ESSENTIALS OF DIAGNOSIS
Symptoms include vague gastrointestinal discomfort, pelvic pressure, or pain.
Many cases of early-stage cancer are asymptomatic.
Pelvic examination and ultrasound are mainstays of diagnosis.
Ovarian tumors are common. Most are benign, but malignant ovarian tumors are the leading cause of death from reproductive tract cancer. The wide range of types and patterns of ovarian tumors is due to the complexity of ovarian embryology and differences in tissues of origin (eTable 18–3).
eTable 18–3.Ovarian functional and neoplastic tumors. |Favorite Table|Download (.pdf) eTable 18–3. Ovarian functional and neoplastic tumors.
|Tumor ||Incidence ||Size ||Consistency ||Menstrual Irregularities ||Endocrine Effects ||Potential for Malignancy ||Special Remarks |
|Follicle cysts ||Rare in childhood; frequent in menstrual years; never in postmenopausal years. ||< 6 cm, often bilateral. ||Moderate ||Occasional ||Occasional anovulation with persistently proliferative endometrium ||None ||Usually disappear spontaneously within 2–3 months. |
|Corpus luteum cysts ||Occasional, in menstrual years. ||4–6 cm, unilateral. ||Moderate ||Occasional delayed period ||Prolonged secretory phase ||None ||Functional cysts. Intraperitoneal bleeding occasionally. |
|Theca lutein cysts ||Occurs with hydatidiform mole, choriocarcinoma; also with gonadotropin or clomiphene therapy. ||To 4–5 cm, multiple, bilateral. (Ovaries may be ≥ 20 cm in diameter.) ||Tense ||Amenorrhea ||hCG elevated as a result of trophoblastic proliferation ||None ||Functional cysts. Hematoperitoneum or torsion of ovary may occur. Surgery is to be avoided. |
|Inflammatory (tubo-ovarian abscess) ||Concomitant with acute salpingitis. ||To 15–20 cm, often bilateral. ||Variable, painful ||Menometrorrhagia ||Anovulation usual ||None ||Unilateral removal indicated if possible. |
|Endometriotic cysts ||Never in preadolescent or postmenopausal years. Most common in women aged 20–40 years. ||To 10–12 cm, occasionally bilateral. ||Moderate to softened ||Rare ||None ||Very rare ||Associated pelvic endometriosis. Medical treatment or conservative surgery recommended. |
|Teratoid tumors: || || || || || || || |
|Benign teratomas (dermoid cysts) ||Childhood to postmenopause. ||< 15 cm; 15% are bilateral. ||Moderate to softened ||None ||None ||Rare ||Torsion can occur. Partial oophorectomy recommended. |
|Malignant teratomas ||< 1% of ovarian tumors. Usually in infants and young adults. ||> 20 cm, unilateral. ||Irregularly firm ||None ||Occasionally, hCG elevated ||All ||Surgery alone may be curative. |
|Cystadenoma, cystadenocarcinoma ||Common in reproductive years. ||Serous: < 25 cm, 33% bilateral; mucinous: up to 1 cm, 10% bilateral. ||Moderate to softened ||None ||None ||> 50% for serous, about 5% for mucinous ||Peritoneal implants often occur with serous, rarely with mucinous. If mucinous tumor is ruptured, pseudomyxoma peritonei may occur. |
|Endometrioid carcinoma ||15% of ovarian carcinomas. ||Moderate, 13% bilateral. ||Firm ||None ||None ||All ||Adenocarcinoma of endometrium coexists in 15–30% of cases. |
|Fibroma ||< 5% of ovarian tumors. ||Usually < 15 cm. ||Very firm ||None ||None ||Rare ||Ascites in 20% (rarely, pleural fluid). |
|Arrhenoblastoma ||Rare. Average age 30 years or more. ||Often small (< 10 cm), unilateral. ||Firm to softened ||Amenorrhea ||Androgens —elevated ||< 20% ||Recurrences are moderately sensitive to irradiation. |
|Theca cell tumor (thecoma) ||Uncommon. ||< 10 cm, unilateral. ||Firm ||Occasional irregularity ||Estrogens or androgens elevated ||< 1% || |
|Granulosa cell tumor...|