Das auffällige Ovar in der Kinder- und Jugendgynäkologie – ein Leitfaden zu Differenzialdiagnosen und klinischem Management

With a frequency of 2.6/100,000 cases per year, ovarian tumors are the most common gynecological tumors in childhood and adolescence. Ovarian cysts and neoplastic processes account for 50% each. They can occur at any age and differ significantly from ovarian tumors in adulthood in the frequency, clinical symptoms and histological classification. Ovarian cysts can already appear in fetuses and neonates but in 75% of the cases regress within the first year of life. Ovarian cysts occur far less frequently in childhood due to the hormonal resting period but can be an indication of pubertas praecox vera, McCune-Albright syndrome or placental aromatase deficiency syndrome. In adolescence the causes of cystic ovarian processes are usually persistent follicular cysts and corpus luteum cysts. Other differential diagnoses include paraovarian cysts, endometriosis cysts, polycystic ovaries, extrauterine pregnancy and a hydrosalpinx or pyosalpinx. Neoplastic ovarian tumors are rare in children before the age of 5 years but occur more frequently with increasing age. Approximately 60% of solid tumors in childhood and adolescence are benign. Germ cell tumors (especially mature teratomas) are found most frequently, epithelial tumors in 19% and stromal tumors in 18% of the cases. If indicated the evaluation of hormones and tumor markers specific for children and adolescents, e.g., inhibin B, anti-Mullerian hormone (AMH), alpha-fetoprotein (AFP) and beta subunit of human chorionic gonadotropin (HCG beta), must be considered as part of the diagnostic work-up. A rapid interdisciplinary clinical management of conspicuous ovarian findings in childhood and adolescence is obligatory to avoid complications (e.g., ovarian torsion, cyst rupture) and to achieve organ and fertility preservation when interventions are necessary.