The article "Ovarian masses in the ...

The article "Ovarian masses in the pediatric patient" is the basis for this AORN Journal independent cogitation The behavioral objectives and examination for this program were prepared by way of Helen Starbuck Pashley, RN, MA, CNOR, with consultation from Trish O'Neill, RN M professional education specialist, Center for Perioperative Education.

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BEHAVIORAL OBJECTIVES

After reading and studying the article in succession ovarian masses in the pediatric patient, the foment will be able to

(1) discuss the incidence of ovarian tumors in the pediatric population,

(2) describe the patterns of ovarian tumors common to the pediatric patient,

(3) identify the signs and symptoms of pediatric ovarian tumors, and

(4) discuss the treatment of pediatric ovarian masses.

Pediatric ovarian masses are rare. The estimated incidence of all childhood ovarian lesions is 26 cases for 100,000 girls per year.(1) In children les than 15 years of age, malignant ovarian tumors comprise roughly 1% of all cancers.(2) Although experience at pediatric institutions varies, upon average, 16% to 55% of pediatric ovarian lesions are malignant.(3) Estimating the risk of malignancy according to age may also vary between institutions. near authors report a higher risk for girls les than nine years of age.(4) Statistics from the Children's Hospital of Philadelphia indicate that children over nine years of age appear to be at greater risk.(5)

Non-neoplastic or entirely cystic lesions represent one third of pediatric ovarian masses and are benign.(6) The predominant nonneoplastic lesion is a functional or follicular pouch that most frequently occurs in the postmenarchal adolescent, although sacs may be present in the neonate secondary to maternal human chorionic gonadotropin ([Beta]HCG) stimulation of the fetal ovaries. While childhood ovarian masses may at hand in utero through adolescence, greatest in number affected children are diagnosed between 10 and 14 years of age.

Pediatric ovarian masses display a broad range of pathology with varying clinical behavior. Despite the overall rarity of ovarian masses in the pediatric population, the relatively high potential for malignancy necessitates ready evaluation and treatment. Current goals of therapy should be aimed at healing and preservation of fertility.

PRESENTATION

Pediatric ovarian masses come to one's mind as a variety of pathologic subtype each presenting with a relatively similar pattern of symptoms and signs. The greatest in number frequently encountered complaint of girls harboring an ovarian mass is abdominal pain.(7) The pain is typically mid-abdominal, because the ovaries, attached to an elongated pedicle, do not get down into the pelvis until puberty. As a follow ovarian masses may mimic other intraabdominal, processe specifically appendicitis or other tumors.

Pain associated with these masses may be either acute, subacute, or chronic. When torsion of the ovary onward its vascular pedicle with infarction meet the eyes severe and unremitting pain eventuates Physical findings are often consistent with what is known as an "acute abdomen" (ie, pain, tendernes guarding, nausea, vomiting) and may be easily confused with acute appendicitis. Interestingly, the majority of pediatric ovarian masses may near on the right side, although without useful explanation.(8) Other children may have a more insidious pattern of les unadorned abdominal discomfort that fluctuates and persists above weeks to months and is ofttimes ascribed to such processes as gastroenteritis or irritable bowel. public constitutional symptoms may include nausea, emesis, febrile affection and anorexia. Parents may find an abdominal mass, fullnes or distension when bathing a young girl or during play. Prepubertal girls may near with precocious puberty if their tumors are hormonally active, and display premature secondary sex characteristics (eg enlargement of breast sprouts areolar discoloration, pubic hair, vaginal bleeding, vulvar hypertrophy)(9) Other les often met with symptoms include urinary frequency, dysuria, and intestinal obstruction when these constructions are involved.

DIAGNOSTICS EVALUATION

As with any medical dilemma, an accurate diagnosis begins with a thorough history and physical examination, addressing those signs and symptoms noted above. A full review of systems also is important to elicit the possibility of disseminated disease. upon examination, a suprapubic mass, frequently extending above the umbilicus, is often palpable (Figure 1). Torsion of the tumor and ovary may lead to necrosis with localized peritoneal irritation and tendernes upon abdominal palpation (Figure 2).