Surgical intervention strategies for pediatric ovarian tumors: experience with 60 cases at one institution.

PURPOSE: The aim of this study was to assess the surgical intervention strategies for pediatric ovarian tumors. METHODS: The clinical features and treatment were analyzed for 60 children with ovarian tumors treated at our institution between 2000 and 2010. RESULTS: Twenty-one of the 60 patients were prenatally diagnosed neonatal cases with cystic lesions. Of the 21 neonates, surgery included ultrasound-guided aspiration in 14 cases, salpingo-oophorectomy by umbilical crease incision in 6 cases with torsions, and cystectomy with ovarian preservation in one case with torsion. The mean age of the other 39 patients was 9.3 years. For 31 of these patients with benign lesions, surgery included tumor resection with ovarian preservation after aspiration of the cystic lesion through a modified Rocky Davis incision in 21 cases containing 3 torsion cases, and salpingo-oophorectomy in 10 cases, including 8 torsion cases. A salpingo-oophorectomy was performed for all eight of the patients with malignant tumors, including borderline lesions of mucinous or serous cyst adenoma, and postoperative chemotherapy was administered for two yolk sac tumors and one dysgerminoma. Only one case demonstrating a yolk sac tumor with lung metastasis at initial diagnosis died of disease after recurrence. CONCLUSIONS: The majority of pediatric ovarian tumors were benign disease, and the patients with malignant lesions had a good prognosis. In neonatal cases, an umbilical crease incision approach is feasible and provides excellent cosmesis. We recommend tumor resection with ovarian preservation through a minimally invasive approach (modified Rocky Davis incision) as the first line treatment for older pediatric patients with ovarian tumors other than those preoperatively diagnosed as malignant.

Correlation between the number of segmental chromosome aberrations and the age at diagnosis of diploid neuroblastomas without MYCN amplification.

BACKGROUND: In neuroblastomas (NBs) without MYCN amplification, segmental chromosome aberrations SCAs such as 1p loss, 11q loss, and 17q gain have been suggested to be associated with the prognosis of the patients. We assessed the correlation between the number of SCAs and other biological factors in primary NBs samples. METHOD: The status of SCAs in 54 primary NBs samples was analyzed using the single-nucleotide polymorphism (SNP) array (Human CMV370-Duo; Illumina, San Diego, CA). The status of MYCN amplification was determined by an SNP array and the fluorescence in situ hybridization method. The DNA ploidy was determined by flow cytometry. RESULTS: Nine of 54 samples showed MYCN amplification. All 9 samples with MYCN amplification and 20 of 45 samples without MYCN amplification showed diploidy/tetraploidy, and the other 25 samples without MYCN amplification showed aneuploidy. The most frequent SCAs were 17q gain (26/54; 48.1%) and 11q loss (16/54; 29.6%), followed by 1p loss (15/54; 27.8%). The number of SCAs in diploidy/tetraploidy NBs without MYCN amplification (7.00 ± 4.67) was higher than that in NBs with MYCN amplification (4.78 ± 2.82) and in aneuploid NBs (1.64 ± 2.78) (P < .05). In diploid/tetraploid NBs without MYCN amplification, there was a significant difference between an age at diagnosis less than 12 months (n = 7) and over 12 months (n = 13) (4.14 ± 3.63 vs 8.54 ± 4.54; P = .04). Moreover, the number of SCAs correlated with the age at diagnosis in diploid/tetraploid samples without MYCN amplification (r = 0.70, P = .0006). In NBs with MYCN amplification, the number of SCAs did not correlate with the age at diagnosis. CONCLUSION: The number of SCAs significantly increased in proportion to age at diagnosis in diploid/tetraploid NBs without MYCN amplification. The increase in the number of these SCAs may play an important role in the prognosis of patients without MYCN amplification over 12 months of age.