgery as a treatment for benign ovarian tumor in childhood gives a good chance to preserve future fertility.     

Update on the surgical management of ovarian neoplasms in children and adolescents: analysis on 32 cases

This study analyzes updated clinical, diagnostic, and surgical directions for the treatment of ovarian neoplasms in children and adolescents, comparing them with a retrospective analysis of 32 cases treated in two Pediatric Surgery University Institutions. From January 2005 to December 2015, 32 pediatric patients were surgically treated for 32 ovarian tumors: 28 (87.5%) benign and 4 (12.5%) malignant neoplastic lesions. Median age at surgery was 11.2 years (12.8 years in patients with benign neoplasms, 7.25 years in patients with malignant ones). All patients with malignant and 25% of patients with benign ovarian lesions had elevated serum level of tumors markers. The surgical approach was laparotomic in 62.5% and laparoscopic in 37.5%; 81.2% surgeries were performed in elective surgery and 18.8% in emergency. Intraoperative frozen section analysis was performed in 18.75% of patients. The most frequent surgery (96.8%) was unilateral oophorectomy. After a median follow-up of 76 months (range 6–132 months), 31/32 patients are alive and disease-free. In case of malignant tumors, fertility-sparing surgery with accurate staging must be performed. Laparoscopic multiport is the gold standard approach for benign pediatric ovarian neoplasms, but the use of laparoscopy in full respect of oncological principles also for early stage malignant tumors is currently increased.     

Ovarian masses during adolescence: clinical, ultrasonographic and pathologic findings, serum tumor markers and endocrinological profile.

This retrospective study was undertaken to assess the epidemiological and clinical features, laboratory findings, preoperative work-up, surgical treatment and pathologic findings in adolescents with ovarian cysts. All adolescents who were referred to our institution and had been operated on because of a diagnosed ovarian mass, from January 1997 to June 2003, were included in this study. Forty-four cases of women with an ovarian mass were retrospectively analyzed. These patients, aged between 12 and 21 years, had 47 ovarian masses (three patients had bilateral lesions), of which 49% were non-neoplastic and 51% were neoplastic. Of the neoplastic lesions, 62.5% were germ cell tumors, 20.8% were epithelial and 16.7% were sex cord-stromal tumors. Of the neoplastic tumors, 95.8% were benign while 4.2% were malignant. Procedures included 30 operative laparoscopies (68.20%) and 14 exploratory laparotomies (31.8%). Simple excision of the ovarian cyst was performed in 39 cases (88.6%). According to our study, most of the adolescents with an ovarian cyst underwent an operation because of a neoplastic lesion. The majority of ovarian tumors occurring in adolescents are non-epithelial in origin, and germ cell tumors are the most common histological type. Ultrasound examination is one of the most important diagnostic tools. Preoperative diagnostic approach of these patients should always include careful history taking, physical examination, imaging and evaluation of serum assays. Gynecologists who care for young girls must be familiar with the differential diagnosis of ovarian masses whose surgical treatment should be conservative when appropriate, so that hormonal status and future fertility are not compromised in this group of patients.     

Progression of Cystadenoma to Mucinous Borderline Ovarian Tumor in Young Females: Case Series and Literature Review

Study ObjectiveTo study the progression of benign ovarian lesions to mucinous borderline ovarian tumors (mBOTs); analyze the clinicopathologic features, diagnosis, and management of mBOTs in pediatric and adolescent girls; and provide a review of the literature on mBOTs in this population.DesignRetrospective chart review of female adolescents younger than 18 years diagnosed with mBOTs between July 2017 and February 2021.SettingYale New Haven Hospital, New Haven, Connecticut; and Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut.ParticipantsThree female patients diagnosed with mBOTs between ages 12 and 17 years.InterventionsNone.Main Outcome MeasuresClinical presentation, preoperative characteristics, surgical technique, histology, tumor stage, treatment, progression, outcome, and rate of recurrence.ResultsThree adolescent patients were identified to have mBOTs. All three patients presented with a chief complaint of abdominal pain. One of the 3 patients was premenarchal at presentation. Two of the 3 patients were initially diagnosed with a mucinous cystadenoma and had recurrences of an ovarian cyst in the same ovary within 5 and 17 months, respectively. Pathology of the recurrent cyst was consistent with mBOT. Two of the 3 patients initially underwent cystectomy, and all ultimately had a unilateral salpingo-oophorectomy. Subsequent surveillance over 2 to 4 years found no evidence of disease recurrence.ConclusionmBOTs are rare in the pediatric and adolescent population and could arise from benign ovarian tumors.     

Effect of Surgical Specialty on Management of Adnexal Masses in Children and Adolescents: An 8-Year Single-Center Review

Study ObjectiveChildren with adnexal masses might be managed by pediatric surgeons, urologists or gynecologists, with the potential for different management strategies between specialties. In this study we compared ovarian conservation rates and surgical approach for adnexal masses in children and adolescents managed either by pediatric surgeons/urologists or gynecologists at a tertiary care institution.DesignRetrospective cohort review.SettingTertiary pediatric and adult university hospital.ParticipantsPatients younger than 18 years of age with an adnexal mass managed surgically with removal of histologically confirmed ovarian or fallopian tube tissue from 2008 to 2015.InterventionsLaparoscopic or open procedure for adnexal mass.Main Outcome MeasuresThe primary outcome was rate of ovarian conservation relative to surgical specialty. The secondary outcome was surgical approach relative to surgical specialty.ResultsForty-eight patients underwent surgery for adnexal masses; 26 (54%) under pediatric surgery/urology and 22 (46%) under gynecology care. Laparoscopy was performed in 5 (19%) pediatric and 19 (86%) gynecology cases (P = .000006). Of 24 patients older than 12 years of age with a benign tumor, 10 (42%) underwent procedures resulting in loss of an ovary with or without fallopian tube; 8 of these (80%) were under pediatric care. Of the remaining 14 (58%) who underwent ovarian conserving surgery, 12 (80%) were under gynecology care (P = .0027).ConclusionPatients with a benign tumor were significantly more likely to undergo ovary-preserving surgery under gynecology care than under pediatric surgery/urology care. A multidisciplinary team approach involving gynecology and pediatric surgical specialties would be valuable in assessing the merits of ablative or conservative surgery in each case.     

Ovarian tumours in childhood and adolescence

Malignant ovarian tumors are very rare during childhood and adolescence where their incidence is approximately 0.71 per 100,000. We reviewed the symptoms, histologic subtypes, diagnostic evaluation and management of ovarian tumours in children and adolescents with emphasis on malignant tumours. The histology of these tumours is complex and their diagnosis frequently poses problems. Surgery and chemotherapy yield high cure rates in patients with malignant germ cell tumours whereas prognosis is poorer in ovarian carcinomas. Elucidation of the mechanisms underlying the pathogenesis of ovarian tumors might further improve the management of these patients.