Original Report
Clinical and Computed Tomographic Features of Ovarian Lesions in Infants, Children, and Adolescents: A Series of 222 Cases

https://doi.org/10.1016/j.jpag.2020.10.007Get rights and content

Abstract

Study Objective

To investigate the clinical and computed tomography (CT) characteristics of ovarian lesions in infants, children, and adolescents.

Design, Setting, and Participants

A retrospective analysis of the clinical and CT data was performed in 222 patients who were 20 years or younger with ovarian lesions. Patients’ age, medical history, symptoms, tumor marker levels, and CT imaging findings were recorded.

Interventions

None.

Main Outcome Measures

Identification of the clinical and CT features of ovarian lesions in infants, children, and adolescents.

Results

A total of 136 patients had abdominal pain, and 73 patients had palpable abdominal mass. The β-HCG was elevated in 4 and AFP was elevated in 16 of the 222 cases. A total of 235 lesions were found in 222 cases, including 75 non-neoplastic and 160 neoplastic lesions. Ovarian cyst exhibited homogeneous low density. The torsion of a normal-sized ovary demonstrated mild or no enhancement. The torsion associated with an ovarian mass demonstrated a thickened, hyperdense wall. Mature teratoma presented as a cystic mass, with bulk fat and coarse calcification. Immature teratoma appeared as a solid mass with foci of fat and fine calcification. Yolk sac tumor was shown as cystic–solid mass with intense enhancement of solid component. Wall and septation of benign epithelial tumors were relatively uniform in thickness; mural nodule was detected in borderline tumor; and malignant epithelial tumor was predominantly a solid mass with intense enhancement.

Conclusion

Ovarian cyst is the most common non-neoplastic lesion. Torsion of a normal-sized ovary was the second most common non-neoplastic lesion, almost always causing abdominal pain. Germ cell tumor has the highest incidence among neoplastic lesions. Fat and calcification are highly specific for germ cell tumor. The elevation of AFP and HCG levels in serum indicates germ cell tumor. Ovarian epithelial tumor is usually large, benign, and predominantly cystic. The combination of clinical and imaging features is helpful for correct diagnosis.

Introduction

With advantages for pediatric abdominal imaging, such as shorter scanning time with increased spatial resolution, decreased sedation rate, less necessity for oral and intravenous contrast agent application, and regulated radiation exposure, abdominal computed tomography (CT) has been frequently used in the evaluation of acute abdominal pain, trauma, oncologic disease, and other complex abdominal pathology in children. Ovarian lesions were not uncommonly encountered in abdominal CT scan.1 In infants, children and adolescents, non-neoplastic ovarian lesions mainly include ovarian cyst, ovarian torsion, and inflammatory disease. The World Health Organization (WHO) divides ovarian tumors into 4 groups: (1) surface epithelial tumors; (2) germ cell tumors; (3) sex cord−stromal tumors; and (4) other rare tumors. With the spectrum of ovarian diseases in neonates, children, and adolescents different from that in adults and often lacking specific clinical symptoms, the diagnosis and treatment for patients may be delayed and may then pose a challenge for preoperative diagnosis. For example, timely and correct diagnosis of torsion of a normal-sized ovary is crucial to save the ovaries and to preserve fertility potential in children.2 Imaging plays an important role in the noninvasive diagnosis and characterization of ovarian lesions. Ultrasound (US) is usually the first-line imaging modality for pediatric ovarian disease, and magnetic resonance imaging is used for further examination of indeterminate lesions found using US. At present, there are few reports about clinical and CT features in pediatric ovarian lesions in a comparatively large clinical sample. This study analyzes the disease spectrum of ovary in infants, children, and adolescents, as well as different clinical and CT features, to improve the level of CT diagnosis and guide the treatment.

Section snippets

Ethical Approval

This was a retrospective study; all procedures performed in the study involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, consent was waived by the ethical board.

General Information

A total of 222 patients with ovarian lesions detected by preoperative CT and confirmed by postoperative pathology who were

Surgical and Pathological Results and Clinical Symptoms

A total of 143 patients underwent ovarian preservation surgery, and 79 patients underwent unilateral oophorectomy. In all, 235 lesions in 222 patients were found, including 13 patients with bilateral lesions of the same kind. A total of 160 tumors (68.1%) included 121 benign tumors with an average diameter of 13.5 cm, 10 borderline epithelial tumors with an average diameter of 15.3 cm, and 29 malignant tumors with an average diameter of 16.2 cm. Among 71 mature cystic teratomas, 29 cases caused

Discussion

The clinical manifestations of ovarian lesions in pediatric patients are lack of specificity, with abdominal pain and fullness as the most common complaint.3 With technical advancements, CT has become an increasingly used tool. Some data have indicated that low-dose radiation may confer a significant risk of cancer, especially in young children. Different strategies can be used to minimize raditation exposure.4 In this study, a tube voltage of 80 or 100 kVp based on body weight and automatic

Conclusion

Most ovarian diseases in neonates, children and adolescents are benign and the percentage of non-neoplastic lesions is higher than neoplastic lesions. Germ cell tumors account for a large percentage of ovarian tumors in children and adolescents. CT can correctly assess the location of ovarian lesions and some lesions have characteristic CT manifestations. When optimise the balance between radiation dose and image quality, CT can be recommended as second-line imaging modality for pediatric

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  • The authors declare that they have no conflict of interest.

    This study was funded by the Program of Science and Technology Development of Ji'nan City (201805088).

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