Savic Djordje, Stankovic Zoran B, Djukic Milan, Mikovic Zeljko, Djuricic Slavisa
Department of Pediatric Surgery, Mother and Child Health Institute of Serbia Dr Vukan Cupic, Belgrade, Serbia.
J Pediatr Endocrinol Metab. 2008 Nov;21(11):1073-8. doi: 10.1515/jpem.2008.21.11.1073.
To investigate the frequency of torsion of malignant ovarian tumors in children and adolescents.
We evaluated all patients treated for adnexal torsion in a tertiary care referral pediatric institution during the last 20 years. Presentation, tumor markers and pathology reports were evaluated. We reviewed the literature on torsion of malignant ovarian tumors.
Ninety-two girls (age 6 months to 19 years), 41 of them premenarchal, were surgically treated for adnexal torsion. Symptoms and signs that led to clinical investigation and subsequent surgery were not specific. Histological findings of torsioned masses showed 69 non-neoplasms and 23 tumors, including five malignant. Origin of the malignant disease included four germ cell tumors and one sex-cord stromal tumor. The morphology index score for malignant tumors was > or = 7 in all five patients. Tumor markers were elevated in 12 patients, including four of the patients with malignant tumors. Complete staging was performed in three adolescents with stage Ia, IIa and IIIa of disease. We found tumor origin for 11 previous reported patients with torsion of malignant ovarian tumor, including seven germ cell and four granulosa cell tumors.
Torsion of malignant ovarian tumors in pediatric and adolescent patients occurs very rarely, but it is nevertheless possible at any stage of disease. The most common torsioned malignant ovarian tumors were of germ cell origin, in both premenarchal and postmenarchal girls. A torsioned adnexal mass with index > or = 7 needs to be considered as a potential malignant tumor.
探讨儿童及青少年恶性卵巢肿瘤扭转的发生率。
我们评估了过去20年在一家三级转诊儿科机构接受附件扭转治疗的所有患者。对临床表现、肿瘤标志物和病理报告进行了评估。我们还回顾了关于恶性卵巢肿瘤扭转的文献。
92名女孩（年龄6个月至19岁）因附件扭转接受了手术治疗，其中41名女孩月经初潮前。导致临床检查及后续手术的症状和体征不具有特异性。扭转肿块的组织学检查结果显示69例为非肿瘤性病变，23例为肿瘤，其中5例为恶性肿瘤。所有5例恶性肿瘤患者的形态学指数评分均≥7。12例患者肿瘤标志物升高，其中4例为恶性肿瘤患者。对3例疾病分期为Ia、IIa和IIIa期的青少年患者进行了完整分期。我们还找到了之前报道的11例恶性卵巢肿瘤扭转患者的肿瘤起源，其中7例为生殖细胞肿瘤，4例为颗粒细胞瘤。
儿童及青少年患者的恶性卵巢肿瘤扭转非常罕见，但在疾病的任何阶段都有可能发生。在月经初潮前和月经初潮后的女孩中，最常见的扭转恶性卵巢肿瘤起源于生殖细胞。指数≥7的扭转附件肿块需要被视为潜在的恶性肿瘤。
