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| CASE REPORT |
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| Year : 2022 | Volume
: 8
| Issue : 2 | Page : 209-211 |
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Mucinous cystadenoma in a 15-year-old girl: An incidental finding
MV Rashmi1, Apurva Bhaskar2
1 Department of Pathology, Sri Siddhartha Institute of Medical Sciences and Research Centre, Nelamangala, Karnataka, India
2 Department of Pediatric Surgery, Sri Siddhartha Medical College, Tumkur, Karnataka, India
| Date of Submission | 16-May-2022 |
| Date of Decision | 27-Sep-2022 |
| Date of Acceptance | 28-Sep-2022 |
| Date of Web Publication | 23-Dec-2022 |
Correspondence Address:
M V Rashmi
Department of Pathology, Sri Siddhartha Institute of Medical Sciences and Research Centre, T-Begur, Nelamangala, Bengaluru - 562 123, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcrsm.jcrsm_37_22
Ovarian tumors in children and adolescents are rare. We present a case of a 15-year-old girl with mucinous cystadenoma (MCA) which was diagnosed incidentally when evaluating for anemia and reduced appetite. The scan reports suggested a large ovarian cyst with a few thick enhancing septa. Serological markers were within normal limits. She underwent a cystectomy with salpingo-oophorectomy. The cyst was reported as MCA on histopathology. The child is on regular follow-up for 6 months with no adverse events.
Keywords: Children and adolescents, mucinous cystadenoma, ovarian tumors
How to cite this article:
Rashmi M V, Bhaskar A. Mucinous cystadenoma in a 15-year-old girl: An incidental finding. J Curr Res Sci Med 2022;8:209-11 |
| Introduction | |  |
Ovarian tumors in children and adolescents are rare and account for less than 2% of all tumors in this age group. Germ cell tumors are the most common tumors, followed by epithelial tumors and sex cord-stromal tumors with an incidence of around 60%, <20%, and <10%, respectively. After mature teratomas, cystadenomas are the second-most common benign ovarian tumors in this age group. Of the epithelial tumors, serous and mucinous cystadenomas (MCAs) occur more frequently. The peak age of presentation in children and adolescents is 15 years, and the size of MCA on an ultrasonogram (USG) varies from 11 to 42 cm. Most of these patients present with pain abdomen and palpable mass per abdomen. The levels of tumor markers, CA125, CA19.9, CEA, alpha-fetoprotein (α-FP), beta-human chorionic gonadotropin (β-HCG), and lactate dehydrogenase are within normal limits in MCAs. Most patients undergo cystectomy for the removal of the tumor.[1],[2],[3],[4],[5],[6],[7]
| Case Report | | |
A 15-year-old female presented to the pediatrician with decreased appetite and anemia. On routine investigations, the hemoglobin (Hb) was 3 g/dl. On further evaluation for low Hb, iron profile and USG were suggested. The USG showed a large ovarian cyst with a few thick enhancing septa measuring 17 cm × 16 cm × 5 cm arising from the right ovary. The cyst was abutting the uterus, urinary bladder, small bowel loops, retroperitoneal vessels, and abdominal wall. No solid component was noted in the cyst. The pelvis showed minimal free fluid and there was no evidence of any organomegaly or lymphadenopathy. A serous cystadenoma of the ovary was suggested. Furthermore, magnetic resonance imaging (MRI) was performed to determine the contents of the cyst and for any other pathology in the uterus, lymph nodes, and surrounding areas. On MRI, the sagittal and coronal views show a large intra-abdominal cystic lesion with few septations arising from the pelvis [Figure 1]. All the tumor markers were within normal limits (CA-125 – 14.5 U/ml (<30.2 U/ml), β-HCG – 1.2 mIU/ml (<10 mIU/ml), and α-FP – 1.01 IU/ml (0.5–5.5 IU/ml). The patient underwent a cystectomy with salpingo-oophorectomy, and the specimen was sent for histopathology. The cyst was lined by mucin-secreting columnar cells [Figure 2]. A diagnosis of MCA was reported. The postoperative period was uneventful. | Figure 1: Magnetic resonance imaging; sagittal and coronal views – show a large intra-abdominal cystic lesion with few septations
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 | Figure 2: Mucinous cystadenoma composed of glands lined by mucin-secreting columnar cells
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| Discussion | | |
Ovarian tumors in children and adolescents constitute <2% of all tumors. Benign tumors (62%) are more common than malignant ones (33%). The incidence of germ cell tumors varies from 67% to 77.5% among various studies. Mature teratomas or dermoid cysts are the most common benign germ cell tumors. The sex cord-stromal tumor constitutes 12.5% of all childhood tumors of which, granulosa cell tumor is more common. The epithelial tumors constitute a mere 7.5% of all tumors. The mucinous and serous tumors are more common epithelial tumors. They usually present with pain abdomen.[3],[5],[7],[8],[9]
MCAs often present as massive cystic masses with loculations. The literature review shows sizes varying from 11 to 42 cm. Most MCAs grow to voluminous sizes and they tend to be much larger than serous cystadenomas at presentation. Although the size of these tumors is large, it is not an indication of malignancy.[1],[4],[6]
Genetic testing for GNAS variants (guanine nucleotide-binding protein) is found to be involved in the predisposition of MCAs, however, the data are limited and require to be validated in a larger sample size.[1]
In adolescents, the differential diagnosis of ovarian masses includes functional cysts, benign or malignant ovarian neoplasms, ovarian torsion, and ovarian involvement with leukemia, lymphoma, or metastatic disease.[10]
Imaging is useful in assessing the quality of the cyst, number and laterality, endometrial thickness, ascites, and any extra-ovarian extensions. Quality of the cyst with regard to size, nature (cystic/solid/mixed), features of the cyst (calcification, intertumoral fat, compartments, blood, papillary vegetations, and mural nodules), vascularity, associated endometrial thickening, ascites, and extra-ovarian extension (peritoneum and LNs) are assessed.[9]
Ultrasound is the method of choice for the initial evaluation of the ovarian cyst as it is noninvasive and easily available. However, in the study by How et al., the sensitivity and specificity of USG to detect malignancy in children and adolescents are found to be lower than that in adults. Computed tomography/MRI gives additional information as to the extent or nature of the lesion. MRI is useful for tumor vascularization and good tissue enhancement. Serological markers help in narrowing down the type of ovarian tumors.[5],[9],[10]
Predictors of malignancy on imaging apart from metastasis are tumor enhancement, a size of >12 cm, and voluminous ascites.[9]
Most MCAs are managed laparoscopically as they cause fewer surgical complications, lesser stays, and costs in the hospital.[5]
These tumors are managed either by cystectomy or oophorectomy or salpingo-oophorectomy. During cystectomy, decompression is done before the excision. Decompression of the cyst avoids any fluid spillage or rupture. There are reports that the chances of recurrence of the tumor are higher with cystadenoma enucleation than with adnexectomy. Intraoperative cyst rupture and cystectomy have higher chances of recurrence when compared to adnexectomy. There is an argument regarding the treatment by oophorectomy with regard to the size of the tumor. Unilateral salpingo-oophorectomy and tumorectomy which allow sparing of the unaffected ovary have been advocated as effective fertility-sparing surgical treatments for ovarian tumors.[2],[4]
| Conclusion | | |
MCA of the ovary should be suspected in children and adolescents whenever large, uni/multilocular ovarian cysts are encountered in this age group. An extremely large size, tumor enhancement on imaging, and voluminous ascites are predictors of malignancy. Imaging and serology must be done to rule out the other more common ovarian tumors occurring among girls of this age. MRI scanning is preferred in young females over USG as it provides high-contrast resolutions with excellent soft-tissue contrast, site of origin of large lesions compressing and overlapping pelvic structures, and above all no exposure to ionizing radiation. Oophorectomy is the preferred method of treatment as cystectomy may be associated with the risk of recurrence.
Declaration of patient consent
The authors certify that we have obtained all appropriate patient consent forms. In the form, the patient and the parent have given consent for images and other clinical information to be reported in the journal. The patient and the parent understand that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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| 7. | Watanabe S, Nagashima S, Onagi C, Yamazaki N, Shimada S, Sakai M, et al. Treatment strategy for pediatric giant mucinous cystadenoma: A case report. Pediatr Rep 2019;11:8190. |
| 8. | Péroux E, Franchi-Abella S, Sainte-Croix D, Canale S, Gauthier F, Martelli H, et al. Ovarian tumors in children and adolescents: A series of 41 cases. Diagn Interv Imaging 2015;96:273-82. |
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[Figure 1], [Figure 2]
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