Ovarian cystic lesions, once considered uncommon in children, represent nowadays subject for many studies. Controversies regarding the diagnostic and treatment still exist. Unspecific symptoms and difficulties in performing an accurate ultrasound in children, sometimes led to misdiagnose this condition. Ovarian cystic lesions in premenarcheal girls may have hormonal influence, changing the biochemical balance, so an endocrinologist should be consulted. The main goal is to preserve the adnexal tissue. The purpose of this study is to analize the diagnostic and treatment of ovarian cystic lesions in premenarcheal girls, highlighting the opportunity of a multidisciplinary team and the necessity of the ovarian preservation.