"Is the incidence of non-epithelial ovarian tumors on the rise? insights from a Tunisian tertiary center".

Introduction: Non-epithelial ovarian tumors (NEOTs), mainly germ cell and sex cord-stromal tumors, are rare entities that pose diagnostic and therapeutic challenges due to their heterogeneity and often nonspecific presentation. This study aimed to describe the epidemiological, clinical, pathological, and surgical characteristics of NEOTs managed at Charles Nicolle University Hospital, Tunis, over a five-year period. Materials and methods: We conducted a retrospective descriptive study including 48 patients operated for NEOTs between January 2020 and December 2024. Clinical, radiological, surgical, and pathological data were analyzed. Results: NEOTs represented 20.9% (48/229) of ovarian tumors. Median age at diagnosis was 35 years (IQR 28-51). Germ cell tumors accounted for 68.8% and sex cord-stromal tumors for 29.1%. Malignant tumors were rare (6.3%), all stage IA. Conservative surgery was performed in 56.2%, predominantly in germ cell tumors, while laparotomy was the main approach (87.5%). Compared with germ cell tumors, sex cord-stromal tumors occurred in older (median 51 vs. 30 years, p=0.003), more frequently postmenopausal patients (57.1% vs. 12.1%, p=0.003), and were more often >10 cm (61.5% vs. 25.8%, p=0.04). Postoperative complications occurred in 8.3%, and no recurrences were observed during follow-up. Conclusion: NEOTs, though rare, accounted for a relatively high proportion of ovarian tumors in our series. They were predominantly benign and diagnosed at an early stage, with favorable outcomes. Conservative surgery should be prioritized in young women to preserve fertility. This study represents the first Tunisian series addressing all histological subtypes of NEOTs and provides a reference for future multicenter research.