Malignant Childhood Ovarian Cancer: A Ten-Year Retrospective Review

BACKGROUND: Although pediatric ovarian cancer is rare (2.1-2.6/ 100,000 females per year), 10-30% of masses are malignant. Our primary aim was to confirm the incidence and type of ovarian malignant and borderline neoplasms over a ten-year period, and to describe their presentation and clinical characteristics. Furthermore, through analysis of pre-operative workups, we sought to elucidate better predictive indicators of malignancy to help guide future treatment. METHODS: Retrospective analysis of patients (<19 years old) who underwent surgery for borderline or malignant ovarian tumors from 01/01/2009 to 12/31/2018 was performed. Patient records were analyzed for age, presentation, serum marker levels, imaging findings, treatment (surgical plan and therapy), and patient outcomes. RESULTS: A total of 42 malignant and 7 borderline ovarian tumors were included in this study. Germ cell tumors were the most common malignancy (64%) followed by stromal tumors (31%), while one epithelial mucinous tumor and one small cell tumor were found (2% each). Of the borderline tumors, serous (71 %) were more common than mucinous tumors (29%). Average patient age was 13 ± 3.9 years, and the primary presenting symptoms were pain (45%) or abdominal distension (43%). Significant elevations in alpha fetoprotein, beta human chorionic gonadotropin, lactate dehydrogenase and cancer antigen-125 serum tumor markers were noted in malignancies. Eighty-eight percent of surgeries were performed as laparotomies, and the most common operation was salpingo-oopherectomy (67%). The average tumor size was 14.6 cm. ±6.6 cm. and the majority were characterized as heterogeneous (80%). All tumors were resected, and 21 (50%) malignant tumors received postoperative chemotherapy, while no borderline cases received therapy. Average postoperative follow-up time was 38.6 months, and forty-five (92%) patients were alive at the time of data collection. CONCLUSIONS: Germ cell tumors were confirmed as the most common pediatric ovarian malignancy, followed by stromal tumors. Very few epithelial tumors were noted, as compared to prior studies. Borderline neoplasms were uncommon and had favorable outcomes. In treating pediatric ovarian malignancy, we aim to maximize patient survival while preserving fertility. We recommend a standardized preoperative workup consisting of multi-modal imaging studies and a complete tumor marker panel for all patients presenting with suspicion for an ovarian tumor.