Malignancy rate of ovarian masses in children: Is it the same as in adults?

Ovarian masses in children present unique diagnostic challenges. The overall malignancy rate of adult women with pelvic masses requiring surgical evaluation is approximately 15%. This study determines malignancy rates in paediatric patients and identifies preoperative predictors to guide surgical decisions. Retrospective analysis of patients <19 years undergoing ovarian surgery at Hong Kong Children's Hospital (2020–2025). Variables included age, presentation, imaging, tumour markers and histopathology. Mann–Whitney U and Fisher's exact tests were used for statistical analysis. Forty patients were included (median age: 11 years, range: 0.03–17). Common presentations were painless abdominal mass (35%), abdominal pain (30%) and incidental findings (20%). Malignant pathology occurred in 13 patients (32.5%), substantially higher than adult rates. Malignant tumours were associated with pre‐pubertal status (84.6% vs. 40.7%, p  < 0.05) and larger size (median 16.3 cm vs. 7.8 cm, p  < 0.05). No statistical difference existed in symptoms or imaging between benign and malignant groups. Ovarian‐sparing procedures were performed in 40% of patients. The malignancy rate of ovarian masses in paediatric population is higher than adult. Elevated malignancy rates in paediatric ovarian masses require careful surgical planning. Ovarian‐sparing procedures should be guided by smaller tumour size, pubertal status and favourable tumour markers.