To investigate the ultrasonographic and pathological features of juvenile granulosa cell tumors (JGCTs) of the ovary in children.

The clinical data and ultrasonographic findings of 14 children with JGCTs diagnosed by surgical pathology at Children's Hospital of Chongqing Medical University from January 2005 to December 2020 were retrospectively analyzed. The ultrasonographic images of the tumors were pattern classified according to the International Ovarian Tumor Analysis Organization (IOTA) standards, and compared with the histopathological results.

Fourteen patients with JGCTs were included in this study. The maximum tumor diameter range of the 14 patients was 37~286 mm, and the mean standard deviation was (105±56) mm. According to IOTA standards, the ultrasonographic manifestations of tumor were classed into five types, namely, solid (6, 42.9%), multilocular cystic solid (4, 28.6%), multilocular cystic solid (2, 14.3%), single-locular cystic solid (1, 7.1%), and single-locular cystic (1, 7.1%). The pathological results showed that the solid mass consisted of diffuse proliferation of a large number of granulosa cells with scattered follicles of unequal size, necrosis and bleeding, and fibrous cord tissue. Multilocular cystic solid, single locular cystic solid, multiple locular cystic, and single locular cystic masses had varying numbers of large follicles, most of which had basophilic and/or eosinophilic fluid secreted by granulosa cells. Clinical endocrine manifestations included breast enlargement in five cases (35.7%), and vaginal bleeding and secretion in five cases (35.7%). Ultrasound revealed uterine enlargement in ten cases (71.4%), and vaginal bleeding and secretion in five cases (35.7%). The preoperative serum estradiol level was increased in all the children, with an average of (534.0±839.5) pmol/L.

The ultrasonic manifestations of JGCTs are diverse, and the mixed type of solid and multilocular cystic solid lesion is more common. The pathological characteristics of JGCTs are diffuse proliferation of large granular cells with scattered follicles of different sizes. The combination of ultrasonographic features, endocrine clinical manifestations, and serum estradiol elevation is helpful for clinical diagnosis.