Ovarian masses in children: A review of 91 cases of malignant and benign masses

Ovarian masses in children are uncommon. We reviewed all cases of ovarian masses presenting to this hospital from 1979 to 1990. Ninety-one patients fulfilled the criteria and had medical records available. All patients were less than 18 years old. Four were diagnosed antenatally. Thirty-four tumors presented prior to 8 years of age and 1 (2.9%) was malignant. Fifty-eight tumors presented after 8 years of age and 18 (33%) were malignant. Seventy-two patients had benign disease and 19 had malignant tumors. Of those with benign disease 22 had simple or epithelial cysts, 25 had teratomas, 13 had torsion with cyst formation, 3 had granulosa cell tumors, and 9 had other less common lesions. Analysis of symptoms could not distinguish between benign and malignant lesions; however, age was less ( P < .03) and tumor size smaller ( P < .001) in patients with benign lesions. Benign lesions presented at a mean age of 8.8 years. Fifty-four patients had an ultrasound, all were diagnostic: simple mass (14), complex mass (8), or cyst (32). Mean size of the masses was 9.5 × 7.7 cm. Fourteen patients had a contralateral ovarian cyst. The malignant lesions included 14 germ cell tumors (4 endodermal sinus, 4 teratoma, 2 choriocarcinoma, 2 dysgerminoma, 1 embryonal, and 1 mixed), 4 epithelial tumors (1 mucinous cystadencarcinoma, papillary cystadeno-carcinoma, papillary serous cystadenocarcinoma, and endometrioid adenocarcinoma), and one patient with leukemic infiltration (ALL). Germ cell tumors presented at a mean age of 11.8 years. Eight of these patients had an ultrasound and all showed a mass (7) or cyst (1). Six patients had an elevated α-fetoprotein and 4 had elevated HCG. Mean size of the masses was 23.0 × 20.4 cm. Only 2 patients have died or have known recurrence. Both died of endodermal sinus tumors at 24 and 30 months. Mean follow-up is 32.8 months. Epithelial tumors presented at a mean age of 14.4 years. One patient had an elevated α-fetoprotein and elevated HCG. Mean size of the masses was 26.0 × 21.5 cm. Operative findings included one unresectable mass and one intraabdominal metastases. None of these patients have died or have evidence of recurrence. Mean follow-up is 45.6 months. These data show that most ovarian masses are benign. The risk of malignancy, in our population, increased to 33% for children 9 years or older. Germ cell tumors are the most common malignancy; epithelial cell tumors are less likely. Epithelial cysts and teratomas are the most common benign lesions. Although, ultrasound was 100% accurate in diagnosis of ovarian pathology it could not distinguish between benign and malignant tumors.