(18) Bilateral Borderline Ovarian Tumors in a 15-Year-Old: A Rare Pediatric Case

Background: Ovarian malignancy in pediatrics, with germ cell tumors being most common, is reported in 3–8% of patients. Borderline tumors, a type of tumor with low malignant potential showing cytologic traits of malignancy but lacking clear invasive growth, occur at even lower rates with no consistent statistical data reported. Pediatric bilateral borderline ovarian tumors (BOTs) have not been well described in the literature beyond case reports.

Case: A 15-year-old female presented to her pediatrician for a routine annual exam which revealed abdominal distention on physical exam. This prompted an abdominal x-ray and CT abdomen/pelvis which identified a 23x17.5x10.3cm cystic mass stemming from the left ovary. She initially did not report any complaints, but upon reflection, she stated that she felt distended one month prior and reported a ten-pound weight gain, fatigue, urinary frequency, light-headedness, and discomfort when stooling over the last two months. She underwent menarche at age 12 and denied any significant past medical or surgical history. She was referred to pediatric surgery for further evaluation. Tumor markers were significant for a slightly elevated CA125 (87) and inhibin-A just above normal limits (106). AFP, bHCG, LDH, and inhibin B were within normal limits. Her pelvic ultrasound noted a normal uterus, no free fluid, and a large multicystic and solid mass arising from the pelvis to the level of the liver. Due to the size of the mass, her ovaries were difficult to specifically delineate. The patient subsequently underwent an exploratory laparotomy that unexpectedly revealed masses on both ovaries, with the right mass appearing benign in the operating room and the left ovarian mass with concerning solid components and increased vascularity. Pelvic washings were obtained followed by ovarian-sparing excision of bilateral ovarian masses. Pathologic specimens were reviewed at the primary institution and sent for secondary review at an institution that specializes in pediatric ovarian pathology. The patient’s pelvic washings were negative. The final diagnoses of the left (208.2g 18.5x14.8x3.2cm) and right (365 g 9.6x9.0x7.2cm) ovarian masses were proliferative serous BOTs.

Comments: This is an example of an extremely rare clinical scenario of bilateral serous BOTs in a pediatric patient. The case demonstrates the importance of an extensive preoperative workup for an abdominopelvic mass including imaging and laboratory assessment, collaboration of teams in the operating room and postoperatively, removal of masses without spillage in the abdominal cavity, and the significance of fertility preservation with ovarian-sparing mass excisions.