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.