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Cystic lesions of the ovaries are common in adolescent girls. Follow-up is recommended to monitor any changes in size. In more than 90% of cases, these cysts are benign. Our aim is to draw attention to the fact, that even extremely large lesions can develop during puberty and in every case our goal is to perform accurate imaging and organ-preserving surgical management. Between 2023 and 2025, four adolescent girls underwent surgery for giant cystic ovarian lesions at the Department of Pediatric Surgery of the Győr-Moson-Sopron County Petz Aladár University Teaching Hospital. We performed a detailed retrospective analysis of the patients' medical histories and a review of the relevant literature. In all four cases, pediatric surgical and gynecological examinations, tumor marker level assessments, abdominal ultrasound, and abdominopelvic magnetic resonance imaging were performed within a short period of time. Based on the findings, surgery was carried out within a few days. Laparoscopic surgery was performed in two patients, open surgery in the other two. In every case, a large cystic lesion was identified, and no clear evidence of malignancy arose during the operations. Organ-preserving surgery was successfully performed in two patients; in the remaining cases, removal of the affected ovary and fallopian tube was necessary. The histopathological findings differed in all four cases. In the first patient, a mucinous cystadenoma was confirmed, which recurred, and needed reoperation. In the second patient, histology revealed mucinous adenocarcinoma, which is a particularly rare malignancy in this age group. In the third case, fluid accumulation caused by torsion was identified as the underlying condition. In the fourth patient, the histopathological diagnosis was a mature cystic teratoma. Although cystic ovarian lesions are common during adolescence, they rarely grow to an extreme size. Accurate imaging and analysis of tumor marker levels are essential for surgical planning. Minimally invasive procedures and organ-preserving surgery should always be preferred if possible. Histopathological findings greatly influence the need for further follow-up or additional treatment. Orv Hetil. 2026; 167(29): 1164-1171.