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DOI: 10.1055/s-0040-1714080
The Case of a Serous Borderline Ovarian Tumor in a 15-Year Old Pregnant Adolescent: Sonographic Characteristics and Surgical Management
Abstract
Objective This study aimed to describe a rare case of a serous borderline ovarian tumor (BOT) diagnosed during pregnancy in a 15-year old adolescent.
Results The suspect of BOT was raised at a transvaginal ultrasound scan in early first trimester (at 5 weeks of amenorrhea), due to the presence of a moderately vascularized irregular papilla in the context of a unilocular low-level right ovarian cyst. The patient and her parents required termination of pregnancy, irrespective of the diagnosis of an ovarian lesion. After termination of pregnancy, the patient underwent laparoscopic enucleation of the ovarian mass, omentectomy, and peritoneal biopsies. No intra-abdominal spillage of the ovarian mass occurred, and the surgical specimens were put in an endobag and extracted transvaginally. Final pathological examination confirmed the diagnosis of a serous borderline ovarian tumor. The patient of free of disease after 8 months of follow-up.
Conclusion Although rare, borderline ovarian tumors can be diagnosed in an adolescent during pregnancy. The combination of specific sonographic assessment and minimally invasive conservative surgery appears as a very effective approach in this type of patient.
Key Points
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BOTs can occur in pregnant adolescents.
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Transvaginal ultrasound is crucial to suspect BOT.
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Laparoscopic conservative treatment is feasible.
Keywords
borderline ovarian tumors - laparoscopy - low-malignant potential tumors - pregnancy - adolescence - minimally invasive surgeryPublication History
Article published online:
08 September 2020
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
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References
- 1 Hazard FK, Longacre TA. Ovarian surface epithelial neoplasms in the pediatric population: incidence, histologic subtype, and natural history. Am J Surg Pathol 2013; 37 (04) 548-553
- 2 Deprest J, Moerman P, Corneillie P, Ide P. Ovarian borderline mucinous tumor in a premenarchal girl: review on ovarian epithelial cancer in young girls. Gynecol Oncol 1992; 45 (02) 219-224
- 3 Tsai JY, Saigo PE, Brown C, La Quaglia MP. Diagnosis, pathology, staging, treatment, and outcome of epithelial ovarian neoplasia in patients age < 21 years. Cancer 2001; 91 (11) 2065-2070
- 4 Morowitz M, Huff D, von Allmen D. Epithelial ovarian tumors in children: a retrospective analysis. J Pediatr Surg 2003; 38 (03) 331-335 , discussion 331–335
- 5 Virgone C, Alaggio R, Dall'Igna P. , et al. Epithelial tumors of the ovary in children and teenagers: a prospective study from the Italian TREP project. J Pediatr Adolesc Gynecol 2015; 28 (06) 441-446
- 6 Höhne S, Milzsch M, Stiefel M, Kunze C, Hauptmann S, Finke R. Ovarian borderline tumors in pre-menarche girls. Pediatr Hematol Oncol 2013; 30 (04) 253-262
- 7 Nasioudis D, Alevizakos M, Holcomb K, Witkin SS. Malignant and borderline epithelial ovarian tumors in the pediatric and adolescent population. Maturitas 2017; 96: 45-50
- 8 Childress KJ, Patil NM, Muscal JA, Dietrich JE, Venkatramani R. Borderline ovarian tumor in the pediatric and adolescent population: a case series and literature review. J Pediatr Adolesc Gynecol 2018; 31 (01) 48-54
- 9 Mascilini F, Savelli L, Scifo MC. , et al. Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis. Ultrasound Obstet Gynecol 2017; 50 (01) 116-123
- 10 Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant?. Gynecol Oncol 2006; 101 (02) 315-321
- 11 Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999; 181 (01) 19-24
- 12 Moro F, Mascilini F, Pasciuto T. , et al. Ultrasound features and clinical outcome of patients with malignant ovarian masses diagnosed during pregnancy: experience of a gynecological oncology ultrasound center. Int J Gynecol Cancer 2019; 29 (07) 1182-1194
- 13 Timmerman D, Testa AC, Bourne T. , et al; International Ovarian Tumor Analysis Group. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol 2005; 23 (34) 8794-8801
- 14 Van Calster B, Van Hoorde K, Valentin L. , et al; International Ovarian Tumour Analysis Group. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ 2014; 349: g5920
- 15 Uccella S, Cromi A, Bogani G, Casarin J, Serati M, Ghezzi F. Transvaginal specimen extraction at laparoscopy without concomitant hysterectomy: our experience and systematic review of the literature. J Minim Invasive Gynecol 2013; 20 (05) 583-590
- 16 Ghezzi F, Cromi A, Uccella S, Bogani G, Serati M, Bolis P. Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. Am J Obstet Gynecol 2012; 207 (02) 112.e1-112.e6
- 17 Hill LM, Connors-Beatty DJ, Nowak A, Tush B. The role of ultrasonography in the detection and management of adnexal masses during the second and third trimesters of pregnancy. Am J Obstet Gynecol 1998; 179 (3 Pt 1): 703-707
- 18 Yazbek J, Salim R, Woelfer B, Aslam N, Lee CT, Jurkovic D. The value of ultrasound visualization of the ovaries during the routine 11-14 weeks nuchal translucency scan. Eur J Obstet Gynecol Reprod Biol 2007; 132 (02) 154-158
- 19 Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011; 205 (02) 97-102
- 20 Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv 2006; 61 (07) 463-470
- 21 Delle Marchette M, Ceppi L, Andreano A. , et al. Oncologic and fertility impact of surgical approach for borderline ovarian tumours treated with fertility sparing surgery. Eur J Cancer 2019; 111: 61-68
- 22 NCCN Guidelines. Available at: https://www.nccn.org/professionals/physician_gls/default.aspx . Accessed 21.06.2020
- 23 Ghezzi F, Cromi A, Fanfani F. , et al. Laparoscopic fertility-sparing surgery for early ovarian epithelial cancer: a multi-institutional experience. Gynecol Oncol 2016; 141 (03) 461-465
- 24 Cromi A, Bogani G, Uccella S, Casarin J, Serati M, Ghezzi F. Laparoscopic fertility-sparing surgery for early stage ovarian cancer: a single-centre case series and systematic literature review. J Ovarian Res 2014; 7: 59
- 25 Uccella S, Cromi A, Seveso A, Siesto G, Ghezzi F. Comprehensive laparoscopic surgical staging of ovarian dysgerminoma in a 13-year-old girl: a case report. J Minim Invasive Gynecol 2008; 15 (01) 110-112