Pediatric ovarian malignancies: how efficacious are current
Sarah C. Oltmann
, Nilda M. Garcia
, Robert Barber
, Barry Hicks
, Anne C. Fischer
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
Department of Pediatric Surgery, Children's Medical Center, Dallas, TX 75235, USA
Received 19 January 2010; accepted 22 February 2010
Purpose: Conventional staging is not routinely practiced because of a lack of preoperative indicators for
pediatric ovarian malignancy. Children's Oncology Group (COG) developed guidelines for germ cell
tumors to revise staging to correlate with primary pediatric ovarian pathology. Are COG guidelines
being used, and are they applicable to all pediatric ovarian malignancies?
Methods: A 15½-year retrospective review of operative ovarian masses from a single academic center
Results: There were 424 patients identified, with 46 malignancies (11%). Most were stage I (73%).
Complete COG staging was performed in 24%. Each staging component performed was as follows:
oophorectomy (91%), examination with or without biopsy of omentum (72%), peritoneum (67%),
retroperitoneum (63%), contralateral ovary (56%), and washings (46%). Advanced stages had visible
findings at exploration to guide biopsies. Of site-directed biopsies, 40.5% were positive, whereas all
random biopsies (n = 38) were negative. Two recurrences and all mortalities (n = 4) had complete initial
COG operative staging. Mean duration of follow-up was 3.62 ± 0.365 years.
Conclusion: The COG staging is not consistently followed. All cases of advanced disease were visibly
obvious and confirmed with site-directed biopsies. Random samplings were all negative and did not
impact stage. Negative outcomes reflected inherent tumor biology not deviation from COG staging. The
COG guidelines appear to be sufficient for all pediatric ovarian malignancies.
© 2010 Elsevier Inc. All rights reserved.
Optimal operative management of pediatric ovarian
masses remains unclear given the paucity of definitive
markers or indicators for malignancy. A malignancy rate of
10% is expected in children, but certain patient subsets are
associated with a lower frequency of malignancy (torsion,
patients b 1 year of age), whereas others have a higher
frequency (age 1-8 years, those presenting with precocious
puberty or an abdominal mass) [1,2]. Thus, surgeons proceed
to simple resection, salvage, or staging, based on the degree
of intraoperative concern for malignancy. The resultant
management has been either an overly aggressive resection
of normal ovaries or inconsistent staging in the face of an
unknown malignancy or cell type.
Corresponding author. Department of Pediatric Surgery, University of
Texas Southwestern Medical Center/ Children's Hospital Dallas, Dallas,
Tex, 75235, United States. Tel.: +1 214 456 6040; fax: +1 214 456 6320.
E-mail address: firstname.lastname@example.org (A.C. Fischer).
0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
Journal of Pediatric Surgery (2010) 45, 1096–1102