Malignant lesions of the ovary in childhood

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Approximately half of all lesions of the ovary in childhood are neoplastic, yet only a small fraction of neoplastic lesions contain malignant elements. Overall, malignancies of the ovary account for 10% of all ovarian masses and 1% of childhood cancers. Primary ovarian malignancies fall into three broad categories based on the cell type of origin. Germ cell tumors predominate and may be further subdivided based on the differentiation of the malignant cells. Epithelial cell tumors, which are most common in adults, and sex-cord stromal tumors each make up 15% of the total in children. Rare malignant lesions and metastatic disease account for the small remaining group of tumors. Regardless of tumor type, the majority of patients present with localized disease, but proper surgical staging is important to determine the need for adjuvant therapy. The development of platinum-based chemotherapeutic regimens has resulted in significant improvements in long-term survival, even for children who present with advanced stage disease.

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Germ cell tumors

Germ cell tumors account for 75% to 80% of all neoplastic ovarian masses in most studies.1 The tumors are divided into five subgroups based on the degree of differentiation and the cellular components involved. Dysgerminomas are the least differentiated tumors and are comparable to the seminoma in males. Germ cells that undergo some degree of differentiation before becoming neoplastic yield the embryonic tumors (embryonal carcinoma or teratoma) or the extraembryonic tumors (endodermal sinus

Sex cord stromal tumors

The sex-cord tumors, granulosa cell tumors and Sertoli—Leydig cell tumors arise from stromal components of the ovary and frequently produce hormones that may result in clinically apparent changes in the patient. Granulosa cell tumors account for 1% to 10% of ovarian malignancies in girls under age 20.23, 24, 25 Ninety-five percent of granulosa cell tumors develop in postpubertal women; however, in 80% of the tumors that develop in patients under the age of 20, the tumors exhibit different

Epithelial tumors

Less than 20% of ovarian tumors in childhood are derived from the surface epithelium of the ovary and such tumors are extremely rare before menarche.32, 33 By contrast, in adults, epithelial neoplasms represent the majority of ovarian tumors.34 Although there are numerous classes of epithelial ovarian cancer in adults, the histologic subtypes of epithelial ovarian tumors in children include only serous and mucinous tumors.35 Each of these tumor types may be further characterized as benign,

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