Lazar E L, Stolar C J
Division of Pediatric Surgery, Babies and Childrens Hospital of New York, NY, USA.
Semin Pediatr Surg. 1998 Feb;7(1):29-34. doi: 10.1016/s1055-8586(98)70003-4.
Solid ovarian tumors are uncommon in the pediatric population, but when they occur, they are a major source of anxiety for the patient and her family. The pediatric surgeon will be relied on to diagnose these tumors because they usually present as abdominal pain with a mass. The diagnostic evaluation consists of a carefully obtained history and physical examination, ultrasound examination, serum assay for tumor markers, and further radiographic evaluation as indicated. Two thirds of malignant tumors in children are germ cell tumors, and most of these are dysgerminomas or endodermal sinus tumors. A multimodal, team-oriented approach to therapy is crucial. Reproductive organ-sparing surgery with salpingo-oophorectomy, ascites sampling, nodule biopsy, omentectomy, and contralateral ovarian biopsy as indicated, may be curative for stage I tumors; more advanced or highly aggressive tumors should be treated with cytoreduction surgery and will require platinum-based chemotherapy. Postinduction surgery is indicated for progressive or recurrent disease. One third of tumors are physiologically active stromal tumors that often become apparent because of hormonal effects. Epithelial tumors, common in the adult, are uncommon in children and are of mild to moderate malignant potential. Other miscellaneous tumors and benign lesions are less common.
实性卵巢肿瘤在儿科人群中并不常见，但一旦发生，就会成为患者及其家人焦虑的主要来源。儿科外科医生将负责诊断这些肿瘤，因为它们通常表现为腹痛并伴有肿块。诊断评估包括仔细获取病史和进行体格检查、超声检查、肿瘤标志物血清检测以及根据需要进行进一步的影像学评估。儿童恶性肿瘤中有三分之二是生殖细胞肿瘤，其中大多数是无性细胞瘤或内胚窦瘤。采用多模式、团队协作的治疗方法至关重要。根据情况进行保留生殖器官的手术，包括输卵管卵巢切除术、腹水采样、结节活检、大网膜切除术和对侧卵巢活检，对于Ⅰ期肿瘤可能具有治愈性；更晚期或侵袭性更强的肿瘤应采用细胞减灭术治疗，并需要铂类化疗。诱导后手术适用于疾病进展或复发的情况。三分之一的肿瘤是具有生理活性的间质肿瘤，通常由于激素作用而变得明显。上皮性肿瘤在成年人中很常见，但在儿童中并不常见，且恶性潜能为轻度至中度。其他杂类肿瘤和良性病变则较少见。
