RESUMO
Juvenile granulosa cell tumors (JGCTs) are rare, though carry significant burden of morbidity and mortality. A 15-year-old menstruating female with abdominal pain was diagnosed with a large 22.3 cm pelvic mass. CA-125 and LDH were elevated. Exploratory laparotomy was undertaken due to lesion size, and left salpingo-oophorectomy with omentectomy was completed. Pathology confirmed JGCTs with focal disruption, consistent with Stage IC disease. Six weeks postoperatively, the patient experienced recurrent abdominal pain and ultrasound revealed a 7.9 cm right ovarian cystic structure. Given size and nodularity, management was discussed with a multidisciplinary team. Serial ultrasounds demonstrated resolution of the cyst. Workup for ovarian masses in pediatric patients has added complexity of fertility preservation. Once ovarian torsion is ruled out, imaging and laboratory studies are completed to characterize the mass. In pediatric patients with cancer of the Mullerian structures and risk of infertility, decision-making can be challenging and is best managed with a multidisciplinary approach.
Assuntos
Tumor de Células da Granulosa , Cistos Ovarianos , Neoplasias Ovarianas , Criança , Humanos , Feminino , Adolescente , Tumor de Células da Granulosa/cirurgia , Tumor de Células da Granulosa/diagnóstico , Tumor de Células da Granulosa/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/patologia , Cistos Ovarianos/cirurgia , Salpingo-Ooforectomia , Dor AbdominalRESUMO
BACKGROUND: Malrotation in children presents with bilious emesis and can be life threatening. Data on adults is lacking. METHODS: Single institution, retrospective 20-year data collection on adult (>18 years) and adolescent patients (12-18) with symptomatic malrotation. We evaluated demographics, surgical approach, hospital stay, time to feed, and type of surgeon with descriptive statistics to analyze each group. RESULTS: Adult (n=17) and adolescent patients (n=8) primarily presented with acute abdominal pain (82% adult, 100% adolescent), and non-bilious emesis (0%), and had elective repair. CT scan was diagnostic for 82% adults and 71% adolescents. Overall, 88% had improvement in symptoms. CONCLUSION: In this single institution series comparing adults and adolescent patients with malrotation, 88% have resolution of pain after repair, despite atypical presentations. CT scan is diagnostic and laparoscopic approach should be considered.