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G105(P) Management and follow-up for children with ovarian mature teratomas
  1. C Kane1,
  2. C Jackson2,
  3. S Farrell2,
  4. P Baldwin3,
  5. S Arul4,
  6. J Nicholson1,
  7. M Murray1
  1. 1Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3Department of Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  4. 4Department of Paediatric Surgery, Birmingham Children’s Hospital, Birmingham, UK

Abstract

Aims Recent concerns have been raised regarding long-term fertility-risk of oophorectomy in children with benign ovarian mature-teratomas (MTs), particularly as contralateral metachronous disease occurs in ~20% (Taskinen, 2014). Here we evaluate management of MT, including surgical approach (oophorectomy vs. ovarian-sparing-cystectomy=OSC) and produce an algorithm for post-operative-monitoring.

Methods 10 year single-centre retrospective analysis of ovarianMT patients<16y (Addenbrooke’s Hospital, Cambridge; 2006–16). We recorded age/presentation/pre-operative tumour-markers (AFP/HCG) and imaging/tumour-size/MDT discussion/surgical approach/follow-up, and conducted a literature review.

Results Thirty-eight patients with ovarian masses were identified; 14 exclusions (3 records unavailable/11 other pathology). The 24 inclusions comprised 17 patients with histological confirmation of MT and 7 cases with typical pre-operative radiological appearances of MT but uninformative histology (complete post-torsionnecrosis).

Pre-operatively, 19 patients (79%) had USS (nine also had 3Dimaging: two CT/seven MRI) and four (17%) had 3D-imaging only (one CT/three MRI). One MT (4%) was identified intraoperatively (suspected appendicitis). Serum AFP and HCG was measured in 19/24 (79%) and 20/24 patients (83%), respectively; there were no pathological elevations. Eleven of 24 patients (46%) were discussed by paediatric-oncology MDT, 1/24 (4%) by gynaecology-MDT, 11/24 by both (46%) and 1/24 (4%) by none.

Surgically, 10/24 patients (42%) underwent laparotomy; 14/24 (58%) laparoscopy. Two operations were emergencies. Greater tumour size was weakly associated with laparotomy (p=0.078). Nine of 24 patients (38%) underwent oophorectomy+/-salpingectomy; 15/24 (63%) OSC. Fourteen of 24 (58%) were operated on by paediatric surgeons, 4/24 (17%) by gynaecologists, and 6/24 (25%) jointly. There was no difference in proportion of OSCs by surgical team.

In follow-up, there were no recurrences, regardless of surgical approach, but hospital follow-up was generally very short (months). There was no consistency in follow-up protocols; three (13%) had no follow-up, 11 (46%) clinical only and ten (42%) baseline-USS within 6 months of surgery. Of these 10, two of these were discharged to GP for annual/biannual USS-schedules.

Conclusion OSC should always be considered in children presenting with radiological features typical for ovarian MT, normal tumour-markers and no suspicion of malignancy. We have developed a follow-up algorithm based on the presence/absence of symptoms before main presentation, torsion, tumour size and surgical approach. Involvement of shared-care-paediatricians may ensure adherence to follow-up-schedules.

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