Ovarian Torsion in Premenarchal Girls

Study ObjectiveTo investigate characteristics that differentiate premenarchal girls with ovarian torsion (OT) from those without OT at the time of surgery.DesignRetrospective chart review of 36 premenarchal girls who underwent 42 surgeries for either OT (n = 33) or a nontorsed ovarian mass (n = 9) from 2006 to 2017.SettingLarge, tertiary care academic institution.ParticipantsWe included patients aged 0-12 years with International Classification of Diseases, Ninth Revision codes for torsion of the ovary, adnexa, ovarian pedicle, or fallopian tube. Controls had International Classification of Diseases, Ninth Revision codes for ovarian mass or cyst, who also underwent surgery and did not have OT.InterventionsRecords were reviewed for patient characteristics including laboratory and imaging studies, surgical intervention, and pathologic diagnosis. Fischer exact test and the nonparametric Mann–Whitney U test were used for statistical analysis.Main Outcome MeasuresCharacteristics predictive of OT in premenarchal girls.ResultsTwenty-nine premenarchal patients were diagnosed with 33 episodes of OT. Nine patients underwent surgery for ovarian masses but did not have OT. All patients with OT reported abdominal pain (compared with 55.6% without OT; P < .001) and most had nausea and/or emesis (81.8% vs 33.3%; P < .009). Ultrasound findings of ovarian enlargement and decreased Doppler flow were significant in the OT group (P < .083, P < .009). There were 2 cases of malignancy in each group.ConclusionPatients with OT had significantly more nausea, emesis, and abdominal pain compared with those without OT. Additionally, 2 of 4 malignancies were found in patients with OT, indicating that malignancy should still be considered with large, complex masses.     

The Role of Ovarian Suspension in Endometriosis Surgery: A Randomized Controlled Trial

Study ObjectiveA very high percentage of patients with severe pelvic endometriosis develop adhesions after laparoscopic surgery. The objective of this trial was to evaluate the role of ovarian suspension performed during surgery for severe endometriosis on ovarian adhesions and postoperative pelvic pain.DesignA randomized controlled trial (Canadian Task Force classification I).SettingThe tertiary care University Hospital of Bologna, Bologna, Italy.PatientsEighty patients with ovarian and posterior deep infiltrating endometriosis were included in the study.InterventionsPatients underwent laparoscopic surgery for endometriosis and were randomized sequentially into 2 groups: transient ovarian suspension was performed in the treatment group (n = 40), whereas in the control group (n = 40) ovaries were left free in the pelvis. Symptom intensity (dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, and dysuria) were ranked using a visual analog scale. Postsurgical ovarian adhesions were evaluated using transvaginal ultrasonographic scans performed by an ultrasound operator who was blinded to the details of the operative procedure and women's randomization allocation. Complications, lesion localization, endometrioma diameter, and surgery time were recorded.Measurements and Main ResultsAt follow-up, a significantly lower rate of ultrasound-detectable ovarian adhesions with the uterus and the bowel was observed in the treatment group, respectively (46.7% vs 77.3%, p = .003 and 26.7% vs 68.2%, p < .0005). Patients in the control group showed a higher percentage of fixed ovaries with moderate and severe adhesions than the treatment group, respectively (56.8% vs 28.9%, p = .003 and 20.5% vs 8.9%, p = .110). No differences between the 2 groups were found regarding complications and pelvic pain.ConclusionOvarian suspension seems to be an additional effective surgical procedure associated with an increased ovarian mobility in women treated for severe endometriosis. Moreover, it is feasible, safe, simple, and fast. Hence, it should be routinely used during laparoscopic surgery for endometriosis.     

Postoperative Ovarian Morphology on Ultrasound after Ovarian Torsion—Effect of Immediate Surgery: A Retrospective Cohort Study

Study ObjectiveOur objective was to determine if ovarian surgery at the time of ovarian detorsion is associated with impaired short-term ovarian function as indicated by ovarian morphology on ultrasound when compared with detorsion alone.DesignRetrospective cohort studySettingThe Hospital for Sick Children, TorontoParticipantsPatients ≤ 18 years old with confirmed ovarian torsion from January 1, 2004, to December 31, 2018, with ovarian-sparing surgery.Main Outcome MeasuresData were collected on demographics, procedure, intraoperative findings, and postoperative ultrasound. To determine ovarian function, we compared the morphology on the postoperative ultrasound between those with surgery to the ovary and those without surgery to the ovary at the time of detorsion. We also compared the ovarian volume of affected and contralateral ovaries after detorsion and surgery to the affected ovary.ResultsOne hundred and nineteen patients met the inclusion criteria, of whom 67 (56%) had detorsion with surgery to the ovary and 52 (44%) had detorsion alone. There was no statistically significant difference in appearance on the postoperative ultrasound between these groups (P =.446). There was also no statistically significant difference on the postoperative ultrasound of affected and contralateral ovarian volumes after detorsion and surgery to the affected ovary (P = .69). Patients who underwent surgery to the ovary experienced a lower rate of recurrence; however, this did not reach statistical significance, with a P value of 0.080.ConclusionOur study demonstrates that surgery, eg cystectomy to the ovary at the time of ovarian detorsion, does not appear to impact ovarian function when compared with detorsion alone, as indicated on postoperative imaging. There was also no difference in volume of the affected and contralateral ovaries in those cases that underwent surgery at the time of initial detorsion. This evidence would support that immediate cystectomy at the time of initial ovarian detorsion is not associated with impaired ovarian function, thus avoiding the need for an interval cystectomy.     

The impact of in situ methotrexate injection after transvaginal ultrasound-guided aspiration of ovarian endometriomas on ovarian response and reproductive outcomes during IVF-cycles

ObjectiveThe primary aim of the present study is to evaluate prospectively whether in situ methotrexate (MTX) injection as alternative treatment of unilateral ovarian endometrioma compromises ovarian response. The secondary aim is to estimate the short term effect of exposure to MXT on reproductive outcomes and fetal congenital anomalies during IVF-cycles.DesignCase controlled study.SettingEl-Menya infertility research and treatment center (MRTC), Egypt.Patient(s)65 patients during their reproductive age complained of a unilateral symptomatic ovarian endometrioma and infertility problem.MethodOvarian endometrioma was successfully treated by transvaginal ultrasound aspiration with in situ methotrexate followed by ICSI. Oocytes retrieved, M II oocytes, quality of embryos, clinical pregnancy rates and reproductive outcomes were prospectively evaluated from the aspirated and contralateral normal ovary.Result(s)There was no statistically significant difference between mean number of oocytes retrieved (6.1 ± 1.5 vs 7.2 ± 0.5), M II oocytes, fertilization rate (67.5% ± 1.32 in the aspirated ovary versus 70% ± 0.55 in the normal ovary), and quality of the embryos obtained from the aspirated ovary and the normal contralateral one (P > 0.05). The mean endometrial thickness was (11.3 ± 1.33 mm) and the quality of the endometrium was homogenous in 54/65 (83.07%). Implantation rate was 30.7% and the clinical pregnancy rate was 21/65 (32.30%). Nine patients (42.85%) have full term deliveries. The total living birth was 14/21 (66.6%) and cumulative pregnancy rate was 48%.Conclusion(s)In situ methotrexate injection after transvaginal ultrasound-guided aspiration was a simple, safe and successful method for treating ovarian endometriomas with minimal effects on ovarian response. Short term effects on reproductive outcomes, risk of fetal loss or anomaly were minimal. Six months was enough as washout period of the drug prior to conception and was advisable to prevent the small chance of chromosomal abnormalities in the offspring.     

Cryoconservation ovarienne : évaluation de deux techniques chirurgicales

ObjectivesTo evaluate various surgical techniques for partial oophorectomy cryopreservation. To evaluate the consequences of prior exposure to cytotoxic therapy on the quality of the ovary removed.Patients and methodsSingle center retrospective observational study over 4 years of women who had ovarian cryopreservation surgery for chemotherapy or radiotherapy which were at high risk of premature ovarian failure. Several techniques have been proposed: partial oophorectomy with clamping of the vascular gonadal pedicle (indirect tissue sample) without clamping (direct tissue sample) and partial oophorectomy with an automatic stapler. Ovarian tissue was immediately prepared for cryopreservation in the operating theatre. The whole sample was divided into small slices. For each ovary, a count of small slices was made. Additionally, one slice was examined to determine the presence of primordial follicles.ResultsOvary was successfully removed and cryopreserved in 13 patients. Two bleeding events occurred with the direct technique, without consequences for patients. The number of fragments obtained between indirect and direct techniques was respectively 19 vs 15, P = 0.18; the number of primordial follicles was 38 vs 36, P = 0.87. The automatic stapler consumed too much ovarian tissue to be interesting. There were fewer fragments, 15 vs 20, P < 0.05 and primordial follicles, 35 vs 40, P = 0.65, after a first cycle of chemotherapy.Discussion and conclusionThe vascular clamping technique is safer but with no difference in the quality of the sample tissue. One cycle of chemotherapy has a pejorative impact on the quality of the sample tissue.     

An Extra-large Ovarian Mucinous Cystadenoma in a Premenarchal Girl and a Review of the Literature

ObjectiveEpithelial ovarian neoplasms are extremely uncommon in children. Ovarian mucinous cystadenoma is benign and an extremely rare presentation in the premenarchal period. We present a case of giant mucinous cystadenoma of the left ovary in a 13-year-old and a review of the supporting literature.Case ReportThe patient was admitted with a history of increasing abdominal distension and pain for approximately 3 months and a history of an ovarian mass for 3 years. An adnexal mass measuring 40 × 30 × 20 cm was detected by abdominal ultrasonography and computed tomography. The tumor markers CEA, CA 19-9, and CA-125 were elevated, although α-fetoprotein and human chorionic antigen levels were within the normal range. The patient underwent surgery. The smooth-surfaced mass filled the abdomen. A frozen section biopsy was performed, and the results indicated a benign mucinous cystadenoma. A unilateral oophorectomy with tumor removal was performed.ConclusionThe ovarian mass was revealed by abdominal distension, and a diagnosis was established by frozen biopsy. Complete and careful surgical resection provides satisfactory results; however, careful follow-up is required.     

Ovarian Ectopic Pregnancy: Laparoscopic Excision and Ovarian Conservation

Study ObjectiveTo show a case of laparoscopic excision of an ovarian ectopic pregnancy and the technique used.SettingA university hospital (Manchester University Foundation Trust).PatientA 23-year-old primigravida presentation at 6 weeks of gestation with an ectopic pregnancy.InterventionA 23-year-old primigravida presentation at 6 weeks of gestation with a 7-day history of light bleeding and intermittent abdominal pain. The examination was unremarkable, and the serum human chorionic gonadotropin level was 7157 IU/L. An ultrasound scan showed an ectopic pregnancy in the right adnexa, and she underwent surgical management. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic pregnancy within the right ovary; 20 IU argipressin diluted in 80 mL 0.9% sodium hypochlorite was injected between the normal ovarian tissue and the ectopic pregnancy to assist hemostasis and hydrodissection. An ultrasonic device was used to incise the ovarian cortex to identify a plane of dissection between the ectopic pregnancy tissue and the normal ovarian tissue. The ectopic pregnancy was excised with conservation of the ovary. The ovary was subsequently closed with absorbable sutures to ensure hemostasis. The ectopic pregnancy was removed in a bag through a 10-mm incision.Measurements and Main ResultsThe patient made an uneventful recovery. The serum human chorionic gonadotropin level in 7 days was <5, and no further medical management was indicated. Histology confirmed a primary ovarian ectopic pregnancy. Ovarian function was not assessed postoperatively; however, she conceived 6 weeks later with an intrauterine pregnancy.ConclusionThis case highlights the importance of considering nontubal ectopic pregnancies when making a diagnosis based on an ultrasound scan. Ovarian preservation with excision of ectopic pregnancy can be achieved using techniques commonly used for ovarian cystectomy. Recourse to oophorectomy should only be considered in the event of acute hemorrhage.     

Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents

Study ObjectiveDescribe the current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian massesDesignProspective cohort study from 2018 to 2021SettingEleven children's hospitalsParticipantsFemales age 6-21 years undergoing surgical management of an ovarian massInterventionsObtaining intraoperative FS pathologyMain Outcome MeasureDiagnostic accuracy of FS pathologyResultsOf 691 patients who underwent surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology. Among FS patients, 12 of 27 (44.4%) underwent ovary-sparing surgery, and 15 of 27 (55.5%) underwent oophorectomy with or without other procedures. FS results were disparate from final pathology in 7 of 27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for identifying malignancy, with a c-statistic of 0.69. Malignant diagnoses missed on FS included serous borderline tumor (n = 1), mucinous borderline tumor (n = 2), mucinous carcinoma (n = 1), and immature teratoma (n = 1). FS did not guide intervention in 10 of 27 (37.0%) patients: 9 with benign FS underwent oophorectomy, and 1 with malignant FS did not undergo oophorectomy. Of the 9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%) had malignant final pathology.ConclusionsFSs are infrequently utilized for pediatric and adolescent ovarian masses and could be inaccurate for predicting malignancy and guiding operative decision-making. We recommend continued assessment and refinement of guidance before any standardization of use of FS to assist with intraoperative decision-making for surgical resection and staging in children and adolescents with ovarian masses.     

Massive Ovarian Edema and Contralateral Mature Cystic Teratoma: Asymptomatic Presentation in a Premenarchal Female

BackgroundMassive ovarian edema is a rare entity, which in most cases occurs in adult females presenting with abdominal pain. We present an unusual case associated with contralateral teratoma in a premenarchal female.CaseA 13-year-old asymptomatic female presenting with an abdominopelvic mass was referred to the gynecological oncology unit with complex bilateral pelvic masses seen on ultrasound. A combination of computed tomography and repeat ultrasound demonstrated a solid mass containing numerous subcentimeter cysts inseparable from a mature teratoma. Exploratory surgery resulted in unilateral oophorectomy and contralateral cystectomy. Pathology confirmed massive ovarian edema and contralateral mature teratoma.Summary and ConclusionRecognition of this rare condition is important to avoid overtreatment of massive ovarian edema. Intraoperative biopsy is recommended as an alternative to oophorectomy in this patient group.     

The Impact of Adnexal Torsion on Antral Follicle Count when Compared With Contralateral Ovary

Study ObjectiveIn women with adnexal torsion, there is an absence of data whether ovarian reserve is affected when treated by detorsion and conservative surgery. We aimed to evaluate ovarian reserve by counting the antral follicles and estimating the ovarian volume in the operated side compared with the contralateral ovary.DesignA case-control study (Canadian Task Force classification II-2).SettingIn vitro fertilization center, Hacettepe University Faculty of Medicine and Etlik Zubeyde Hanim Women's Health and Research Hospital, Ankara, Turkey.PatientsPatients who underwent conservative surgery because of adnexal torsion between January 2008 and August 2012 were retrospectively investigated from patient files and computer-based data. Eighteen patients were eligible for the study protocol and further evaluated for their ovarian reserve with ultrasonography.InterventionsComparing ovarian reserve in the torsioned and contralateral sides with ultrasonography by physicians who were blind to the previously operated side.Measurement and Main ResultsThe mean age was 28.3 ± 5.8 years. The mean antral follicle count on the operated and contralateral ovaries were 12.3 ± 8.4 and 11.3 ± 7.4, respectively (p = .23). The respective figure for ovarian volume was 7.6 ± 4.2 and 9.1 ± 5.3 mL (p = .063). Among 3 patients seeking to become pregnant, 1 of them conceived spontaneously and one achieved pregnancy with clomiphene citrate use.ConclusionThe finding of the current study suggests that ovarian reserve reflected by the antral follicle count is not compromised in patients treated with detorsion of the twisted adnexa.     

Interdisciplinary Care and a Focus on Fertility Preservation When Multi-cystic Ovaries Cause Ovarian Torsion: A Case of a 9-year-old Girl with Severe,Undiagnosed Hypothyroidism

BackgroundOvarian torsion can occur in Van Wyk Grumbach syndrome, a disorder characterized by severe primary hypothyroidism and ovarian enlargement. To date, all documented cases of torsion in this setting describe oophorectomy, which has significant hormonal and fertility implications.CaseA 9-year-old pubertal girl presented to the emergency room with abdominal pain. Magnetic resonance imaging demonstrated bilateral, multi-cystic ovaries. Operative laparoscopy confirmed unilateral adnexal torsion, and detorsion without oophorectomy was accomplished. Postoperative laboratory tests revealed severe primary hypothyroidism. Ovarian size was reduced with hormone replacement therapy.Summary and ConclusionThis case demonstrates that prompt interdisciplinary intervention and awareness of severe hypothyroidism as a cause of ovarian torsion related to enlarged, multi-cystic ovaries may reduce the rate of oophorectomy, allowing preservation of pediatric patients’ future fertility, and reducing morbidity postoperatively through prompt, long-term thyroid supplementation.     

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio Might Predict Pediatric Ovarian Torsion: A Single-Institution Experience and Review of the Literature

Study ObjectiveTo determine clinical and laboratory characteristics of ovarian torsion (OT; n = 28) compared with a non-OT control (OC; n = 64) group.DesignRetrospective single-center review performed between January 2006 and December 2016.SettingAcademic department of pediatric surgery.Participants and InterventionsPostoperative diagnosis of pediatric ovarian pathology (International Classification of Diseases, 10th Revision code N83) in 88 patients who underwent 92 surgeries for suspected OT, aged from 3 days to 17.8 years.Main Outcome MeasuresPredictive value for OT according to biometric, procedural, and laboratory parameters at the time of admission.ResultsCompared with OC, OT in patients aged older than 1 year was associated with elevated values regarding white blood cell count, neutrophils, neutrophil to lymphocyte ratio (NLR; all P < .001), platelet to lymphocyte ratio (PLR; P = .003), platelets (P = .011), and a trend toward raised C-reactive protein (P = .054), whereas lymphocytes and lymphocyte to C-reactive protein ratio (both P < .001) were decreased. Using receiver operating characteristic analysis for differentiating OC from OT, besides lymphocytes and NLR (both area under the curve > 0.9), PLR elicited strongest discriminatory accuracy (area under the curve = 0.946 ± 0.037; P < .001; sensitivity 82%; specificity 90%). At binary logistic regression analysis PLR (P = .018) was independently predictive of OT. OT was suspected on ultrasound imaging in 15/18 (83%), showed a right-sided dominance in 13/18 (72%), and was associated with younger age (P = .003). No differences regarding laboratory or procedural parameters in patients aged younger than 1 year were discerned.ConclusionBlood count indices such as PLR, NLR, and lymphocyte to C-reactive protein ratio might be helpful in identification of inflammatory processes as induced by ischemia in OT. Together with ultrasound and clinical features, these parameters constitute potential predictors of OT in girls aged older than 1 year.     

Intraoperative Indocyanine Green Dye Use in Ovarian Torsion: A Feasibility Study

Study ObjectiveTo determine the feasibility of  intravenous indocyanine green (ICG) dye use in patients with adnexal torsion to intraoperatively evaluate ovarian perfusion after detorsion.DesignA prospective multicenter single-arm feasibility study.SettingA teaching hospital.PatientsA total of 12 nonpregnant patients, 18 to 45 years old with surgically confirmed adnexal torsion.InterventionsTorsion was surgically confirmed, the involved adnexa were untwisted laparoscopically, and ICG dye was injected intravenously. The absence or presence of ICG perfusion was documented, and the clinical decision for ovarian conservation or removal was determined by the surgeon.Measurements and Main ResultsThe primary outcome was feasibility of using ICG dye including measures such as time to visualized perfusion and operative time. Secondary outcomes included presence or absence of ovarian preservation and postoperative follow-up measures. Intraoperative visualization of ICG perfusion to the detorsed adnexa was achieved in 10 patients (83%) in a median time of 1 minute (0, 2), resulting in entire (n = 9) or partial (n = 1) ovarian conservation. Perfusion was absent in 2 cases, and postoophorectomy histologic necrosis was confirmed in one case. Median operative time was 74 minutes (48, 94). There were no adverse events related to ICG dye use.ConclusionIntraoperative ICG dye use in this study was logistically feasible and conservation of the entire or partial ovary was observed in 83% of patients, including one case where preoperative Doppler flow was absent.     

Topical Hemostatic Agent May Be Mistaken for Ovarian Teratoma

BackgroundOvarian teratomas are common, as is use of topical hemostatic agents in ovarian surgery.CaseFollowing laparoscopic right ovarian cystectomy, a flowable hemostatic agent was placed in the ovarian bed. Postoperative ultrasound demonstrated an enlarged heterogeneous right ovary with solid and cystic components interpreted as residual or recurrent teratoma. Visual inspection during repeat laparoscopy revealed an irregularly shaped, enlarged right ovary with a smooth cortex. A cavity inside the ovary contained brown, shaggy material. Pathological evaluation demonstrated normal ovary and fibrin.Summary and ConclusionWe report the first case of a hemostatic agent routinely used in ovarian cystectomy postoperatively, mimicking a teratoma. Consideration of this finding is important when planning surgery in adolescent patients to optimize fertility preservation and minimize ovarian follicle damage.     

Ovarian mucinous cystadenoma with a mural nodule of osteosarcoma: A case report

ObjectiveOsteosarcoma as a mural nodule in the ovary is extremely rare. We aimed to describe a case of a mural nodule with features of an osteosarcoma arising in an ovarian mucinous cystadenoma.Case reportThe 65-year-old woman presented with progressive abdominal swelling and poor intake. Image studies showed a huge (diameter, >30 cm) intra-abdominal multiloculated cystic lesion, suspected to be an ovarian tumor. She underwent unilateral salpingo-oophorectomy with no postoperative adjuvant therapy. She was disease-free at 16-month follow-up.ConclusionOsteosarcoma presenting as a primary ovarian neoplasm is rare, either as a pure osteosarcoma or arising from a teratoma. However, two osteosarcoma cases occurring arising from a mural nodule in an ovarian mucinous neoplasm have been reported. There is no consensus regarding the treatment strategy for osteosarcomatous mural nodules in mucinous tumors because of its rarity. More case studies are needed before its pathogenesis can be fully understood.     

Asynchronous Bilateral Ovarian Torsion. A Case Report and Mini Review

BackgroundAdnexal torsion is a serious condition and delay in surgical intervention may result in loss of ovary. Children and adolescents who have suffered from uterine adnexal torsion may be at risk for asynchronous torsion of the contralateral adnexa.CaseWe report the case of asynchronous bilateral ovarian torsion in a 9-year-old girl, resulting in right and subsequently left salpingo-oophorectomy.ConclusionThe diagnosis of ovarian torsion often is delayed. When ovarian torsion is suspected, laparoscopy should be performed without delay, and conservative management should be strongly considered to prevent surgical castration. Oophoropexy of the ipsilateral and contralateral ovary should be considered to prevent a recurrent torsion.     

Early Polycystic Ovary Syndrome as a Possible Etiology of Unexplained Premenarcheal Ovarian Torsion

Study ObjectiveTo study evidence of polycystic ovary syndrome (PCOS) in premenarcheal adolescents with unexplained ovarian torsion.DesignRetrospective observational case series.SettingTertiary university clinical centerParticipantsSix premenarcheal adolescents and six adults with acute ovarian torsionInterventionA chart review.Main Outcome MeasuresContralateral ovarian size, operative findings, ovarian pathology, hormone testingResultsFive of the six premenarcheal cases had no pathologic explanation for their ovarian torsion. In four of the cases, size measurements of the contralateral ovary were noted to be larger than the criterion of their respective age group. Three of the four cases had either an ovarian volume (28.5 cm³) or an area (16.0 cm² and 57.6 cm²) that was above the size criterion for a polycystic ovary (volume >10 cm³ or area > 5.5 cm²). Pathology of a wedge biopsy of one of the contralateral ovaries suggested evidence of polycystic ovary. Finally, hormone testing available in three of the cases revealed elevated testosterone levels in two. Among the adults, half of the cases had a pathologic explanation for ovarian torsion. One out of the five cases had a contralateral ovary that was significantly enlarged and this was noted in a woman with a diagnosis of PCOS. The remaining two cases had extensive necrosis of the torsed ovary and no other diagnosis was made.ConclusionWe propose that premenarcheal girls presenting with ovarian torsion, without obvious ovarian pathology, be screened for ultrasound and biochemical evidence of PCOS. In those with evidence of PCOS, treatment with oral contraceptives should be considered taking into account the age and pubertal development, to decrease ovarian volume.     

Clinical and Computed Tomographic Features of Ovarian Lesions in Infants,Children, and Adolescents: A Series of 222 Cases

Study ObjectiveTo investigate the clinical and computed tomography (CT) characteristics of ovarian lesions in infants, children, and adolescents.Design, Setting, and ParticipantsA retrospective analysis of the clinical and CT data was performed in 222 patients who were 20 years or younger with ovarian lesions. Patients’ age, medical history, symptoms, tumor marker levels, and CT imaging findings were recorded.InterventionsNone.Main Outcome MeasuresIdentification of the clinical and CT features of ovarian lesions in infants, children, and adolescents.ResultsA total of 136 patients had abdominal pain, and 73 patients had palpable abdominal mass. The β-HCG was elevated in 4 and AFP was elevated in 16 of the 222 cases. A total of 235 lesions were found in 222 cases, including 75 non-neoplastic and 160 neoplastic lesions. Ovarian cyst exhibited homogeneous low density. The torsion of a normal-sized ovary demonstrated mild or no enhancement. The torsion associated with an ovarian mass demonstrated a thickened, hyperdense wall. Mature teratoma presented as a cystic mass, with bulk fat and coarse calcification. Immature teratoma appeared as a solid mass with foci of fat and fine calcification. Yolk sac tumor was shown as cystic–solid mass with intense enhancement of solid component. Wall and septation of benign epithelial tumors were relatively uniform in thickness; mural nodule was detected in borderline tumor; and malignant epithelial tumor was predominantly a solid mass with intense enhancement.ConclusionOvarian cyst is the most common non-neoplastic lesion. Torsion of a normal-sized ovary was the second most common non-neoplastic lesion, almost always causing abdominal pain. Germ cell tumor has the highest incidence among neoplastic lesions. Fat and calcification are highly specific for germ cell tumor. The elevation of AFP and HCG levels in serum indicates germ cell tumor. Ovarian epithelial tumor is usually large, benign, and predominantly cystic. The combination of clinical and imaging features is helpful for correct diagnosis.     

Recurrence Rates for Pediatric Benign Ovarian Neoplasms

Study ObjectiveTo examine the recurrence rates of pediatric benign ovarian neoplasmsMethodsA retrospective review of females up to 21 years of age who underwent surgery for a benign ovarian neoplasm at 8 pediatric hospitals from January 2010 through December 2016 was conducted. Data include primary operation details, follow-up imaging, and reoperation details.ResultsFour hundred and twenty-six females were included in our cohort, with a median age of 15 years at the time of the primary operation. Of the patients, 69% had a mature teratoma, 18% had a serous cystadenoma, and 8% had a mucinous cystadenoma. Two-thirds of patients underwent ovarian-sparing surgery. There were 11 pathologically confirmed recurrences (2.6%) at a median follow-up of 12.8 months. The pathologically confirmed recurrence was 10.5 per 100 person-months at 12 months (SE = 5.7) for mucinous cystadenomas and 0.4 months (SE = 0.4) for mature teratomas (P = .001). For half of the patients, the pathologically confirmed recurrences occurred by 12.8 months, and for 75%, they occurred by 23.3 months. There were no differences in reoperation or recurrence on the basis of initial procedure (ovary-sparing surgery vs oophorectomy).ConclusionWe measured the pathologically confirmed recurrence rate for pediatric benign ovarian neoplasms in a large cohort. Oophorectomy was not protective against recurrence. Mucinous cystadenomas were at a greater risk of pathologically confirmed recurrence.