{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:52:21Z","timestamp":1776253941559,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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\u201318 years) treated at a tertiary center between 2010 and 2020. Patients were grouped by age (6\u201312, 13\u201315, 16\u201318 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\u201315 year group (p = 0.04), while torsion (9.1%) occurred exclusively in patients aged \u226415 years (p &lt; 0.01). Preoperative O-RADS accurately stratified risk: all borderline or malignant tumors were O-RADS 4\u20135, whereas 84.6% of non-malignant lesions were O-RADS 2\u20133. 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.<\/jats:p>","DOI":"10.3390\/children13040549","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T10:30:23Z","timestamp":1776249023000},"page":"549","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Features of Surgically Managed Adnexal Masses in Children and Adolescents at a Tertiary Referral Center"],"prefix":"10.3390","volume":"13","author":[{"given":"Jimin","family":"Bae","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2528-6231","authenticated-orcid":false,"given":"Hyun Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inha","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea"},{"name":"Institute of Women\u2019s Life Medical Science, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2718-6645","authenticated-orcid":false,"given":"SiHyun","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul 06273, Republic of Korea"},{"name":"Institute of Women\u2019s Life Medical Science, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1157-4822","authenticated-orcid":false,"given":"Young Sik","family":"Choi","sequence":"additional","affiliation":[{"name":"Institute of Women\u2019s Life Medical Science, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Severance Hospital, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6388-5975","authenticated-orcid":false,"given":"Joo Hyun","family":"Park","sequence":"additional","affiliation":[{"name":"Institute of Women\u2019s Life Medical Science, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin 16995, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1001\/archsurg.1993.01420200023004","article-title":"Ovarian neoplasms in children","volume":"128","author":"Skinner","year":"1993","journal-title":"Arch. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S1054-139X(03)00057-0","article-title":"Cancer incidence in adolescents and young adults in the United States, 1992\u20131997","volume":"32","author":"Wu","year":"2003","journal-title":"J. Adolesc. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/0022-3468(93)90700-U","article-title":"Ovarian masses in children: A review of 91 cases of malignant and benign masses","volume":"28","author":"Brown","year":"1993","journal-title":"J. Pediatr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1053\/jpsu.2001.22939","article-title":"Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period","volume":"36","author":"Cass","year":"2001","journal-title":"J. Pediatr. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bayramoglu, Z., Timur, B., Kizmazoglu, D., Timur, H.T., Ulusoy, O., Aktas, S., Olgun, N., and Kurt, S. (2025). Pediatric and young adult ovarian masses: Clinical approach, diagnostic evaluation, and management. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1639582"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S1083-3188(01)00146-2","article-title":"The forgotten female: Pediatric and adolescent gynecological concerns and their reproductive consequences","volume":"15","author":"Elford","year":"2002","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.fertnstert.2003.06.031","article-title":"Ovarian function preservation in the cancer patient","volume":"81","author":"Falcone","year":"2004","journal-title":"Fertil. Steril."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/MOP.0000000000000776","article-title":"Ovary-sparing surgery for benign pediatric ovarian masses","volume":"31","author":"Lawrence","year":"2019","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.3332\/ecancer.2025.2002","article-title":"A single institutional study on survival and fertility outcomes in malignant ovarian germ cell tumour patients","volume":"19","author":"Raji","year":"2025","journal-title":"Ecancermedicalscience"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0020-7292(96)02719-1","article-title":"Diagnosis and management of malignant germ cell ovarian tumors in young females","volume":"55","author":"Zalel","year":"1996","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/S0031-3955(05)70138-3","article-title":"Evaluation of adnexal masses in adolescents","volume":"46","author":"Pfeifer","year":"1999","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jpedsurg.2009.10.021","article-title":"Pediatric ovarian malignancy presenting as ovarian torsion: Incidence and relevance","volume":"45","author":"Oltmann","year":"2010","journal-title":"J. Pediatr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5377","DOI":"10.2147\/IJWH.S544674","article-title":"Comparison of the Surgical Treatment of Adnexal Masses in Pediatric and Adolescent Patients by Gynecologic Surgeons versus Pediatric Surgeons, a Systematic Review","volume":"17","author":"Marchand","year":"2025","journal-title":"Int. J. Womens Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jpedsurg.2018.08.058","article-title":"Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review","volume":"54","author":"Renaud","year":"2019","journal-title":"J. Pediatr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jpedsurg.2009.10.022","article-title":"Can we preoperatively risk stratify ovarian masses for malignancy?","volume":"45","author":"Oltmann","year":"2010","journal-title":"J. Pediatr. Surg."},{"key":"ref_16","first-page":"229","article-title":"Noninflammatory ovarian masses in girls and young women","volume":"96","author":"Templeman","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"van Winter, J.T., Simmons, P.S., and Podratz, K.C. (1994). Surgically treated adnexal masses in infancy, childhood, and adolescence. Am. J. Obstet. Gynecol., 170, 1780\u20131786; discussion 1786\u20131789.","DOI":"10.1016\/S0002-9378(94)70354-X"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wang, H., Wang, L., An, S., Ma, Q., Tu, Y., Shang, N., and Pan, Y. (2023). American college of radiology ovarian-adnexal reporting and data system ultrasound (O-RADS): Diagnostic performance and inter-reviewer agreement for ovarian masses in children. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1091735"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5073","DOI":"10.1007\/s00330-025-11444-0","article-title":"MRI of pediatric ovarian masses: Validation of the O-RADS framework","volume":"35","author":"Munari","year":"2025","journal-title":"Eur. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/09513590410001712895","article-title":"Ovarian masses during adolescence: Clinical, ultrasonographic and pathologic findings, serum tumor markers and endocrinological profile","volume":"19","author":"Deligeoroglou","year":"2004","journal-title":"Gynecol. Endocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/00006250-199903000-00028","article-title":"The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals","volume":"93","author":"Tingulstad","year":"1999","journal-title":"Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0090-8258(87)80009-4","article-title":"Tumor antigen CA 125 as a marker of ovarian epithelial carcinoma","volume":"28","author":"Zanaboni","year":"1987","journal-title":"Gynecol. Oncol."},{"key":"ref_23","first-page":"337","article-title":"Ovarian masses","volume":"10","author":"Kozlowski","year":"1999","journal-title":"Adolesc. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ijpam.2017.08.001","article-title":"Ovarian lesions among pediatric patients: A tertiary center experience (1997\u20132016)","volume":"4","author":"Alsuhaibani","year":"2017","journal-title":"Int. J. Pediatr. Adolesc. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3949","DOI":"10.1038\/s41598-022-08015-4","article-title":"Ultrasonographic diagnosis and surgical outcomes of adnexal masses in children and adolescents","volume":"12","author":"Kang","year":"2022","journal-title":"Sci. Rep."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/549\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T10:59:38Z","timestamp":1776250778000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/549"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["children13040549"],"URL":"https:\/\/doi.org\/10.3390\/children13040549","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]}}}