Ovarian tumors

Abstract

Ovarian tumors comprise a heterogenous group of benign and malignant lesions. Their clinical presentation can vary based on age of the patient, size of the tumor, hormonal activity, histology and local spread or metastasis. Although ovarian malignancies are the fi fth most common cause of cancer among adult females, they are considered rare in children and adolescents. A signifi cant proportion of ovarian tumors are potentially malignant. Therefore, a thorough understanding of the characteristics that distinguish malignant from benign ovarian tumors is necessary to optimize prompt evaluation, appropriate treatment and to consider the options for ovarian preservation in the event of a benign condition. The annual incidence of ovarian masses in children is approximately 2.6 cases/100,000 girls per year. The majority of masses are benign, although various studies have estimated the occurrence of malignancy between 10-64%. This wide discrepancy in malignancy rate in case series is due to the biases in patient referrals, variable inclusion of benign lesions, and differences in data collection based both on the age groups and types of tumors included in these studies. As newer diagnostic imaging techniques have increased the detection of previously occult masses and cysts, the incidence of malignancy has declined. More recent series of patients have estimated malignancy rates at approximately 20%. The majority of ovarian lesions have no specific etiology with regards to environmental exposure, genetic background or drugs. However, there are certain diseases, genes or hormonal factors that might increase the risk for certain ovarian tumors. Nulliparity, use of ovulatory-inducing drugs, lack of oral contraceptive use, and high-fat diets are risk factors associated with later development of adult epithelial neoplasms. There are also numerous syndromes associated with various ovarian tumors (Table 77.1). The most signifi cant risk factor for ovarian cancer is genetic predisposition. The tumor suppressor genes BRCA1 and BRCA2 are responsible for 70-90% of familial cases of ovarian malignancy. The role for genetic testing in children and adolescents for such mutations is controversial since there are no medical benefi ts including preventive measures and therapy that have been studied in this population. © 2009 Springer Berlin Heidelberg.