当院における小児卵巣腫瘍58例の検討  [in Japanese] A Review of 58 Ovarian Tumors Treated at a Single Children's Hospital  [in Japanese]

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Abstract

【目的】小児卵巣腫瘍は日常診療でも遭遇しうる疾患である.成熟奇形腫が多いが,悪性化しなくとも再発する症例がみられる.また,卵巣腫瘍茎捻転は急性腹症として発症し,緊急手術にて片側付属器切除が選択されることも多い.摘出した付属器の病理学的検討では,卵巣温存の可能性が示唆されている.今回我々は,自験例から小児卵巣腫瘍における再発と卵巣温存の可能性について検討した.【方法】1999年1月から2010年10月までに当院で経験した卵巣腫瘍患児の診断,再発率,病理組織学的検討を後方視的に行った.【結果】卵巣腫瘍は58例で,平均発症年齢は10.6歳,左27例,右28例,同時性両側発症を3例認めた.卵巣腫瘍茎捻転は21例(36.2%)であった.診断は成熟奇形腫38例,未熟奇形腫3例,粘液性嚢胞腺腫4例,漿液性嚢胞腺腫4例,濾胞性嚢胞2例であった.悪性組織としては卵黄嚢癌4例,胚細胞腫2例,胎児性癌1例であった.同側再発は4例(6.9%),対側再発は6例(10.3%)にみられた.茎捻転症例では手術時に付属器壊死の有無を判断し,術式を選択した.2008年までは肉眼的に卵巣壊死を認めた症例で付属器切除を行った.しかし,摘出標本の検討では壊死と判断した症例でviableな卵巣組織の残存が確認された.2009年以降は卵巣壊死が強く疑われても,捻転解除と腫瘍核出術のみを行い,患側卵巣を温存している.【結論】卵巣腫瘍患児の約20%に再発を認めるので,十分長期間の経過観察が必要である.卵巣腫瘍の約40%が茎捻転で発症するため,女児の強い下腹部痛では卵巣腫瘍茎捻転を考慮すべきである.緊急手術の際には卵巣壊死が疑われても,捻転解除・腫瘍核出術のみとして患側卵巣の温存に努めるべきと考えられた.

Purpose: The aim of this study is to review our experiences with ovarian tumors at our children's hospital. Materials and Methods: A total of 58 children treated with ovarian tumors from January 1999 to October 2010, except for neonate cases, were retrospectively analyzed. We evaluated distribution of age at onset, the clinical outcome, and the rates and timings of recurrence of ovarian tumors. Results: Mean age was 10.6 years with 53% occurring between 10 and 15 years. We encountered 3 cases (5.2%) of bilateral ovarian tumors. Forty-eight benign neoplasms (82.8%), 3 borderline tumors (5.2%), and 7 malignancies (12%) were present. All recurrences occurred in 10 patients (17.2%). Among benign tumors, 7 out of 48 patients developed recurrent ovarian neoplasms at a median time of 33 months (2-61 months). Twenty-one patients (36.2%) with ovarian torsion were identified and underwent emergency surgery. Acute abdominal pain was the most common symptom, seen in 81% of those patients. Previously, the oophorectomy was routinely performed in 10 black-bluish ovaries after detorsion during surgery. Tumor enucleation with an ovary-sparing approach was performed in 11 cases. Recently, the ovaries that were black-bluish after detorsion were preserved and followed closely. The black-bluish ovaries were significantly twisted to a high degree, compared with ovary-sparing cases. Conclusion: Ten malignancies (17%) and 21 torsion cases (36%) were present among our pediatric ovarian tumors. Three out of seven recurrences in benign neoplasms occurred after more than 50 months. A long-term follow-up might be necessary for early recognition of postoperative recurrences. Now, we closely follow spared ovaries which looked like black-bluish after detorsion.

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 47(6), 943-947, 2011

    The Japanese Society of Pediatric Surgeons

References:  9

Codes

  • NII Article ID (NAID)
    110008790676
  • NII NACSIS-CAT ID (NCID)
    AN00192281
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    0288-609X
  • NDL Article ID
    11279684
  • NDL Source Classification
    ZS35(科学技術--医学--外科学・整形外科学・麻酔学)
  • NDL Call No.
    Z19-244
  • Data Source
    CJP  NDL  NII-ELS  J-STAGE 
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