(22) Characteristics of Pediatric Ovarian Malignancies

Background: Pediatric ovarian malignancies are rare and have diverse presentations, histologic subtypes, and management considerations. We describe the clinical and pathologic characteristics of a population of pediatric patients with ovarian cancer or borderline masses from a large tertiary children’s hospital.

Methods: A retrospective chart review was performed of all patients assigned female sex at birth, ≤ 18 years of age, who underwent surgery for an ovarian mass or cyst between 2009 and 2021. IRB approval from our institution was obtained prior to beginning the study. Data was collected on preoperative assessment, surgical intervention and pathologic outcome.

Results: On initial chart review, 409 patients with ovarian masses were identified. Malignant or borderline pathology was identified in 27 patients (Table 1). 25 of 27 were primary ovarian neoplasms. Two patients underwent cystectomy, 18 underwent unilateral salpingo-oophorectomy, and six patients underwent unilateral oophorectomy. 26 of 27 had concerning preoperative imaging findings, and 7.4% (n=2) had suspicion for metastatic disease at the time of surgery. 26 had any tumor marker drawn prior to surgery, with 23 of the 27 having a pre-operative AFP collected. Beta HCG was checked most frequently (25/27), although this was possibly used to screen for pregnancy (see Table 1). LDH was notably elevated in 69.2% of cases that evaluated LDH preoperatively, compared to only 18.2% of AFPs being elevated.

Conclusions: The incidence of malignancy and borderline pathology among our patient population was 6.6% which is at the lower end of previously reported rates in the literature. The use of tumor markers and imaging studies to better characterize ovarian masses in the pediatric population has not yet been standardized. Additionally, because of their rarity, pediatric ovarian malignancies are often managed by pediatric surgeons or gynecologic oncologists with varying levels of training and practices in pediatric gynecology. Further description of malignant ovarian masses in this population will help solidify informative preoperative assessments of ovarian masses.