O'Neill Kathleen E, Cooper Amber R
Department of Obstetrics and Gynecology, Washington University, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
J Pediatr Adolesc Gynecol. 2011 Jun;24(3):176-80. doi: 10.1016/j.jpag.2010.11.006.
Mature cystic teratomas (MCTs) are the most common ovarian neoplastic lesions found in adolescents. MCTs are usually asymptomatic and are often discovered incidentally on exam or imaging. The recurrence rate of MCTs following cystectomy is 3-4% and incidence of malignant transformation is estimated to be 0.17-2%. Given the accuracy with which MCTs can be diagnosed preoperatively studies suggest that these lesions can be treated surgically using laparoscopic techniques. The management of MCTs in the adolescent population poses unique challenges given the potential impact on sexual development and fertility.
A 17-year-old female was found to have bilateral adnexal masses consistent in appearance with MCTs on computed tomography after a motor vehicle accident. She underwent exploratory laparotomy with pathology confirming the presence of bilateral ovarian MCTs. Three years later she returned to the office with occasional abdominopelvic pain. Ultrasound revealed bilateral complex cysts suggestive of recurrent MCTs. She was expectantly managed with serial ultrasounds and after 24 months, slow but visible growth of the MCTs was confirmed. The patient is now 22 years old and asymptomatic. What is the most appropriate management?
The risks of expectant management in women like the one presented are small. This suggests that although the traditional treatment for MCTs is laparoscopic ovarian cystectomy, in children and adolescents with MCTs we should consider close follow-up without intervention to preserve ovarian function and future fertility.
成熟性囊性畸胎瘤（MCTs）是青少年中最常见的卵巢肿瘤性病变。MCTs通常无症状，常在检查或影像学检查时偶然发现。囊肿切除术后MCTs的复发率为3% - 4%，恶性转化的发生率估计为0.17% - 2%。鉴于术前可准确诊断MCTs，研究表明这些病变可采用腹腔镜技术进行手术治疗。鉴于对性发育和生育的潜在影响，青少年人群中MCTs的管理带来了独特的挑战。
一名17岁女性在机动车事故后进行计算机断层扫描时发现双侧附件肿块，其外观与MCTs一致。她接受了剖腹探查术，病理证实存在双侧卵巢MCTs。三年后，她因偶尔出现的腹盆腔疼痛回到诊所。超声检查显示双侧复杂性囊肿，提示MCTs复发。对她进行了连续超声检查的观察性管理，24个月后，证实MCTs有缓慢但明显的生长。患者现在22岁，无症状。最合适的管理措施是什么？
像本例患者这样进行观察性管理的风险很小。这表明，尽管MCTs的传统治疗方法是腹腔镜卵巢囊肿切除术，但对于患有MCTs的儿童和青少年，我们应考虑密切随访而不进行干预，以保留卵巢功能和未来生育能力。
