(79) Management of Bilateral Ovarian Masses in the Pediatric Population

Background: Current literature reports that benign ovarian masses in the pediatric population are bilateral 4.8% of the time and are most often mature teratomas (11-17%). Beyond the recommendations for ovarian sparing surgery when appropriate, there is little guidance for the management of adolescents with bilateral ovarian masses. The objective of this study is to describe how bilateral ovarian masses are evaluated, treated, and followed at a large tertiary care children’s hospital.

Methods: A retrospective chart review was conducted from Jan 1st, 2010 to Oct 1st, 2022. All patients ≤ 18 years of age with diagnosis of ovarian or adnexal mass/cyst were reviewed. Those noted to have synchronous bilateral disease on imaging or operative report were included. Simple cysts ≤ 3 cm and those that had operative intervention at an outside hospital were excluded. Patient demographics, evaluation, treatment modality, and surveillance were analyzed using descriptive statistics. This study received institutional IRB approval.

Results: Of the 4,235 patients who had the diagnosis of ovarian cyst, 61 patients met inclusion criteria. The average age of patient was 14.05 ± 3.02 years with a mean BMI of 27.13 ± 8.19 kg/m2. Most common races were Black (41.0%, n=25) and White (32.8%, n=20). Bilateral ovarian masses were diagnosed by imaging in 95.1% (n=58) of cases, with ultrasound as the most common imaging modality (63.8%, n=37), and intraoperatively in 4.9% (n=3) of cases. At least one tumor marker was obtained in 80.3% (n=49) of cases (Table 1). Approximately 82.0% underwent surgery (n=50), most commonly via bilateral cystectomy (58.0%) with the minority undergoing bilateral oophorectomy or unilateral cystectomy, wedge resection or biopsy (2.0%, 2.0%). The most common pathology was mature teratoma (Table 2). Following surgery, 64.0% (n=32) underwent surveillance imaging, most often with US (71.1%), with the average time to first imaging of 3.9 ± 3.8 months. For the 11 individuals who did not undergo surgery, average time to first imaging following diagnosis was 8.4 ± 9.0 months.

Conclusions: This review includes the largest number of bilateral ovarian masses with heterogenous pathologies in the pediatric and adolescent population. We hope the experience at our institution will provide a framework for further investigation in this population.