Endocrine Abstracts

Introduction: Gonadal tumors are rare in children. Because surgery is the primary treatment for ovarian tumors, ovarian salvage with fertility preservation and use of a minimally invasive surgical technique are important in children and adolescents. We report the case of an adolescent girl who was referred after bilateral annexectomy.

Observation: This is a 14-year-old girl who just had her first menses. She has been followed the last year for an ovarian tumor. She initially had a right annexectomy. The pathology examination concluded to a moderately differentiated Sertoli tumor of 11*13 mm. Two months later, she developed large ascites. Radiological explorations showed a mass of the remaining left ovary of 9*7 mm with peritoneal carcinosis classified as high risk stage IIIc. After a multidisciplinary discussion about fertility, cryopreservation of the ovarian cortex and all other preservation techniques have been discussed but they are impossible due to the high risk of recurrence upon reintroduction of the ovarian tissue. The child received 2 lines of chemotherapy followed by a left annexectomy. The surgery was considered complete and the pathology examination concluded to an ovarian teratoma. Currently, the 16-year-old patient is castrated with complete remission and no tumor recurrence. Her major complaint was the regression of secondary sexual characteristics.

Discussion-Conclusion: In the absence of high-level evidence literature, the Expert Consensus regarding hormone replacement therapy was consulted (1). Overall, the options for hormonal treatment depend on possible hormone dependence and the risk of recurrence. For germline tumors, these treatments can be used. On the other hand, a certain caution has been adopted for tumors of the sexual cords.

1- ROUSSET-JABLONSKI, Christine, SELLE, Frédéric, ADDA-HERZOG, Elodie, et al. Préservation de la fertilité, contraception et traitement hormonal de la ménopause chez les femmes traitées pour tumeurs malignes rares de l’ovaire: recommandations du réseau national dédié aux cancers gynécologiques rares (TMRG/GINECO). Bulletin du Cancer, 2018, vol. 105, no 3, p. 299-314.