Clinical Features of Surgically Managed Adnexal Masses in Children and Adolescents at a Tertiary Referral Center.

Background/

Objectives

We aimed to characterize age-related clinicopathologic features, preoperative risk stratification, surgical management, and menstrual and reproductive outcomes of surgically managed ovarian and adnexal masses in children and adolescents.

Methods

This retrospective study included 77 patients (aged 6-18 years) treated at a tertiary center between 2010 and 2020. Patients were grouped by age (6-12, 13-15, 16-18 years).

Results

Abdominal pain (63.6%) was the most common presentation, and laparoscopic surgery was performed in 72.7% of cases. Overall, 84.4% of masses were non-malignant, with mature cystic teratoma being the most common (39.0%). Twelve patients (15.6%) had borderline or malignant tumors. Cyst diameter peaked in the 13-15 year group (p = 0.04), while torsion (9.1%) occurred exclusively in patients aged ≤15 years (p < 0.01). Preoperative O-RADS accurately stratified risk: all borderline or malignant tumors were O-RADS 4-5, whereas 84.6% of non-malignant lesions were O-RADS 2-3. Elevated CA-125 and AFP correlated well with epithelial and malignant germ cell tumors, respectively. Ovary-sparing surgery (OSS) was achieved in 11 of 12 patients with borderline or malignant tumors; after a median 4.2-year follow-up, 11 were alive without disease, and 10 had resumed menstruation.

Conclusions

Most pediatric and adolescent adnexal masses are non-malignant. Age influences mass size and torsion risk. Preoperative O-RADS combined with tumor markers effectively aids risk stratification. Fertility preservation is feasible and safe for nearly all patients, supporting conservative surgical planning when intervention is necessary.