Management in ovarian cysts in children and adolescents TOG 2020 Flashcards
What are ovarian cyst common in 1st year of life?
Fetal gonadotrophins, material estrogen, placental hCG - follicles produced in ovary.
Most regress spontaneously
Conservative management
What is the most common cause of ovarian cyst in children and adolescents?
Simple cyst - 60%
Follicles forms corpus lutum, will resolve spontaneously.
Most common complex cyst in children and adolescents?
Risks associated
Mature cystic teratoma (dermoids) 10% BL
- 15% pain/torision
- 1% spont ruptures
- 1.7% risk malignancy transformation
What is a gonadoblastoma? Risk?
mixed germ cell tumour that characteristically develops in gonadal dysgenesis, when there is presence of a Y chromosome.
Although benign, it can evolve into a dysgerminoma with malignant features.
Most common malignant ovarian tumour in children and adolescents?
Juvenile granulose cell tumours 50% age 6-13yrs.
- 95% unilateral
- >90% survival with surgical resection alone
Common presenting symptoms of Juvenile granulose cell tumours
Pseudoprecious puberty - pigmentation breast areola, breast enlargement, vaginal discharge, public hair
- Secrete oestrogen or androgens
When do malignant
ovarian germ cell tumours present?
Mostly 1st 2 decade’s of life. 1.5% all ovarian cancers
(1/3 dysgerminomas, 1/3 immature teratoma, others embryonal tumour, endodermal sinus tumour, choriocarcinoma.
Treatment for malignant
ovarian germ cell (MOGCTs)
Multiagent chemotherapy high cure rate
3% risk POF
What is the most common presenting symptoms of ovarian cyst in children and adolescents?
Pain (30%)
What is the incidence of ovarian torsion in children and adolescents diagnosed with an ovarian cyst?
10.5%
Differentials for abdominal pain in neonates
Urinary tract infection
Hirschprung’s enterocolitis
Incarcerated hernia
Intussusception
Meckel’s diverticulum
Volvulus
Differential for abdominal pain in children
Appendicitis
Gastroenteritis
Mesenteric adenitis
Ovarian pathology
Pneumonia
Constipation
Urinary tract infection
Which types of cysts can present with Meig’s syndrome?
Fibroma
Thecoma
Granulose cell tumour
1st imaging for children and adolescents? 2nd line?
Transabdominal USS (if adolescent sexually active can have TVUS)
MRI - but young children require sedation
Sensitivity and specificity of IOTA rules?
95% sensitivity
91% specificity
B rules
Unilocular
Solid <7mm
Prescence acoustic shadowing
Multilocular tumour <100m
Blood flow absent
M rules
Irregular solid
ascites
+4 papillary structures
Irregular multilocular solid tumour >100mm
Very strong blood flow
What other test to Ix cyst in child/adolescent
FBC, CRO
Tumour: AFP, LDH, CA124
Urine supstick (sterile pyuria seen in torsion)
+/- endocervical swan
If precocious puberty - FSH, LH, estradiol, TSH
Which ovarian neoplasms can cause a raised AFP?
Immature teratoma
Sertoli-Leydig Cell
Yolk Sac tumour
Embryonal carcinoma
Which ovarian neoplasms can cause a HCG AFP?
Dysgerminoma
Embryonal carcinoma
Which ovarian neoplasms can cause a raised LDH?
Dysgerminoma
Immature teratoma
Which ovarian neoplasms can cause a raised CA125?
Epithelial tumour
Which ovarian neoplasms can cause a raised CEA?
Epithelial tumour
Which ovarian neoplasms can cause a raised estradiol?
Juvenile granulosa cell tumour?
Which ovarian neoplasms can cause a raised testosterone?
Sertoli-Leydig Cell tumours
Flow diagram for management of ovarian cyst
Simple ovarian cysts under which size, is not further investigations?
<3cm
If a cyst is 3-7cm and patient is asymptomatic when should a repeat scan be offered?
3 months
If a cyst is 3-7cm and patient is symptomatic what additional test should be considered?
MRI and tumour markers
How much do mature cystic teratomas grow per year?
1.8mm/year
If <5cm can be conservatively managed
Where is the bladder located in children?
Intraperitoneal - care with suprapubic ports
What levels should the pneumoperitoneum be kept whilst operating?
12-15mmHg for thin adolescents, 8-10mmhg for younger children
What is the risk of currency after surgical removal of a mature cystic teratoma
10%
In torsion, should oophorectomy be performed if the ovary appears necrotic?
No - ovarian function has been proven to return in detorsion of blue black ovary
