Ovarian tumors, or ovarian neoplasms, are tumors in the ovary. [1] Not all are ovarian cancer. [1] They consist of mainly solid tissue, while ovarian cysts contain fluid. [2]
In 2020, the World Health Organization (WHO) divided ovarian tumours as 90% epithelial, 3% germ cell, and 2% sex cord-stromal types. [3]
Tumor of the ovary vary remarkably as they may arise from any of the 3 cell types of the normal ovary.
Ovarian tumors are classified according to the histology of the tumor, obtained in a pathology report. Histology dictates many aspects of clinical treatment, management, and prognosis.
The most common forms are:
| Type | Subtype | Relative incidence [5] | Percent malignant [5] | Comments | Micrograph |
|---|---|---|---|---|---|
| Germ cell tumor | Mature cystic teratoma | 46.0% | 0.17% to 2% [6] | Cystic, with elements of all 3 germ layers (endoderm, mesoderm and ectoderm). [7] |  |
| Immature teratoma | 2.5% | 100% | A teratoma that contains anaplastic immature elements, and is often synonymous with malignant teratoma. [8] |  | |
| Other germ cell tumors | 3.0% | Others mainly include dysgerminoma, yolk sac tumor, struma ovarii and squamous cell carcinoma arising from a dermoid cyst, and malignant mixed germ cell tumor. [5] | |||
| Surface epithelial-stromal tumor | Serous tumor | 25% | 18.5% | Benign serous tumors of the right ovarian cyst are thinwalled unilocular cysts that are lined by ciliated pseudostratified cuboidal or columnar epithelium. [9] |  |
| Mucinous tumor | 15% | 8.8% | Benign mucinous tumors of the ovary consist of simple, nonstratified columnar epithelium with basally-located hyperchromatic nuclei and resemble gastric foveolar epithelium. [9] |  | |
| Endometrioid tumor | 1% | Almost 100% | Tubular glands, resembling endometrium. [10] |  | |
| Other surface-epithelial tumors | 1.5% | Others include mainly malignant mixed Müllerian tumor, Brenner tumor and mixed epithelial tumor. [5] |  | ||
| Sex cord-stromal tumor | Ovarian fibroma | 1.5% | 0% | Spindle-shaped fibroblastic cells and abundant collagen. [11] |  |
| Adult granulosa cell tumor | 1% | Almost 100% | Small, bland, cuboidal to polygonal cells in various patterns. [12] |  | |
| Other sex cord-stromal tumors | 1% | Others include mainly juvenile granulosa cell tumor, thecoma and sclerosing stromal tumor [5] | |||
| Secondary/metastatic) tumor | 2% | 100% | Usually from breast cancer, colon cancer, endometrial cancer, stomach cancer or cervical cancer. [13] | ||
Mixed tumors contain elements of more than one of the above classes of tumor histology.
An 1882 article appearing in Scientific American mentions the case of a patient at University of Pennsylvania Hospital when Dr. William Goodell removed a 112 lbs tumor from a 31 year old patient, who weighted 75 lbs after removal from the tumor. [14]
A teratoma is a tumor made up of several types of tissue, such as hair, muscle, teeth, or bone. Teratomata typically form in the tailbone, ovary, or testicle.
Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different cell types including epithelial cells, germ cells, and stromal cells. When these cells become abnormal, they have the ability to divide and form tumors. These cells can also invade or spread to other parts of the body. When this process begins, there may be no or only vague symptoms. Symptoms become more noticeable as the cancer progresses. These symptoms may include bloating, vaginal bleeding, pelvic pain, abdominal swelling, constipation, and loss of appetite, among others. Common areas to which the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver.
A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands, while other commonly found components include clumps of long hair, pockets of sebum, blood, fat, bone, nail, teeth, eyes, cartilage, and thyroid tissue.
Brenner tumours are an uncommon subtype of the surface epithelial-stromal tumour group of ovarian neoplasms. The majority are benign, but some can be malignant.
Endometrioid tumors are a class of tumors that arise in the uterus or ovaries that resemble endometrial glands on histology. They account for 80% of endometrial carcinomas and 20% of malignant ovarian tumors.
Mucinous tumors are a type of ovarian tumor. They are typically large.
A serous tumour is a neoplasm that typically has papillary to solid formations of tumor cells with crowded nuclei, and which typically arises on the modified Müllerian-derived serous membranes that surround the ovaries in females. Such ovarian tumors are part of the surface epithelial-stromal tumour group of ovarian tumors. They are common neoplasms with a strong tendency to occur bilaterally, and they account for approximately a quarter of all ovarian tumors.
Surface epithelial-stromal tumors are a class of ovarian neoplasms that may be benign or malignant. Neoplasms in this group are thought to be derived from the ovarian surface epithelium or from ectopic endometrial or fallopian tube (tubal) tissue. Tumors of this type are also called ovarian adenocarcinoma. This group of tumors accounts for 90% to 95% of all cases of ovarian cancer; however is mainly only found in postmenopausal women with the exception of the United States where 7% of cases occur in women under the age of 40. Serum CA-125 is often elevated but is only 50% accurate so it is not a useful tumor marker to assess the progress of treatment. 75% of women with epithelial ovarian cancer are found within the advanced-stages; however younger patients are more likely to have better prognoses than older patients.
Granulosa cell tumours are tumours that arise from granulosa cells. They are estrogen secreting tumours and present as large, complex, ovarian masses. These tumours are part of the sex cord–gonadal stromal tumour or non-epithelial group of tumours. Although granulosa cells normally occur only in the ovary, granulosa cell tumours occur in both ovaries and testicles. These tumours should be considered malignant and treated in the same way as other malignant tumours of ovary. The ovarian disease has two forms, juvenile and adult, both characterized by indolent growth, and therefore has high recovery rates. The staging system for these tumours is the same as for epithelial tumours and most present as stage I. The peak age at which they occur is 50–55 years, but they may occur at any age.
Sex cord–gonadal stromal tumour is a group of tumours derived from the stromal component of the ovary and testis, which comprises the granulosa, thecal cells and fibrocytes. In contrast, the epithelial cells originate from the outer epithelial lining surrounding the gonad while the germ cell tumors arise from the precursor cells of the gametes, hence the name germ cell. In humans, this group accounts for 8% of ovarian cancers and under 5% of testicular cancers. Their diagnosis is histological: only a biopsy of the tumour can make an exact diagnosis. They are often suspected of being malignant prior to operation, being solid ovarian tumours that tend to occur most commonly in post menopausal women.
Germ cell tumor (GCT) is a neoplasm derived from the primordial germ cells. Germ-cell tumors can be cancerous or benign. Germ cells normally occur inside the gonads. GCTs that originate outside the gonads may be birth defects resulting from errors during development of the embryo.
A struma ovarii is a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism.
Cystadenocarcinoma is a malignant form of a cystadenoma and is a cancer derived from glandular epithelium, in which cystic accumulations of retained secretions are formed. The neoplastic cells manifest varying degrees of anaplasia and invasiveness, and local extension and metastases occur. Cystadenocarcinomas develop frequently in the ovaries, where pseudomucinous and serous types are recognized. Similar tumor histology has also been reported in the pancreas, although it is a considerably rarer entity representing 1–1.5% of all Pancreatic cancer.
An immature teratoma is a teratoma that contains anaplastic immature elements, and is often synonymous with malignant teratoma. A teratoma is a tumor of germ cell origin, containing tissues from more than one germ cell line, It can be ovarian or testicular in its origin. and are almost always benign. An immature teratoma is thus a very rare tumor, representing 1% of all teratomas, 1% of all ovarian cancers, and 35.6% of malignant ovarian germ cell tumors. It displays a specific age of incidence, occurring most frequently in the first two decades of life and almost never after menopause. Unlike a mature cystic teratoma, an immature teratoma contains immature or embryonic structures. It can coexist with mature cystic teratomas and can constitute of a combination of both adult and embryonic tissue. The most common symptoms noted are abdominal distension and masses. Prognosis and treatment options vary and largely depend on grade, stage and karyotype of the tumor itself.
Mucinous cystadenoma is a benign cystic tumor lined by a mucinous epithelium. It is a type of cystic adenoma (cystadenoma).
Ovarian serous cystadenoma is a non-cancerous type of tumor of the ovary. It is typically larger than 1cm in diameter and presents with signs and symptoms of a growth in the pelvis, or is discovered when investigating something else. A fifth occur in both ovaries at the same time.
Endodermal sinus tumor (EST) is a member of the germ cell tumor group of cancers. It is the most common testicular tumor in children under three, and is also known as infantile embryonal carcinoma. This age group has a very good prognosis. In contrast to the pure form typical of infants, adult endodermal sinus tumors are often found in combination with other kinds of germ cell tumor, particularly teratoma and embryonal carcinoma. While pure teratoma is usually benign, endodermal sinus tumor is malignant.
The ovarian fibroma, also fibroma, is a benign sex cord-stromal tumour.
Ovarian germ cell tumors (OGCTs) are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2.6% of all ovarian malignancies. There are four main types of OGCTs, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma.
Ovarian squamous cell carcinoma (oSCC) or squamous ovarian carcinoma (SOC) is a rare tumor that accounts for 1% of ovarian cancers. Included in the World Health Organization's classification of ovarian cancer, it mainly affects women above 45 years of age. Survival depends on how advanced the disease is and how different or similar the individual cancer cells are.
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