I. Vannix1, A. Munoz1, R. Hazboun1, V. Pepper1, D. Moores1, E. Tagge1, J. Baerg1 1Loma Linda University Children’s Hospital,Division Of Pediatric Surgery,Loma Linda, CA, USA
Aim: To prospectively identify the unique features, radiologic-pathologic correlation and ovary preservation for pediatric ovarian mature cystic teratoma (MCT) compared to a control group.
Methods: Between January 2013 and December 2017, 68 girls were identified, ten infants were excluded, 58 between 2-18 years were included. MCT’s were compared to controls undergoing operation for functional adnexal pathology. Tumor markers were obtained for all and were negative. Chi-square compared categorical and t-tests compared continuous variables. Radiologic-pathologic correlation was documented for ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Sensitivity, specificity, and accuracy were examined for identification of torsion with US and CT as sample sizes were similar. Ovary preservation was recorded.
Results: Of 58 girls, 28 had 30 MCT’s, of which two had synchronous, bilateral tumors. Four girls with unilateral MCT’s torsed (13.3%). Of 30 controls, 8 had solitary cysts without torsion (26.7%), 22 torsed (73.3%), 4 with cysts (18.0%) and 18 without (82.0%).
The mean age for MCT’s vs. controls was similar 12(3.0) vs. 11(4.0) years (p=0.28). Each had similar ultrasound-measured volumes (p=0.58) and similar proportions were post-menarchal (p=0.79).
Girls with MCT’s had significantly lower body mass indexes (p=0.01), pain >1 month (p=0.02), more palpable masses (p=0.01), less torsion (p=<0.01), fewer laparoscopic procedures (p=0.02) and more oophorectomies (p=0.01). All four ovaries were preserved in the two girls with bilateral, synchronous MCT’s (13.3%). For unilateral MCT’s, two-thirds (66.7%) resulted in oophorectomy.
Conclusion: When compared to functional adnexal pathology, girls with MCT’s have a lower BMI, longer pain history, more palpable masses and less torsion. Ultrasound for first-line imaging is recommended as it has similar radiologic/pathologic correlation for all lesions, but better sensitivity for torsion. MRI is a feasible second imaging study to avoid CT radiation, and improve diagnostic capability. Promotion of ovary preservation for all MCT’s is warranted, as bilateral synchronous lesions resulted in complete ovary preservation.
