Rare and common Pediatric ovarian neoplasms: A comprehensive study of tumour types and features

Pediatric ovarian neoplasms (PONs) are rare and diagnostically challenging due to nonspecific symptoms and diverse presentation. While most are benign, prompt recognition of malignant cases is crucial for effective management. This study aimed to comprehensively analyze the spectrum of PONs diagnosed at a tertiary care center. A retrospective review was conducted over 12 years(2013- 2024). All PONs diagnosed in Pathology department with available slides/blocks were included. Inflammatory masses and gonads from disorders of sexual development were excluded. Of 83 ovarian lesions, 77 neoplasms were analyzed after exclusions. Patients' age ranged from 8 months to 18 years (median: 13 years). Common presentations were abdominal pain/torsion (33.3%), isolated pain (30.7%), and abdominal mass (22.7%). Most tumors were unilateral; one was functional. Benign tumors (71.4%) included mature teratomas (22.1%), serous (19.5%) and mucinous cystadenomas (5.2%). Borderline tumors were rare (3.9%). Malignant tumors (24.7%) comprised germ cell tumors (n = 12), sex cord-stromal tumors (n = 5), one mixed germ cell-sex cord tumor, and one small cell carcinoma. Malignant germ cell tumors were more common in children < 4 years; 82% of benign tumors occurred in those > 10 years. Imaging was available in 36 cases: all cystic lesions were benign, while most solid lesions were malignant (80%). Tumor markers (n = 29) including AFP, CA-125, β-hCG, and LDH showed good correlation with histology. IHC supported diagnosis in 10 malignant cases. Surgical treatment ranged from cystectomy to oophorectomy. PONs require careful evaluation due to diagnostic complexity. Histopathology, supported by IHC and tumor markers, is key to accurate diagnosis and appropriate management.