WOFAPS 2025 8th World Congress of Pediatric Surgery

Qiuxiang Shen ¹, Weizhong Gu ¹, Liying Sun ¹, Leek Mei Lim ²

¹ Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
² Hospital Sultan Ismail Johor,Malaysia

Aim: The objectives of the study were to analyze the demographic characteristics, presenting complaints, timeliness of diagnosis, treatments received, and prognosis of all prepubertal girls diagnosed with ovarian granulosa cell tumors (OGCT) who were managed in our center.

Method and Analysis: We conducted a retrospective cohort analysis of all prepubertal girls pathologically diagnosed with OGCT in Children's Hospital Zhejiang University School of Medicine, Hangzhou, China, between 2019 and 2025. Data were collected by reviewing patients' medical notes.

Results：A total of seven prepubertal girls, aged 1.8 to 6.7 years, were diagnosed with ovarian granulosa cell tumors (OGCT) between 2019 and 2025. Four patients presented with premature thelarche, one with excessive upper lip hair and elevated serum testosterone, two with abdominal pain, and one with constipation. Among those with abdominal symptoms, the duration of illness ranged from 10 hours to 11 days. Anti-Müllerian hormone (AMH) levels were markedly elevated in four patients, while one had a normal level, the rest two didn’t have the test. No cases of distant metastasis were identified. One patient experienced ovarian rupture prior to surgery and was classified as FIGO stage III; the remaining six were classified as stage I.

All patients except one underwent adnexectomy. The exception was a 1.8-year-old girl with a 2.8 cm ovarian tumor, who underwent laparoscopic ovarian tumor resection. All tumors were confirmed as juvenile granulosa cell type on histopathology. Two patients experienced recurrence and subsequently died. One had preoperative ovarian rupture and the other presented with ovarian torsion lasting 11 days. The remaining five patients are under regular follow-up, with no signs of recurrence to date.

Conclusion：Juvenile granulosa cell tumor is the predominant pathological type of ovarian OGCT in prepubertal girls. Most patients present with precocious puberty or abdominal pain, and the majority are diagnosed at stage I with a favorable prognosis. Fertility-preserving surgery, particularly adnexectomy, is a feasible and commonly recommended option in early-stage disease. In contrast, patients with disease beyond stage I tend to have a poorer prognosis, and the decision to preserve fertility should be approached with caution, carefully weighing oncologic safety against future reproductive potential. Even in stage I, if the ovarian torsion and necrosis have lasted for a long time, the possibility of recurrence should be guarded against, and the postoperative management plan may need to be changed.