OVARIAN NEOPLASMS IN CHILDREN

Objective: To review the clinical presentation, treatment, and outcome in a series of children with ovarian neoplasms. Design: A retrospecti ve review of the medical records in a case series of 29 girls with ova rian neoplasms. The length of follow-up ranged from 6 months to 7 1/2 years and averaged 3.0 years in the girls with malignant tumors. Setti ng: The patients were treated at a large referral children's hospital. Patients: Twenty-nine girls with ovarian neoplasms were treated from 1976 to 1992. The average age of the patients was 10 years and ranged from 2 to 16 years. Main Outcome Measures: The principal outcomes exam ined were mortality and surgical morbidity. Results: The most common p resenting symptoms for these ovarian tumors in pediatric patients incl uded chronic abdominal pain, an abdominal mass, or distention. Three g irls presented with precocious puberty or hirsutism. In 27 cases, the tumor was a primary ovarian lesion. In two patients, the ovarian mass was the presenting finding for a stage IV non-Hodgkin's lymphoma. Seve nteen tumors were benign and 12 were malignant. Tumors originating fro m the germ-cell line predominated (n=17). Seven of the 10 ovarian mali gnant neoplasms were stage I at the time of diagnosis. All but one of the girls with malignant tumors received either adjunctive radiation t herapy or multiple-agent chemotherapy. Two girls with sex cord/stromal cell tumors who presented with stage I disease ultimately developed w idespread metastases. Both girls with large epithelial tumors survived . All of the girls with benign tumors and seven (70%) of 10 with malig nant lesions survived. Conclusion: Ovarian tumors are unusual lesions in the pediatric population. Unlike in adults, such neoplasms generall y originate from the germ-cell line. Whereas most ovarian tumors in gi rls are benign, some children have malignant tumors that are very aggr essive and do not respond well to adjuvant therapy. In particular, mal ignant sex cord/stromal cell tumors, even when they present at an earl y stage, may behave unpredictably.