A 27-year retrospective single-center descriptive case series evaluating 69 pediatric and adolescent patients surgically treated for adnexal masses revealed that anatomical ovarian preservation was achieved in 60.9 percent of the overall cohort. The investigation, spanning surgical treatments conducted between 1997 and 2024, reviewed the anatomical management and preservation rates associated with diverse adnexal lesions in young patients. Historically, the clinical management of adnexal masses in pediatric populations has posed operational challenges, frequently culminating in the complete excision of the affected ovary alongside the mass itself.

The study observed that the vast majority of identified pediatric adnexal lesions were non-malignant, with benign pathologies accounting for 98.6 percent of cases. Simple ovarian cysts represented the most frequent individual diagnosis among the reviewed cohort. Growing clinical recognition of the overwhelmingly benign character of these pediatric masses has fostered an ongoing shift in surgical strategy toward anatomical ovarian preservation rather than routine total oophorectomy.

Among cases categorized as neoplastic masses, benign cystic teratomas formed the predominant subgroup, representing 18 out of 19 neoplastic lesions, or 94.7 percent. In contrast, mixed malignant germ cell tumors accounted for the remaining 5.3 percent of the neoplastic cases. Additionally, pre-existing ovarian autoamputation was documented in five patients, representing 7.2 percent of the 69 surgically treated cases evaluated across the 27-year institutional experience.

Surgical outcomes indicated distinct variations in anatomical conservation depending on underlying lesion pathology. Anatomical ovarian preservation rates were highest among patients presenting with simple ovarian cysts. Conversely, anatomical ovarian conservation rates reached their lowest levels in cases involving benign cystic teratomas and cases complicated by adnexal torsion.

Minimally invasive approaches proved feasible across a substantial portion of the cohort. Pure laparoscopic excision was successfully accomplished in 30 cases. Furthermore, the surgical team utilized initial laparoscopic decompression as a preferred procedural strategy in selected patients requiring intervention.

Across the complete surgical series of 69 patients, surgeons preserved anatomical ovarian tissue in 42 individuals, representing an overall rate of 60.9 percent. When researchers excluded the five individuals with pre-existing ovarian autoamputation and the single patient diagnosed with a mixed malignant germ cell tumor where preservation proved unfeasible, the evaluable anatomical ovarian preservation rate reached 42 of 63 patients, or 66.7 percent.

The authors concluded that the 27-year single-center cohort demonstrates the viability of minimally invasive procedures and the clinical importance of prioritizing anatomical ovarian preservation. Nevertheless, the researchers emphasized that high rates of ovarian loss persist as a substantial clinical challenge, particularly when dealing with acute emergency conditions and complex surgical scenarios.

Surgical approaches detailed in the institutional dataset highlighted the role of minimally invasive techniques across varied clinical presentations. Despite these technical possibilities, preserving ovarian integrity remained difficult when presentations involved acute adnexal torsion or benign cystic teratomas, and preservation was deemed unfeasible in the presence of malignancy.

Subject of Research: Surgical management and anatomical ovarian preservation rates in pediatric adnexal masses

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

Article References: Esen, H. K., Bilgili, Y. D., & Güvenç, B. H. (2026). Clinical spectrum of adnexal masses in children and adolescents: Lessons learned from a 27-Year institutional experience. BMC Pediatrics. https://doi.org/10.1186/s12887-026-08021-9

Image Credits: AI Generated

DOI: 10.1186/s12887-026-08021-9

Keywords: pediatric surgery, adnexal masses, ovarian preservation, laparoscopy, benign cystic teratoma, ovarian cysts, adnexal torsion, ovarian autoamputation, pediatric gynecology, germ cell tumors, case series, minimally invasive surgery, pediatrics, adolescent health, surgical outcomes, reproductive health