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ORIGINAL ARTICLE Table of Contents   
Year : 2010  |  Volume : 7  |  Issue : 2  |  Page : 75-77
A histopathological study of ovarian neoplasms in children in a tertiary hospital of northern Nigeria


Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

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Date of Web Publication29-Apr-2010
 

   Abstract 

Background: Information concerning the frequency and pattern of ovarian tumours in children is scant, more so in northern Nigeria. In view of this, we reviewed ovarian biopsies obtained from children in Zaria over a 25-year period. Materials and Methods: Ovarian tumours occurring in 48 patients of age 15 years and below were reviewed and classified using the current World Health Organization (WHO) histological classification of ovarian tumours. Results: Ovarian tumours in children accounted for 8.6% of all cases of tumours seen in all age groups over the period. Among all the malignant tumours seen in this period, 32% occurred in children, and Burkitt's lymphoma accounted for 31.2% of these. Germ cell tumours accounted for 58.0% while epithelial tumours had a frequency of 2.1%. Conclusion: Burkitt's lymphoma is the most common childhood ovarian tumour in Zaria, northern Nigeria.

Keywords: Children, neoplasms, ovary

How to cite this article:
Mohammed A, Malami S A, Calvin B, Abdullahi K. A histopathological study of ovarian neoplasms in children in a tertiary hospital of northern Nigeria. Afr J Paediatr Surg 2010;7:75-7

How to cite this URL:
Mohammed A, Malami S A, Calvin B, Abdullahi K. A histopathological study of ovarian neoplasms in children in a tertiary hospital of northern Nigeria. Afr J Paediatr Surg [serial online] 2010 [cited 2019 Dec 5];7:75-7. Available from: http://www.afrjpaedsurg.org/text.asp?2010/7/2/75/62848

   Introduction Top


Ovarian neoplasms are rare in children, [1] and little information is available on the relative frequency and pattern of these in Nigerian children. [2] Earlier studies on ovaries of African children centred on individual neoplastic lesions rather than general neoplastic growths. [3],[4] Other studies in African children generally included all other age groups in their analysis. [5],[6],[7],[8],[9],[10],[11],[12],[13],[14]

It is worthy of note that these lesions in children may have certain peculiarities even though they may constitute only a small proportion of all ovarian neoplasms. [1]

We retrospectively reviewed ovarian biopsy materials obtained from 48 children in our centre over a 25-year period.


   Materials and Methods Top


All cases of ovarian tumours received in the Department of Pathology, Ahmadu Bello University Teaching Hospital, between January 1981 and December 2005, were retrieved. Subsequently, those in children below 15 years of age were subjected to further study. The routine cards, bench books and histology slides stained with routine haematoxylin and eosin (H and E) were retrieved. Where necessary, fresh paraffin sections were made and stained with routine H and E. Special stains for fibrous tissue, smooth muscle and mucin identification were used where necessary. Cases where the request card or the slides and paraffin blocks were missing were excluded from the study.

The tumours were classified according to the World Health Organization classification of ovarian tumours. [15] Synchronous bilateral tumours of the same histologic type were regarded as one.


   Results Top


Over the study of period (1981-2005) of 25 years, a total of 48 consecutive cases of neoplastic enlargement of the ovary were diagnosed in children aged 15 years and below.

This made up 8.6% of all ovarian tumours in all age groups. Among them, the malignant ones accounted for 32% of all malignant ovarian tumours in all age groups.

The various histological types seen were as follows [Table 1]: 58% germ cell tumours [mature cystic teratoma 14 (29%), dysgerminoma 7 (14.6%), yolk sac tumours 2 (4.2%), embryonal carcinoma 2 (4.2%), mixed germ cell tumours 1 (2.1%), immature teratoma 2 (4.2%)], 31.2% Burkitt's lymphoma; 8.4% sexcord - stromal tumours [juvenile granulosa cell tumours 2 (4.2%), malignant granulosa cell tumours 1 (2.1%), sertoli leidig cell tumour 1 (2.1%)]; 2.1% epithelial tumours [cystadeno carcinoma 1 (2.1%)].

Overall benign tumours accounted for 17 (35.4%) and malignant tumours accounted for 31 (64.6%) cases.

The age distribution of the ovarian tumours was as follows: nine (18.8%) occurred in 0-4 years, 16 (33.3%) in 5-9 years and 23 (47.9%) in 10-15 years [Table 1].

Mature cystic teratoma occurring in 14 (29%) was the most common benign tumour and was most prevalent between 5 and 15 years of age [Table 1].

The most common malignant tumours were Burkitt's lymphoma, 15 (48.3%) and dysgerminoma, 7 (22.6%) [Table 2], their peak age of presentation being 10-15 years [Table 2].

The major clinical features of presentation were abdominal swelling, 85% and abdominal pain, 40%.


   Discussion Top


Over a period of 25 years, 48 cases of ovarian tumours in children were recorded in this tertiary institution, which has served, for most of this period, the whole of northern Nigeria. This figure is low when compared to what was seen in Ibadan, South Western Nigeria, over the same period of time, which recorded 122 cases. [2] Sigmund et al.[16] recorded 75 cases in 44 years from the Toronto Children Hospital in the same age group.

This low figure of ovarian tumours in children may be explained by possible underdiagnosis or an actual rarity of these lesions in children, as suggested by some earlier reports.

The frequency of occurrence of the ovarian tumours increased with increasing age, with the highest (47.9%) occurring in the age group of 10-15 years. This is comparable with the findings of Ibadan and James and Maxson. [2],[15]

Ovarian tumours in children in this study accounted for 8.6% of all ovarian tumours in all age groups. Malignant tumours accounted for 32%, which is a significant proportion in this study. This can be explained by the high relative incidence of Burkitt's lymphoma in African children. Excluding Burkitt's lymphoma, the malignant tumours (64.6%) will be halved and thus the proportion of malignant contribution by childhood ovarian malignancy to the overall malignancy will be remarkably reduced. Other African studies show a similar trend, where Burkitt's lymphoma played a significant role in contributing to the higher proportion of malignant ovarian enlargements in children.

Regarding other primary ovarian tumours, germ cell tumours predominate, as in other similar studies. The major contributor here is mature cystic teratoma (29%). This is less than the reported frequency of 40-60% recorded in some literature. [16] The second most common germ cell tumour observed in this study is dysgerminoma (14.6%). However, in this study, it is the most common malignant germ cell tumour, which is in keeping with observations in other studies. [16] Interestingly, the other germ cell tumours: yolks sac tumour, embryonal carcinoma and immature teratoma, all share a similar frequency of 4.2%. This contrasts with findings in other centers, which show that yolk sac tumour is the second most common of the germ cell tumours. [16]

The sexcord - stromal tumours comprising 10% of all ovarian tumours, as reported in the literature [16] (as having a 10% frequency of all ovarian tumours), have a low overall frequency, with the juvenile granulosa cell tumour being the most common, 4.2%.

Epithelial tumours however have maintained a low frequency of 1% in keeping with what is obtained in other centres. [16]

These findings show that there is some degree of similarity and a number of variations in the frequencies of the various childhood ovarian tumours in this centre when compared with others. [15],[16]

This study has revealed that Burkitt's lymphoma is the most common malignant childhood neoplasm of the ovary in northern Nigeria.

 
   References Top

1.Breen JL, Maxson SW. Ovarian Tumours in children and adolescents. Clin Obstet Gyn 1977;20.  Back to cited text no. 1      
2.Junaid TA. Ovarian neoplasms in children and adolescents in Ibadan, Nigeria. Cancer 1981;47:610-4.  Back to cited text no. 2  [PUBMED]    
3.Hussain S. Ovarian Tumours in Infants and children. A case report of a 9 months infant with granulosa cell tumour. Med J Zambia 1975;10:54- 5.  Back to cited text no. 3      
4.Nmadu PT. Childhood teratoma in Zaria, Nigeria. East Afr Med J 1995;9:551-3.  Back to cited text no. 4      
5.Edington GM, Maclean CM. A cancer rate survey in Ibadan, Western Nigeria, 1960-63. Br J Cancer 1965;176:471-81.  Back to cited text no. 5      
6.Venter PF, Anderson JD, van Velden DJ. Incidence of ovarian neoplasms at the Bloemfontein Academic Hospitals, 1972-1977. S Afr Med J 1979;55:91-3.  Back to cited text no. 6      
7.Ojwang SB, Makokha AE, Sinei SK. Ovarian cancer in Kenya. East Afr Med J 1980;57:131-7.  Back to cited text no. 7  [PUBMED]    
8.Smith EG, Elmes BGT. Malignant diseases in natives of Nigeria. An analysis of 500 tumours. Ann Trop Med 1934;28:261-76.  Back to cited text no. 8      
9.Grech ES, Lewis MG. Ovarian tumours in Ugandan Africans. East Afr Med J 1967;44:487.  Back to cited text no. 9  [PUBMED]    
10.Naik DK, Bhagwandeen SB. Ovarian Neoplasms in Zambia. Med J Zambia 1976;110:73-6.  Back to cited text no. 10      
11.Briggs ND, Katchy KC. Pattern of primary gynaecological malignancies as seen in a tertiary hospital situated in River State of Nigeria. INT J Gynecol obstet 1990;3:157-61.  Back to cited text no. 11      
12.Katchy KC, Briggs ND. Clinical and pathological features of ovarian tumours in Rivers state of Nigeria. East Afr Med J 1992;69:456-9.  Back to cited text no. 12  [PUBMED]    
13.Okonofua FE, Ishinkaye O, Abejide O. Analysis of 31 consecutive cases of ovarian carcinoma in Nigeria. Trop Doct 1993;23:27-29.  Back to cited text no. 13  [PUBMED]    
14.Naik KG. Endodermal Sinus Tumours of Ovary. Med J Zambia 1976;10:51-4.   Back to cited text no. 14      
15.James LB, Wagne SM. Ovarian Tumours in children and adolescents. Clin Obst And Gyaneocol 1977;20:3.  Back to cited text no. 15      
16.Stocker JT, Dehner LP. Ovarian Tumors: In Pediatric Pathology. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 920-32.  Back to cited text no. 16      

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Correspondence Address:
Abdullahi Mohammed
Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.62848

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    Tables

  [Table 1], [Table 2]

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