Abstract | PURPOSE: With ovarian torsion, concern for underlying malignancy in the enlarged ovary has previously driven surgeons to resection. Detorsion alone has been recommended to allow for resolution of edema of the ovary with follow-up ultrasound surveillance to evaluate for a persistent mass, yet is not routine practice. However, the incidence of malignancies presenting as ovarian torsion is not documented. Does the risk of an underlying malignancy justify salpingoophorectomy and decreased fertility? METHOD: After institutional review board exemption (IRB#-022008-095), a 15(1/2)-year retrospective review was conducted to identify cases of operative ovarian torsion in our medical center. Tumors with neoplastic pathology (malignant and benign) were analyzed and compared with all reported cases in the literature. RESULTS: CONCLUSION: By combining our series with 13 in the literature, a 1.8% malignancy rate occurred in 707 patients with ovarian torsion, markedly less than the reported malignancy rate of 10% in children with ovarian masses. Thus, neither a pathologic nor malignant lead point should be assumed in cases of torsion. In our series, which represents the largest series of torsion in the pediatric literature, all malignancies presented as stage I. These data further support the implementation of operative detorsion and close postoperative ovarian surveillance, with reoperation for persistent masses. Further study is needed to determine if delaying resection by weeks in those cases of persistent masses would result in tumor progression and thus change prognosis.
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Authors | Sarah C Oltmann, Anne Fischer, Robert Barber, Rong Huang, Barry Hicks, Nilda Garcia |
Journal | Journal of pediatric surgery
(J Pediatr Surg)
Vol. 45
Issue 1
Pg. 135-9
(Jan 2010)
ISSN: 1531-5037 [Electronic] United States |
PMID | 20105593
(Publication Type: Comparative Study, Journal Article, Review)
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Copyright | Copyright 2010 Elsevier Inc. All rights reserved. |
Topics |
- Adenocarcinoma
(diagnosis, surgery)
- Adolescent
- Adult
- Age Factors
- Child
- Child, Preschool
- Diagnosis, Differential
- Dysgerminoma
(diagnosis, surgery)
- Female
- Granulosa Cell Tumor
(diagnosis, surgery)
- Humans
- Incidence
- Infant
- Ovarian Diseases
(diagnosis, epidemiology, surgery)
- Ovarian Neoplasms
(diagnosis, epidemiology, surgery)
- Torsion Abnormality
(diagnosis, epidemiology, surgery)
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