Contemporary approach to pediatric ovarian tumors

Abstract

Introduction. Pediatric ovarian tumors represent a rare but clinically important category of gynecologic conditions, comprising approximately 1-2% of all childhood malignancies and about 5% of pediatric abdominal masses. While most are benign, a meaningful percentage can be hormonally active, raising diagnostic and therapeutic challenges. Due to nonspecific symptoms such as abdominal pain or distension, early diagnosis is often delayed, potentially compromising fertility preservation and long-term outcomes. A multidisciplinary, age-specific approach is essential to optimize management. Material and methods. This study is a narrative literature review based on an extensive search across PubMed, Science- Direct, SpringerLink, and Google Scholar. The search covered the period from 2008 to 2025 and included terms such as “pediatric ovarian tumors”, “germ cell tumors”, “sex cord-stromal tumors”, “diagnostic imaging”, and “fertility preservation”. Inclusion criteria encompassed peer-reviewed, full-text articles in English focusing on patients aged 0-19 years. A total of 20 sources, including clinical guidelines and articles, were selected for their thematic relevance and quality of evidence. Results. Pediatric ovarian tumors show wide clinical and histological variability, with germ cell tumors being the most prevalent malignant subtype. Transabdominal ultrasound is the first-line imaging tool, while Magnetic Resonance Imaging is reserved for complex or inconclusive cases. Tumor markers, such as alpha-fetoprotein, beta-human chorionic gonadotropin, lactate dehydrogenase, and Inhibin B, are essential in differentiating tumor types and guiding management. Surgical decisions prioritize minimally invasive, fertility-sparing approaches when malignancy is unlikely. Long-term follow-up includes hormonal, reproductive, and psychosocial monitoring. Psychological support is particularly important for adolescents. Despite advancements, diagnostic delays, lack of pediatric-specific guidelines, and disparities in care, especially in low-resource settings, remain critical challenges. Conclusions. Pediatric ovarian tumors require an individualized, multidisciplinary management strategy that integrates early detection, age-appropriate surgical care, fertility preservation, and long-term endocrine and psychological support. This review highlights the need for pediatric-specific protocols and improved access to diagnostics to enhance outcomes and preserve the future reproductive potential of affected children and adolescents.