난소종양을 치료받은 초경 전 후 여아에서 수술요법, 항암화학요법이난소기능에 미치는 영향

Abstract

Objective: Treatment of ovarian tumor in pre- or perimenarcheal period dramatically improved, so the focus has been shifted to evaluated the reproductive and menstrual function. We checked pre- or perimenarcheal patients with ovarian tumor including malignancy to determine how the treatment affects patient’s reproductive and menstrual function. Methods: Clinical records of 74 pre- or perimenarcheal ovarian tumor managed at Ajou University Hospital from 1994 through 2004, were reviewed. All the patients underwent fertility preserving surgery and chemotherapy was added in some advanced malignant cases. Then we checked menstrual and reproductive status by history and physical exam, endocrine evaluation, pelvic ultrasonography, etc. Results: In 74 evaluable patients, 46 cases (62.2%) were benign, 28 cases (37.8%) were malignant nature. The mean age of the premenarcheal patients at the time of diagnosis was 8.37 years (range, 3.2-14.0 years), and that of the perimenarcheal patients was 13.87 years (range, 11.5-16.9 years). The number of patients with benign tumor was 21 cases (75.0%), and that of malignant tumor was 7 cases (25.0%) in premenarcheal patients, and 25 cases (54.3%) and 21 cases (45.7%) in perimenarcheal patients respectively. The most common diagnosis in 46 cases of benign tumor was mature teratoma which constituted 82.6% (38 cases). Immature teratoma accounted for 8 cases (28.6%) in 14 cases of malignant germ cell tumor. In the patients treated with operation followed by chemotherapy 4 cases (50.0%) were suffered by menstrual problems and follow up data showed the ratio of menstrual problems was increased to 75%, which revealed statistical difference (p<0.05). Only one case (2.6%) in 38 cases of surgery only group experienced menstruation change such as period, duration, dysmenorrhea, and 3 cases (37.5%) in 8 of surgery and chemotherapy group were suffered from menstrual change (p=0.019). None of menstrual changes last permanently. Conclusion: After fertility sparing operation with/without adjuvant chemotherapy, majority can anticipate normal menstrual function. Anticancer treatment especially chemotherapy can affect ovarian function but it may be transient. This information is expected to prove helpful in the future counselling of such patients.