Ovarian mature teratomas: Differences in management and outcomes in adolescents cared for by gynecologic and pediatric surgeons - 06/09/25

Doi : 10.1016/j.bulcan.2025.04.016

Iliasse Baatti ^1,⁎ , Fanny Delehaye ^2,^3,^⁎ , Sabine Sarnacki ⁴, Christine Denoual Ziad ¹, Frédéric Hameury ⁵, Estelle Aubry ⁶, Edouard Habonimana ⁷, Solène Joseph ⁸, Aurélien Scalabre ⁹, Yann Chaussy ¹⁰, Guillaume Podevin ¹¹, Quentin Ballouhey ¹², Frédéric Lavrand ¹³, Matthieu Peycelon ¹⁴, Sabine Irtan ¹⁵, Florent Guérin ¹⁶, Anne Dariel ¹⁷, Claude Borrione ¹⁷, Louise Galmiche ¹⁸, Elodie Haraux ¹⁹, Léopold Gaichies ²⁰, Raffaële Fauvet ^1,³, Julien Rod ^3,²¹
¹ Obstetrics and Gynecology Department, University Hospital of Caen, Caen, France
² Department of Pediatric Hematology and Oncology, University Hospital of Caen, Caen, France
³ ANTICIPE U1086, Caen, France
⁴ Pediatric Surgery Department, Hôpital Necker-Enfants–Malades, GH Centre, AP–HP, Université de Paris Cité, Paris, France
⁵ Pediatric Surgery Department, Femme-Mère–Enfant University Hospital, 59, boulevard Pinel, 69677 Bron, France
⁶ Pediatric Surgery Department, URL 2694, Hospital Jeanne-de-Flandres, CHU de Lille, Lille, France
⁷ Department of Pediatric Surgery, Rennes University Hospital, Rennes, France
⁸ Department of Pediatric Surgery, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
⁹ Department of Pediatric Surgery, University Hospital of Saint-Étienne, Saint-Étienne, France
¹⁰ Pediatric Surgery Department, University Hospital of Besançon, Besançon, France
¹¹ Pediatric Surgery Department, Angers University Hospital, Angers, France
¹² Department of Pediatric Surgery, Hôpital des Enfants, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France
¹³ Department of Pediatric Surgery, Groupe Hospitalier Pellegrin, Hôpital d’enfants, Bordeaux, France
¹⁴ Department of Pediatric Surgery and Urology, UMR Inserm 1141 NeuroDev, National Reference Center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert-Debré, AP–HP, Université Paris Cité, Paris, France
¹⁵ Pediatric Surgery Department, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
¹⁶ Pediatric Surgery Department, Hôpital Bicêtre, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP–HP), Paris, France
¹⁷ Pediatric Surgery Department, Hôpital d’enfants de la Timone, Marseille, France
¹⁸ Pathology Department, CHU de Nantes, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
¹⁹ Pediatric Surgery Department, Amiens University Hospital, Amiens, France
²⁰ Oncologic Surgery Department, François-Baclesse Center, Caen, France
²¹ Pediatric Surgery Department, University Hospital of Caen, Caen, France

^⁎Fanny Delehaye, Department of Pediatric Hematology and Oncology, University Hospital of Caen, avenue de la Côte de Nacre, 14000 Caen, France.Department of Pediatric Hematology and Oncology, University Hospital of Caenavenue de la Côte de NacreCaen14000France^⁎⁎Iliasse Baatti, Obstetrics and Gynecology Department, University Hospital of Caen, Caen, France.Obstetrics and Gynecology Department, University Hospital of CaenCaenFrance

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Summary

Background

Ovarian mature teratomas (OMTs) are the most common benign ovarian tumors in pediatric patients. Management in adolescents can be performed by pediatric (PSs) or gynecologic surgeons (GSs). The aim of this study was to assess the differences in OMT management and the repercussions according to the risk of secondary events.

Design

Based on a multicentric study, we compared patients aged 14 to 18 who underwent surgery for OMT between 2009 and 2022 from the French national pediatric database of OMTs with patients managed by GSs.

Results

In total, 119 patients were included (80 by PSs, 39 by GSs). Differences between teams were noted: (i) tumor marker analysis is systematic by PSs (80%, n=72) but rare by GSs (18%, n=7) (P<0.001), (ii) PSs mostly carried out a laparotomy (78%, n=62), whereas GSs preferred laparoscopy (90%, n=35) (P<0.001), (iii) peroperative rupture was more frequent by GSs (56%, n=22) than PSs (10%, n=8) (P<0.001), (iv) median duration of follow-up increased by PSs (20months) versus 1month by GSs (P=0.001). Ten second events (13% by GSs [n=5], 6% by PSs [n=5]) occurred in nine patients, without significant differences (P=0.151).

Conclusion

A notable difference exists in the management of OMTs between PSs and GSs in our study, GSs may overlook a malignant component in germ cell tumors in adolescents and the risk of metachronous recurrence, reported up to 10–20%. We recommend a compliance to SIOPE 2020 guidelines (Sessa et al., 2020) to avoid rupture of potential malignant tumor and to preserve fertility.

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Keywords : Germ cell tumors, Mature teratoma, Pediatric oncology, Ovarian tumors