Clinical spectrum of adnexal masses in children and adolescents: Lessons learned from a 27-Year institutional experience

The management of pediatric adnexal masses has historically been challenging and has often resulted in removal of the ovary together with the mass. Growing recognition that most pediatric adnexal lesions are benign has supported a shift toward anatomical ovarian preservation. This study describes the surgical management of adnexal masses and rates of anatomical ovarian preservation among children and adolescents treated at a single center over a 27-year period. We conducted a retrospective, single-center descriptive case series of 69 pediatric patients treated surgically for adnexal masses between 1997 and 2024. Most lesions were benign (98.6%), with simple ovarian cysts being the most common diagnosis. Among neoplastic masses, benign cystic teratomas accounted for 18/19 (94.7%) and mixed malignant germ cell tumor for 5.3%. Ovarian autoamputation was identified in five cases (7.2%). Anatomical ovarian preservation rates were highest for simple ovarian cysts and lowest for benign cystic teratomas and adnexal torsion. Pure laparoscopic excision was feasible in 30 cases, and initial laparoscopic decompression was preferred in selected patients. This 27-year cohort highlights the significance of anatomical ovarian preservation and feasibility of minimally invasive approach in the surgical management of pediatric adnexal masses. Anatomical ovarian tissue was preserved in 42 of 69 patients (60.9%) across the full surgical cohort. After excluding five patients with pre-existing ovarian autoamputation and one patient with a malignant germ cell tumor in whom preservation was not feasible, the evaluable preservation rate was 42 of 63 patients (66.7%). Nevertheless, high rates of ovarian loss remain a challenge, particularly in emergency and complex clinical scenarios.