Ultrasonic, Clinical, and Pathological Characteristics of Malignant Ovarian Tumors in Children

Abstract

Objectives: To explore and correlate the ultrasonic, clinical, and pathological characteristics of malignant ovarian tumors in children for early diagnosis and pathological typing.

Methods: A retrospective analysis was performed on the ultrasonic examination results, clinical data, and laboratory indicators of 49 cases of pathologically confirmed malignant ovarian tumors in children from January 2020 to December 2024.

Results: (1) Pathological types: Germ cell tumors accounted for 75.5% (immature teratoma 59.5%, endodermal sinus tumor and mixed germ cell tumor each 16.2%), sex cord-stromal tumors accounted for 16.3%, and lymphoma accounted for 8.2%. (2) Ultrasonic characteristics: Tumors were predominantly large (>10 cm, 73.5%), solid (51.0%), with irregular contours (81.6%), calcification (57.1%), and high-risk ovarian-adnexal reporting and data system (O-RADS) 4-5 (98.0%). (3) Significant differences were observed among different pathological types: Germ cell tumors were mostly unilateral, large-sized, and accompanied by calcification, with significantly elevated alpha-fetoprotein (AFP); sex cord-stromal tumors were solid without calcification, and 37.5% were associated with precocious puberty; lymphoma was predominantly bilateral, small-sized, and solid, with elevated lactate dehydrogenase (LDH). (4) Clinical features: Pubertal patients accounted for 32.7%; the primary presenting symptoms were abdominal pain/distension (55.1%).

Conclusions: Childhood malignant ovarian tumors are predominantly germ cell tumors, manifesting as large, solid-predominant, calcified lesions with high-risk ultrasound features. Ultrasonic, clinical, and laboratory features vary significantly by pathological type. Integrating these characteristics (including O-RADS and tumor markers) enables preoperative pathological diagnosis, supporting early multi-dimensional and personalized management.

Keywords: O‐RADS classification; children; clinical features; malignant ovarian tumors; pathological types; ultrasonic characteristics.