Pediatric ovarian neoplastic tumors: incidence, age at presentation, tumor markers and outcome

Abstract

Objective: To investigate the incidence, age of onset and tumor marker levels in benign and malignant pediatric ovarian neoplastic tumors.

Design: Retrospective database study.

Setting: Single-center study.

Population: Forty-five 0-15-year-old girls operated on for ovarian neoplastic tumors from the beginning of 1999 to the end of 2013.

Methods: Serum alpha-fetoprotein, human chorionic gonadotropin and CA 125 levels as well as follow-up data were recorded from patient charts and tumor histology was re-evaluated.

Main outcome measures: Incidence of ovarian neoplastic tumors in the pediatric population. Differences in patient characteristics and tumor marker levels between those with benign and malignant tumors.

Results: The annual incidence of ovarian tumors was 2.2/100,000 females. Median age at presentation was 13.0 years (range 0.9-15.7), similar in both the 33 (73%) girls with a benign tumor and the 12 (27%) girls with a malignant tumor. The tumors with the highest propensity to metastasize (yolk sac tumors, mixed germ cell tumors, small cell carcinoma) were only found in girls > 9 years. Elevated serum alpha-fetoprotein and CA 125 values associated more often with malignant tumors (p < 0.001 and p < 0.031, respectively). There were no deaths or local recurrences. Four girls with a mature teratoma developed a contralateral benign ovarian tumor during follow up.

Conclusions: Both benign and malignant ovarian tumors are rare in the pediatric population, but the incidence increases with age. High alpha-fetoprotein and CA 125 levels were associated with malignant tumors. The prognosis of the pediatric ovarian tumors seems to be favorable.

Keywords: Ovary; children; incidence; pediatric; teratoma; tumor; tumor marker.