Surgery for Ovarian Masses in Infants, Children, and Adolescents: 102 Consecutive Patients Treated in a 15-Year Period By Darrell L. Cass, Edith Hawkins, Mary L. Brandt, Murali Chintagumpala, Robert S. Bloss, Alan L. Milewicz, Paul K. Minifee, David E. Wesson, and Jed G. Nuchtern Houston, Texas Background/Purpose: Ovarian pathology, although rare in children, must be included in the differential diagnosis of all girls who present with abdominal pain, an abdominal mass, or precocious puberty. Methods: To improve clinical appreciation of these lesions, the authors reviewed the presentation, evaluation, and out- come of all patients with ovarian pathology surgically treated at their institution since 1985. Results: One hundred two girls (aged 9.8  5.5 years; range, 2 days to 20 years) underwent 106 separate ovarian opera- tions (43 salpingo-oophorectomies, 21 oophorectomies, 33 ovarian cystectomies, and 9 ovarian biopsies). Of those pre- senting with acute abdominal pain (n = 59), 25 (42%) had ovarian torsion (14 associated with a mature teratoma), and only 1 (2%) had a malignant tumor. In contrast, of those presenting with an abdominal mass (n = 23), 6 (26%) had malignancies. There was no age difference between those with benign disease (9.9  5.6 years; n = 96) and those with malignant tumors (8.6  3.9 years, n = 10). Nine children had 10 operations for presumed malignant tumors (3 dysgermi- nomas, 2 immature teratomas with foci of yolk sac tumor, 2 juvenile granulosa cell tumors, 1 yolk sac tumor, and 1 Sertoli-Leydig cell tumor). These patients all had unilateral salpingo-oophorectomy, 4 had chemotherapy, and all are now disease free at 8.4  4.1 years follow-up. Conclusions: Ovarian pathology remains a rare indication for surgery in girls less than 20 years of age. Because most of these lesions are benign, ovarian-preserving operations should be performed whenever feasible. J Pediatr Surg 36:693-699. Copyright © 2001 by W.B. Saunders Company. INDEX WORDS: Ovarian mass, ovarian cyst, ovarian neo- plasm, ovarian torsion, surgery, ovarian. O VARIAN MASSES, whether cystic, solid, or both, generally have been considered rare in the pedi- atric age group. 1-5 As a group, these lesions span a spectrum of pathology from functional (nonneoplastic) ovarian cysts to ovarian torsion, and from benign to highly aggressive malignant neoplasms. The actual inci- dence of pediatric ovarian lesions is unknown; however, ovarian neoplasms (which make up about one-half of all ovarian masses in children) are estimated to occur at a rate of approximately 2.6 cases per 100,000 girls per year, and malignant ovarian neoplasms make up about 1% of all childhood cancers. 4 Ovarian masses come to surgical attention in a variety of ways. Patients may present with acute abdominal pain and signs of peritonitis that can be difficult to distinguish from acute appendicitis. Patients may be referred with a large pelvic or abdominal mass and concerns of malig- nancy. Patients with ovarian lesions may present with precocious puberty, masculinization, or other signs of endocrine disturbance. Some patients with a mass effect from an enlarged ovary experience ureteral compression and hydronephrosis, bowel obstruction, or respiratory insufficiency. More rarely, patients may present with bleeding. Ovarian disorders must be included in the differential diagnosis in any girl who presents for eval- uation of abdominal pain, a pelvic or abdominal mass, or gynecologic endocrine disorder. In this report we review a 15-year experience with the surgical management of ovarian mases in children at a large children’s hospital. It is our goal that such infor- mation may help guide the evaluation and surgical man- agement of future children with ovarian disorders. MATERIALS AND METHODS We searched the pathology database at our institution to identify all patients who had tissue from ovary or fallopian tube submitted for pathologic analysis between January 1, 1985 and February 22, 2000. From this search, 132 patients were identified. Twenty-six patients (with malignant ovarian tumors) were treated primarily elsewhere and From the Departments of Surgery, Pathology, and Pediatrics at the Texas Children’s Hospital and the Baylor College of Medicine, Hous- ton, TX. Presented at the 32nd Annual Meeting of the Canadian Association of Paediatric Surgeons, Cha ˆteau Montebello, Quebec, Canada, Sep- tember 15-18, 2000. Address reprint requests to Jed G. Nuchtern, MD, Pediatric Surgery, Feigin Center, Suite 245, 6621 Fannin, MC 3-2325, Houston, TX 77030-2399. Copyright © 2001 by W.B. Saunders Company 0022-3468/01/3605-0005$35.00/0 doi:10.1053/jpsu.2001.22939 693 Journal of Pediatric Surgery, Vol 36, No 5 (May), 2001: pp 693-699