Surgical intervention strategies for pediatric ovarian tumors: experience with 60 cases at one institution

The aim of this study was to assess the surgical intervention strategies for pediatric ovarian tumors.

The clinical features and treatment were analyzed for 60 children with ovarian tumors treated at our institution between 2000 and 2010.

Twenty-one of the 60 patients were prenatally diagnosed neonatal cases with cystic lesions. Of the 21 neonates, surgery included ultrasound-guided aspiration in 14 cases, salpingo-oophorectomy by umbilical crease incision in 6 cases with torsions, and cystectomy with ovarian preservation in one case with torsion. The mean age of the other 39 patients was 9.3 years. For 31 of these patients with benign lesions, surgery included tumor resection with ovarian preservation after aspiration of the cystic lesion through a modified Rocky Davis incision in 21 cases containing 3 torsion cases, and salpingo-oophorectomy in 10 cases, including 8 torsion cases. A salpingo-oophorectomy was performed for all eight of the patients with malignant tumors, including borderline lesions of mucinous or serous cyst adenoma, and postoperative chemotherapy was administered for two yolk sac tumors and one dysgerminoma. Only one case demonstrating a yolk sac tumor with lung metastasis at initial diagnosis died of disease after recurrence.

The majority of pediatric ovarian tumors were benign disease, and the patients with malignant lesions had a good prognosis. In neonatal cases, an umbilical crease incision approach is feasible and provides excellent cosmesis. We recommend tumor resection with ovarian preservation through a minimally invasive approach (modified Rocky Davis incision) as the first line treatment for older pediatric patients with ovarian tumors other than those preoperatively diagnosed as malignant.