Adnexal lesions including ovarian, paraovarian, paratubal, and benign or malignant tumors are the most common reason for gynecologic surgery during childhood. Ovarian cysts represent 60 % of all ovarian lesions and typically do not require surgery as a majority of cysts are benign and self-resolving.1 Although malignant tumors are rare in childhood, approximately 10 %−20 % of surgically treated ovarian tumors are found to be malignant and account of 1 %−2 % of all pediatric cancers.1, 2, 3, 4

Adnexal lesions can occur at any age and may be secondary to hormonal influences. Presentation of a benign or malignant adnexal lesion is non-specific. Occurrence is usually asymptomatic and progression slow making early diagnosis challenging.4 The most common presenting symptom is abdominal pain (57 %−78 %). Other symptoms include palpable abdomino-pelvic mass (46 %−56 %), distension (39 %), nausea/vomiting (36 %), fever (12 %), early onset puberty (7 %), virilization (3 %−5 %), and hemorrhagic shock (2.5 %).1,4

Management of these lesions most often includes observation given their benign nature and propensity for spontaneous resolution. However, patients should be adequately assessed for adnexal torsion as this is a surgical emergency and can compromise future fertility. If surgery is indicated, benign ovarian lesions can be successfully treated with ovarian-sparing approaches with low recurrence rates and need for repeat surgery.5

The purpose of this article will be to review benign adnexal lesions categorized by patient age of occurrence. We will focus on the pathophysiology of each lesion, clinical presentation, diagnostic approach, and management options.