Ovarian tumours: general approach and balance between risk of unnecessary surgery and oncological risk

Ovarian masses are very frequent and represent one of the most common reasons for gynaecological consultation, even in the paediatric/adolescent population. In recent years, the increased availability of ultrasonography has revealed a great number of ovarian ‘neoplasms’ in different age groups. In more than 90% of cases, these are considered ‘functional’ and resolve spontaneously, and simple ultrasonographic follow-up can demonstrate their disappearance. Rarely, and mainly due to greater size, they can cause complications such as torsion, bleeding and rupture, and require surgical attention. Only a small portion of all ovarian masses are represented by tumours, which can be benign or malignant. The general approach to ovarian tumours must consist of a conservative attitude toward functional and benign neoplasms, and an aggressive and surgically/oncologically correct strategy for malignant tumours. The correct balance between these two positions has to rely on accurate diagnosis and an honest evaluation of the risk represented by a ‘wait and see’ policy.