Two to five in 100,000 girls are diagnosed to have adnexal masses per year. Majority of these cases are benign and yet are still managed with laparotomy and removal of the ovary. The emerging trend is to stratify these neoplasms preoperatively into benign and malignant masses in order to arrive at a definitive surgical plan that will conserve as much of the ovary as possible. The principle of such management is to maximize fertility and reduce early menopause while ensuring adequate surgical intervention. However, when an adnexal mass has definitive evidence of malignancy, this becomes an absolute indication for oophorectomy. Nonetheless, it is ethically appropriate for physicians to discuss and offer the options for fertility preservation with patients and their parents. Presented is a case of immature teratoma in a 2 year-old and a review of current literature on the management of ovarian masses in the pediatric population.