Gynecologic tumors and symptoms in childhood and adolescence; 10-years' experience

OBJECTIVES: The advancement of diagnostic imaging evaluations and the earlier occurrence of secondary sexual development prompted us to review our recent experience with genital tract tumors in children. METHODS: We analyzed data for 1938 patients aged less than 18 years who were referred to Gifu University School of Medicine-affiliated Hospitals for the years 1984 through 1993. RESULTS: Of the patients, 145 underwent surgical treatment. Vaginal tumor was seen in 5 patients; 1 endodermal sinus tumor, 1 sarcoma botryoides and 3 Gartner's duct cysts. Two patients with malignant tumor presented only with bloody vaginal discharge; recurrent abdominal pain due to vaginal obstruction was noted in 1 patient with the cyst. Ten had benign tumors in the vulva, presenting with a genital mass. Of 114 ovarian tumors, 3 were diagnosed by antenatal ultrasonographic examinations. Fifty-five had germ cell tumors, 33 had epithelial tumors, and 18 had stromal tumors. The most common symptom was abdominal pain and approximately one-third of girls who complained of abdominal pain had an ovarian tumor. Precocious puberty was noted in 4 girls with stromal tumor. Two of the 23 malignant tumors developed in the vagina and the others originated in the ovary. In 19 patients unilateral salpingo-oophorectomy or local excision was done in an attempt for reproductive organ conservation; 4 cases of advanced stage disease were treated with hysterectomy and/or bilateral salpingo-oophorectomy. Only 3 of the 23 patients with malignant tumor died within 4 years and others are free from disease. CONCLUSIONS: Genital symptoms, even common, alert us to the posibility of a genital tract tumor. The prompt and precise detection of either benign or malignant tumors in children may lead to cure and preservation of fertility with conservative surgery.