Marko Bašković

Ovarian Collision Tumor in a Pediatric Patient: A Mature Teratoma Associated with a Combined Tumor Containing a Mucinous Cystadenocarcinoma Component

Background: Collision tumors, especially in the ovary, are a rare phenomenon where two distinct types of tumors develop adjacent to each other within the same organ but remain separate histologically. We present a case of the first collision ovarian tumor in a 14-year-old girl consisting of a combined tumor and a mature teratoma. Case Report: A 14-year-old girl presented with abdominal swelling for the past three months, without other symptoms. Ultrasound (US) examination of the abdomen revealed a large cystic mass with multiple septa, filling the entire abdomen from the diaphragm to the pelvis. Magnetic resonance imaging (MRI) showed an intraperitoneal mass, inseparable from the right ovary, measuring 22 cm × 13 cm × 30 cm. Serum tumor markers were within normal limits. The tumor mass was completely extirpated along with the fallopian tube. Histological and immunohistochemical analysis determined that it was a mucinous cystadenocarcinoma, characterized by a transition pattern from benign and borderline components to an adenocarcinoma component with a smaller mature teratoma. Six-month follow-up revealed no recurrence or postoperative complications. Conclusions: As the first documented case, this case provides valuable insights into pediatric ovarian neoplasms, guiding future diagnostic and therapeutic approaches.

The Evaluation, Diagnosis, and Management of Ovarian Cysts, Masses, and Their Complications in Fetuses, Infants, Children, and Adolescents

The majority of abdominal masses in female children derive from the ovaries. Ovarian masses in pediatric populations can vary from simple functional cysts to malignant neoplasms. Their incidence, clinical presentation, and histological distribution vary across age groups. In the assessment of ovarian masses in children, the primary aim is to determine the probability of malignancy, as the treatment approaches for benign and malignant lesions are significantly distinct. The primary imaging tool for evaluating ovarian cysts and masses is ultrasound, which can assess the size, location, and characteristics of masses. Magnetic resonance imaging (MRI) or computed tomography (CT) may be used for further evaluation if ultrasound findings are inconclusive or if malignancy is suspected, especially in older adolescents. Serum markers may be considered in older adolescents to help assess the risk of malignancy, though it is less useful in younger populations due to normal developmental variations. Many functional ovarian cysts, especially those detected in fetuses or infants, often resolve spontaneously without intervention. Surgical intervention is indicated in cases of large cysts that cause symptoms, or if there are concerns for malignancy. Common procedures include primarily ovarian sparing laparoscopy or laparotomy. Complications like torsion, rupture, or hemorrhage may require urgent surgical intervention. Treatment should be performed in specialized centers to avoid unnecessary oophorectomies and ensure the best possible outcome for the patient. This comprehensive review aims to provide an overview of the evaluation, diagnosis, and treatment of ovarian masses in the pediatric population. Emphasis is placed on the particularities of the lesions and their management in relation to age subgroups.