RESUMEN
OBJECTIVE: To determine whether there were differences in presentation, imaging, and tumour markers between pediatric and adolescent gynaecology patients with adnexal masses managed expectantly and those managed surgically. METHODS: We conducted a retrospective review of patients who presented to the pediatric and adolescent gynaecology service with adnexal masses between January 2003 and January 2006 at Toronto's Hospital for Sick Children. We used t tests, chi-square, and Pearson correlation tests for analysis. RESULTS: We identified 114 patients with an adnexal mass. Fifty-nine percent had surgery (laparotomy 41.8%, laparoscopy 58.2%) and 41% were managed conservatively. The mean age of patients was 12.7 years (range 7 days to 18 years) and there was no difference in age between management groups (P = 0.59). The most common presenting symptom was abdominal pain (72.8%). Increased abdominal girth was found only in the surgical group (P < 0.01). Size of the mass was the only feature on imaging that differed between groups (11.1 cm surgical vs. 5.3 cm observed, P < 0.001). CT scans were performed in 35 patients, 94.3% of whom had surgery (P < 0.001). Tumour markers were drawn in 41.2% of patients, more often in surgical patients (P < 0.001), and 27% were abnormal, all in the surgical group. Surgical approaches included cystectomy, oophorectomy, or detorsion. Twelve percent of surgeries were for malignancies, representing 7.0% of all adnexal masses, and malignant masses were larger than benign masses (16.1 cm vs. 10.5 cm, P < 0.05). In cases that required only expectant management with serial ultrasound, both simple and complex masses resolved, with or without hormonal suppression. CONCLUSION: Larger masses and masses associated with increased abdominal girth or abnormal tumour markers were more likely to be managed by surgical intervention. Surgically managed patients had more investigations. Forty-one percent of masses in patients referred to pediatric and adolescent gynaecology specialists resolved with expectant management.
Asunto(s)
Enfermedades de los Anexos/patología , Enfermedades de los Anexos/terapia , Dolor Abdominal , Enfermedades de los Anexos/cirugía , Adolescente , Biomarcadores de Tumor/análisis , Canadá , Niño , Preescolar , Enfermedades de las Trompas Uterinas/patología , Enfermedades de las Trompas Uterinas/cirugía , Enfermedades de las Trompas Uterinas/terapia , Femenino , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Enfermedades del Ovario/patología , Enfermedades del Ovario/cirugía , Enfermedades del Ovario/terapia , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/terapia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Anomalía TorsionalRESUMEN
STUDY OBJECTIVE: To evaluate the surgical approach used in the management of ovarian dermoid cysts in the pediatric and adolescent population. DESIGN: A descriptive retrospective chart review of all cases of ovarian dermoid cyst excision between January 2001 and January 2006. SETTING: The Hospital for Sick Children, Toronto, Canada. PARTICIPANTS: Forty-one female children and adolescents who underwent operative management of an ovarian dermoid cyst. MAIN OUTCOME MEASURES: Surgical approach (laparoscopy vs laparotomy), intraoperative cyst rupture, length of hospital stay, and postoperative complications. RESULTS: The mean age was 12.5 years. All cysts were unilateral. Twenty-three patients (56%) underwent laparoscopic cystectomy, 14 (34%) underwent cystectomy via laparotomy, and 4 (10%) oophorectomies were performed via laparotomy. Cyst size was significantly larger in the laparotomy group compared to the laparoscopy group (mean diameter 14.4 cm vs 7.1 cm, respectively, P < .001). A significantly higher rate of cyst rupture was experienced during laparoscopic cystectomy (100%), compared to excision via laparotomy (27.7%, P < .001). Length of hospital stay was significantly shorter in the laparoscopy group compared to the laparotomy group (median of 0 vs 3 days, respectively, P < .001). A single case in the laparoscopy group sustained a bladder injury and developed postoperative necrotizing fasciitis resulting in a prolonged hospitalization and recovery. There were no operative or postoperative complications related to cyst content spillage, regardless of the surgical approach. CONCLUSION: Laparoscopic cystectomy is a safe and effective method of managing ovarian dermoid cysts in the pediatric and adolescent patient population.