In this issue, Koo and colleagues authored an interesting article entitled “An 11-year experience with ovarian surgery during pregnancy”. They investigated the characteristics and outcomes of pregnant women who underwent surgical intervention for ovarian neoplasm and found that either conventional laparotomy or laparoscopy approach could be successfully used in the management of ovarian tumor during pregnancy without adverse events. We acknowledge the probity of this publication. Ovarian neoplasms, presenting as either benign or malignant tumors, now can easily be identified and likely more often detected because of the widespread use of ultrasound earlier in pregnancy. The incidence rate of ovarian tumors in pregnancy is around 0.05% of all deliveries. Although the incidence rate is still low, ovarian tumors remain a challenge for clinical physicians. This is in part, because proper medical management of these tumors by necessity takes into consideration both the technical difficulty caused by enlargement of the uterus, and the risk of fetal loss. Caring for these pregnant patients should always involve multidisciplinary teamwork with the aim of optimizing outcomes for both the mother and the fetus. Before surgery, it is important to obtain an obstetrics consultation to discuss key aspects of maternal physiology and anatomy. Besides the obstetrics specialty, we can also obtain valuable contributions from anesthesiology, pediatrics, and even a surgical consultation to protect most efficaciously the safety of the mother and fetus. In the Koo et al study, the most common type of ovarian neoplasm during pregnancy was mature teratoma, which was consistent with previous studies, although some studies have shown variation, including benign cystadenoma (41.9%). However, all studies have shown that primary ovarian malignancies are extremely rare. Koo et al reminded us of the possibility of secondary ovarian tumors, because they found that both ovarian malignancies were secondary to metastasis from other organs, especially gastrointestinal tract malignancy. Since the development of high-resolution imaging tools, particularly ultrasound and magnetic resonance imaging, such tools have been reported to have a clear ability to distinguish benign from malignant neoplasms of the adnexa. This accurate diagnosis is important because it helps us to reach informed decisions about the relative necessity of a surgical approach for ovarian tumors during pregnancy. If the tumor diameter