Vol 93, No 4 (2022)
Clinical vignette
Published online: 2022-04-06

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Ovarian adenocarcinoma in 14-year-old girl

Agnieszka Drosdzol-Cop1, Agnieszka Mizia-Malarz2, Katarzyna Wilk1, Tomasz Koszutski3, Krzysztof Wilk1, Rafal Stojko1
Pubmed: 35419802
Ginekol Pol 2022;93(4):343-344.

Abstract

Ovarian tumors have an uncommon occurrence in children and adolescent girls compared with adult women. The peak incidence of ovarian tumors is between 15–19 years of age. Malignant ovarian tumors in children and adolescent girls are extremely rare. A case of a 14-year-old girl with ovarian mucinous adenocarcinoma that has probably not been described before in the literature is presented below.

CLINICAL VIGNETTE

Ovarian adenocarcinoma in 14-year-old girl

Agnieszka Drosdzol-Cop1Agnieszka Mizia-Malarz2Katarzyna Wilk1Tomasz Koszutski3Krzysztof Wilk1Rafal Stojko1
1Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, Poland
2Department of Pediatrics, Upper Silesia Children’s Care Health Centre, Medical University of Silesia, Katowice, Poland
3Department of Pediatric Surgery and Urology, Medical University of Silesia, School of Medicine in Katowice, Poland

Corresponding author:

Katarzyna Wilk

Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, 87 Markiefki St, 40-211 Katowice, Poland

e-mail: kkatarzynawilkk@gmail.com

Received: 16.03.2022 Accepted: 17.03.2022 Early publication date: 6.04.2022

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

a Ovarian tumors have an uncommon occurrence in children and adolescent girls compared with adult women. The peak incidence of ovarian tumors is between 1519 years of age. Malignant ovarian tumors in children and adolescent girls are extremely rare. A case of a 14-year-old girl with ovarian mucinous adenocarcinoma that has probably not been described before in the literature is presented below.
Key words: adolescent gynecology; ovarian tumor; adenocarcinoma
Ginekologia Polska 2022; 93, 4: –344

INTRODUCTION

Ovarian tumors have an uncommon occurrence in children and adolescent girls compared with adult women. The peak incidence of ovarian tumors is between 1519 years of age. Malignant ovarian tumors in children and adolescent girls are extremely rare. The most common type of pediatric ovarian tumors are ovarian germ cell tumors (GCTs). The GCTs are around 36.3% of all malignant tumors of an adolescent age. The most frequently recognized malignant tumor within GCTs is the dysgerminoma type [1, 2].

The most frequently reported clinical manifestations of ovarian tumor are abdominal pain (57%) and a palpable pelvic mass (46%) [2]. The surgical procedure without removing ovaries should only be considered in cases when the mass is not diagnosed as a malignant neoplasm or ovarian torsion. The main purpose of the surgical intervention should be preserving future fertility.

In girls, adenocarcinoma generally does not exist. A case of a 14-year-old girl with ovarian mucinous adenocarcinoma that has probably not been described before in the literature is presented below.

CASE PRESENTATION

A case of a 14-year-old girl with ovarian mucinous adenocarcinoma was reported. The girl was referred to our Department from the Pediatrician Department due to complaints of lower abdominal pain for over three weeks and with suspicion of an 8 cm left ovarian cyst shown by ultrasonographic scan. The patient experienced regular periods since menarche at the age of 12. The patient was diagnosed previously with albinism. A physical examination was unremarkable.

An ultrasound scan examination of the pelvis revealed a cystic mass sized at 7 x 5.5 cm in the left ovary. MRI images of the abdomen and pelvis revealed a left ovarian mass with solid and cystic component measured as 5 x 5 x 7 cm. Preoperative serum levels according to the ROMA test showed elevation of CA-125: 125.7 IU/mL (normal: < 35 IU/mL), but the HE4: 36 pmol/L (normal: < 70 pmoI/L) was in the normal range. The remaining tumor markers were as follows: a-fetoprotein (a-FP) 2.68 ng/mL (normal: 0.794.69 ng/mL) and human chorionic gonadotropin (HCG) < 0.5 mlU/mL. After examination, it was decided to conduct laparoscopic surgery due to the adolescent age of the patient and to limit invasiveness of the procedure.

Laparoscopic surgery, which included the resection of the tumor, left salpingo-oophorectomy and collection of part of the tissue from the right ovary, was performed in oncological purity (Fig. 1 and 2).

Figure 1. Laparoscopic surgery: ovarian adenocarcinoma of the left ovary

Figure 2. Laparoscopic surgery: ovarian adenocarcinoma of the left ovary

Final histology analysis revealed an adenocarcinoma of intestinal type of the left ovary without fallopian tube infiltration, but with simple carcinoma cells in peritoneal fluid. The part of the tissue from the right ovary did not reveal any oncological changes.

After receiving histopathological results, the Oncological Council decided to conduct urgent gastroenterological consultation, gastroscopy, colonoscopy and a PET scan. All the mentioned procedures did not show any abnormalities.

The patient was transferred to the Department of Pediatric Oncology, Hematology and Chemotherapy of Upper Silesian Child Health Center in Katowice for complementary therapy. Based on the results of diagnostic tests she was qualified for IIB stage of disease according FIGO 2014.

Regarding to the decision of the European Reference Network for Pediatric Oncology, six cycles of chemotherapy with carboplatin and paclitaxel was applied as well as in the procedure for ovarian cancer in adult women treatment.

Six months after completed the treatment process, all tumor markers were negative, the control MRI scan was correct and an ultrasonography examination of the pelvis and abdominal did not show any abnormalities.

A further follow-up of the patient was recommended.

CONCLUSIONS

Considering the case mentioned above, it is necessary to keep in mind that during a medical examination of adolescent girls having lower abdominal pain, beside commonly typed diseases, ovarian cancer might occur even though it is extremely rare. Mucinous adenocarcinoma of the ovary should be considered in the differential diagnosis of an ovarian tumors in an adolescent group of girls. This is the reason for conducting an advanced diagnostic process, including an ultrasonography examination, MRI, biochemical tumor markers and a consultation with a specialist experienced in adolescent gynecology.

Conflict of interest

All authors declare no conflict of interest.

REFERENCES

  1. Heo SH, Kim JW, Shin SS, et al. Review of ovarian tumors in children and adolescents: radiologic-pathologic correlation. Radiographics. 2014; 34(7): 20392055, doi: 10.1148/rg.347130144, indexed in Pubmed: 25384300.
  2. Sleiman Z, Karaman E, Terzic M, et al. Fertility preservation in benign gynecological diseases: current approaches and future perspectives. J Reprod Infertil. 2019; 20(4): 201208, indexed in Pubmed: 31897386.