Neuroblastoma Metastasis to the Ovary in Pediatric Female Patients: Preliminary Results of a Scoping Review.

Abstract

Background. Neuroblastoma is the most common extracranial solid tumor in childhood and presents with wide clinical variability, including abdominal mass, orbital manifestations, Horner syndrome, and paraneoplastic syndromes such as opsoclonus-myoclonus syndrome. Although metastatic dissemination is common in advanced stages, ovarian involvement is a rare and potentially underdiagnosed manifestation that poses diagnostic, therapeutic, and reproductive challenges in pediatric female patients. Objective. To describe the diagnostic and therapeutic advances reported in the literature regarding neuroblastoma metastasis to the ovary in pediatric female patients. Materials and methods. A search was conducted in PubMed using the terms Child AND Neuroblastoma AND Ovary AND Fertility. Studies including patients aged ≤18 years with neuroblastoma and ovarian involvement were included. Screening was performed in two stages: title/abstract and full-text review, through peer review. A narrative synthesis was reported under PRISMA parameters, considering age, INRGSS stage, characteristics of ovarian involvement, therapeutic approach, and outcomes. Results. Eight articles were identified and five were included: three case reports of ovarian metastasis, one case of primary ovarian neuroblastoma, and one retrospective study of 31 patients with stage 4 disease. Ages ranged from 5 to 17 years. Two cases presented with metastatic stage M disease, and one corresponded to a localized primary ovarian tumor. In metastatic disease, multi-agent chemotherapy regimens and myeloablative chemotherapy were used. The primary ovarian tumor was managed with complete resection. Complete remission was documented, with disease-free survival ranging from 18 months to 3 years. No objective assessments of ovarian function or long-term reproductive outcomes were reported. Conclusions. Ovarian metastasis in pediatric neuroblastoma is an exceptional presentation with limited evidence. Prognosis depends mainly on systemic stage; therefore, standardized protocols integrating oncologic control and fertility preservation are needed.