TY - JOUR T1 - Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study. JF - J Pediatr Adolesc Gynecol Y1 - 2017 A1 - Bertozzi, Mirko A1 - Esposito, Ciro A1 - Vella, Claudio A1 - Briganti, Vito A1 - Zampieri, Nicola A1 - Codrich, Daniela A1 - Ubertazzi, Michele A1 - Trucchi, Alessandro A1 - Magrini, Elisa A1 - Battaglia, Sonia A1 - Bini, Vittorio A1 - Conighi, Maria Luisa A1 - Gulia, Caterina A1 - Farina, Alessandra A1 - Camoglio, Francesco Saverio A1 - Rigamonti, Waifro A1 - Gamba, Piergiorgio A1 - Riccipetitoni, Giovanna A1 - Chiarenza, Salvatore Fabio A1 - Inserra, Alessandro A1 - Appignani, Antonino KW - Adolescent KW - Child KW - Child, Preschool KW - Cohort Studies KW - Female KW - Humans KW - Infant KW - Italy KW - Laparoscopy KW - Laparotomy KW - Menarche KW - Ovarian Diseases KW - Ovariectomy KW - Postoperative Complications KW - Recurrence KW - Retrospective Studies KW - Surveys and Questionnaires KW - Torsion Abnormality AB -

STUDY OBJECTIVE: To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence.

DESIGN: Multicenter retrospective cohort study.

SETTING: Italian Units of Pediatric Surgery.

PARTICIPANTS: Participants were female aged 1-14 years of age with surgically diagnosed OT between 2004 and 2014.

INTERVENTIONS: Adnexal detorsion, adnexectomy, mass excision using laparoscopy or laparotomy. Different kinds of oophoropexy (OPY) for OT or recurrence, respectively.

MAIN OUTCOME MEASURES: A total of 124 questionnaires were returned and analyzed to understand the current management of pediatric OT and its recurrence. The questionnaires concerned patient age, presence of menarche, OT site, presence and type of mass, performed procedure, OPY technique adopted, intra- and postoperative complications, recurrence and site, procedure performed for recurrence, OPY technique for recurrence, and 1 year follow-up of detorsed ovaries.

RESULTS: Mean age at surgery was 9.79 ± 3.54 years. Performed procedures were open adnexectomy (52 of 125; 41.6%), laparoscopic adnexectomy (25 of 125; 20%), open detorsion (10 of 125; 8%), and laparoscopic detorsion (38 of 125; 30.4%). Recurrence occurred in 15 of 125 cases (12%) and resulted as significant (P = .012) if associated with a normal ovary at the first episode of torsion. Recurrence occurred only in 1 of 19 cases after OPY (5.2%). Ultrasonographic results of detorsed ovaries were not significant whether an OPY was performed or not (P = 1.00).

CONCLUSION: Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT.

VL - 30 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27894860?dopt=Abstract ER - TY - JOUR T1 - Mature and immature teratoma: A report from the second Italian pediatric study. JF - Pediatr Blood Cancer Y1 - 2015 A1 - Terenziani, Monica A1 - D'Angelo, Paolo A1 - Inserra, Alessandro A1 - Boldrini, Renata A1 - Bisogno, Gianni A1 - Babbo, Gian Luca A1 - Conte, Massimo A1 - Dall' Igna, Patrizia A1 - De Pasquale, Maria Debora A1 - Indolfi, Paolo A1 - Piva, Luigi A1 - Riccipetitoni, Giovanna A1 - Siracusa, Fortunato A1 - Spreafico, Filippo A1 - Tamaro, Paolo A1 - Cecchetto, Giovanni KW - Adolescent KW - Adult KW - Child KW - Child, Preschool KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Infant KW - Infant, Newborn KW - Italy KW - Male KW - Neoplasm Grading KW - Neoplasm Recurrence, Local KW - Neoplasm Staging KW - Neoplasms, Second Primary KW - Neuroblastoma KW - Ovarian Neoplasms KW - Prognosis KW - Prospective Studies KW - Survival Rate KW - Teratoma KW - Testicular Neoplasms KW - Young Adult AB -

BACKGROUND: Teratomas demonstrate a benign clinical behavior, however they may recur with malignant components or as teratoma, and in a small group of patients prognosis could be fatal. After the first Italian study, we collected cases of teratoma, alongside the protocol for malignant germ cell tumors.

PROCEDURE: Patients with teratoma were collected from 2004 to 2014. Teratomas were classified according to the WHO classifications, as mature and immature. Patients with pathological aFP and/or bHCG, and those with a malignant germ cell component were not included.

RESULTS: The study enrolled 219 patients (150 mature, 69 immature teratomas) with a median age at diagnosis of 42 months. The primary sites involved were: 118 gonadal and 101 extragonadal teratomas. Two females with ovarian teratoma had a positive family history. Complete and incomplete surgeries were performed in 85% and 9% of cases. Seventeen events occurred: six females had a second metachronous tumor (5 contralateral ovarian teratoma, 1 adrenal neuroblastoma) and 11 teratomas relapsed/progressed (3 mature, 8 immature teratomas). Two patients died, one of progressive immature teratoma and one of surgical complications. At a median follow up of 68 months, the event-free, relapse-free, and overall survival rates were 90.6%, 94.3%, 98.6%, respectively.

CONCLUSIONS: Teratomas show a good prognosis, especially the mature ones: surgery and follow-up remain the standard approach. Incomplete surgery in immature teratoma is the group at greatest risk of relapse. Bilateral ovarian tumors are a possibility, and the rare family predisposition to ovarian mature teratoma warrants further analyses.

VL - 62 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25631333?dopt=Abstract ER -