TABLE 1.

Differential Diagnosis of Ovarian Masses in Children

Tumor type	Cell origin	Imaging features	Tumor Markers	Clinical features
Teratoma	GCT	Fat, calcium fluid	CA 19-9 (AFP in immature)	Rare association with NMDA receptor encephalitis
Yolk sac tumor	GCT	Mixed cystic and solid. May have dilated vessels seen as flow voids on MRI	AFP
Dysgerminoma	GCT	Solid; septa enhances but with low signal on T2 weighted sequence	LDH	Associated with gonadal dysgenesis; predilection for nodal spread
Choriocarcinoma	GCT	Solid; hemorrhagic	β-hCG	Nongestational tumors occur but are very rare in children
Polyembryoma	GCT			Rare
Sertoli-Leydig	Sex cord stromal	Variable; May be solid mass; may have low signal intensity on MRI	AFP	Virilization; Associated with DICER-1 mutations
Juvenile granulosa cell	Sex cord stromal	Sponge-like appearance	Inhibin
Fibroma		Low MRI signal; delayed or variable enhancement		Associated with pleural effusions and ascites (Meigs syndrome)
Cystadenoma/ Cystadenocarcinoma	Surface epithelial	Single or multiple cysts. Malignancy risk if mural nodules or other cystic complexities.	CA-125	Can be of mucinous or serous origin. Carcinoma is rare in children.
Borderline tumor	Surface epithelial	Mildly complex cystic lesion; may have papillary projections
Gonadoblastoma	Hybrid of GCT and Sex cord components	solid mass; calcifications may be present however paucity of data		Precocious puberty; association with gonadal dysgenesis where Y chromosome present
Small cell carcinoma	Origin unclear	Rare; too little data		Hypercalcemia

AFP [Alpha-fetoprotein]

β-hCG [human chorionic gonadotropin, beta subunit]

LDH [lactate dehydrogenase]