Pediatric Gynecological and Breast Surgical Lesions from Fetal Life to Early Adulthood: A Comprehensive Review

Abstract Objectives: To synthesise current evidence on congenital, developmental, infectious, neoplastic, and traumatic gynecological and breast lesions requiring surgical evaluation or intervention in girls from fetal life to 21 years, highlighting diagnostic pathways, operative indications, outcomes, and gaps in knowledge. Design: Narrative review of published literature, clinical guidelines, and surgical series across pediatric gynecology, pediatric surgery, and adolescent medicine. Data Sources: MEDLINE, Embase, Cochrane Library, and major pediatric surgical and gynecologic society guidelines. Eligibility Criteria: Studies describing structural, functional, or neoplastic lesions of the female genital tract or breast in patients from fetal life to 21 years, with emphasis on conditions requiring surgical assessment or intervention. Results: Lesions span five domains: congenital anomalies (e.g., Müllerian anomalies, ovarian cysts, cloacal malformations), developmental disorders (e.g., labial adhesions, breast asymmetry), infectious/inflammatory conditions (e.g., vulvar abscess, hidradenitis suppurativa), neoplastic lesions (benign and malignant ovarian, vulvar, vaginal, and breast tumours), and traumatic/ iatrogenic injuries. Advances in fetal imaging, minimally invasive surgery, and fertility‑preserving techniques have improved outcomes, yet diagnostic delays and fragmentation of care persist. Conclusions: Pediatric gynecological and breast surgical lesions require age‑specific diagnostic frameworks, multidisciplinary care, and long‑term follow‑up. Evidence remains limited for rare lesions, optimal timing of surgery, and long‑term reproductive and psychosocial outcomes.