WOFAPS 2025 8th World Congress of Pediatric Surgery

Milena Senica Verbič, Tina Purgaj, Tadej Petek, Maja Vičič, Dejan Bratuš

Univerzitetni klinični center Maribor

Purpose:
Ectopic adrenocortical tissue (EACT) is a rare incidental finding during pediatric inguinal surgery. It consists of adrenal cortex cells located outside their usual anatomical site (anywhere between diaphragm and pelvis) and typically presents as a small solid yellow nodule 2-6 mm in diameter in the inguinal canal. Although usually is asymptomatic, EACT may undergo pathological transformation, including hyperplasia or neoplastic change, and may mimic metastatic lesions. The 2022 WHO classification includes adrenal ectopia under potentially neoplastic lesions. This study aimed to determine the incidence of EACT in pediatric patients undergoing inguinal procedures at our hospital and compare it with global data.

Methods:
We retrospectively analyzed 997 pediatric patients with inguinal surgery in last 10 years (performed between June 1, 2015, and May 30, 2025), including hernia repairs, orchidopexies, and hydrocele procedures. All suspicious nodules were excised and pathohistologically examined. Postoperative endocrinological evaluation was conducted in all EACT-confirmed cases. The results were compared with global literatura data.

Results:
Among 997 surgeries (547 hernia repairs, 289 orchidopexies, 161 hydroceles), 37 nodules suspicious for EACT were identified in our 10 years period. Pathohistologically was EACT comfirmed in 33 cases (3.3%): 20 in hernia repairs, 10 in orchidopexies, and 3 in hydrocele surgeries. All confirmed EACT cases were male; none were observed in female patients. No hormonal activity, hyperplasia, or malignancy was detected.Endocrinological evaluations of all children with EACT were performed postoperatively. Four nodules were identified as calcified epidermoid cysts.

Conclusions:
The 3.3% incidence of EACT in our study exceeds reported international rates (1–2.7%). This may reflect regional variability, improved intraoperative recognition, or heightened pathological awareness. Given the potential for pathological change, all incidental founded suspicious inguinal nodules in children should be excised and pathohistologically examined. Further multicenter studies are warranted to evaluate potential epidemiological trends and clinical implications.