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Ovarian Tumor (Benign)

Ovarian Tumor (Benign) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • The ovaries are a source of many tumor types because they have complex histologies and embryonic origins.
  • Adnexal masses have a wide differential diagnosis, including malignant or benign tumors, infectious processes, and ectopic pregnancy.
  • Tumors are often clinically silent until well-developed.
  • Tumors may have a mixture of solid or cystic components and may produce hormones.
Pediatric Considerations
  • Ovarian masses are rare in the neonatal period.
  • Malignancy must be ruled out in premenarchal patients.
  • Management of tumors in pediatric patients must prioritize preservation of normal ovarian tissue.
Pregnancy Considerations
  • Most cysts discovered during pregnancy are corpus luteum or follicular cysts.
  • Large, bilateral theca lutein cysts in early pregnancy, in conjunction with an elevated hCG, should raise suspicion for a molar pregnancy.
  • The most commonly encountered tumors during pregnancy are cystadenomas (serous/mucinous) and dermoid cysts.
  • The ideal time for surgical management is the 2nd trimester.

Geriatric Considerations
The risk of malignancy is greatly increased in women age >50 years. Postmenopausal patients warrant comprehensive evaluation and follow-up.

Epidemiology

Incidence
  • Premenarchal
    • 2–5% in prepubertal girls
    • Premenarchal girls have a 6–11% risk of malignancy in an ovarian tumor.
  • Premenopausal
    • 30% in women with regular menses and 50% in women without regular menses
  • Postmenopausal
    • Prevalence of ovarian tumor (benign or malignant) in postmenopausal women is 7%.
    • The risk of malignancy in an ovarian tumor in postmenopausal women is 29–35%.

Etiology and Pathophysiology

  • Functional cyst
    • Results from dysregulation of ovarian follicles during the menstrual cycle
    • Bleeding into a functional cyst will result in a hemorrhagic cyst.
    • These cysts do not appear to be precursor lesions to epithelial ovarian malignancies.
  • Endometrioma
    • Endometriosis causes localized, repeated ovarian hemorrhage.
    • May arise from retrograde menstruation
  • Hormone mediated
    • Theca lutein cysts develop in response to β-hCG.

Risk Factors

  • Benign ovarian tumors
    • Early menarche, obesity, infertility, and hypothyroidism
    • Cigarette smoking doubles the relative risk for developing functional ovarian cysts.
    • Risk factors for endometriomas and mature teratomas are not well-defined.
    • Tamoxifen increases the risk of ovarian cyst formation (15–30%).
    • Hormone replacement therapy increases the frequency of unilocular ovarian cysts in women age >50 years (1)[B].
  • Malignant ovarian tumors
    • Lifetime risk of ovarian cancer is 1.3%, and the average age of diagnosis is 63 years.
    • In children up to 14 years old, 78% of malignant ovarian tumors are germ cell tumors (2)[B].
    • Risk factors for ovarian cancer include age >60 years, early menarche, late menopause, nulligravidity, infertility, endometriosis, polycystic ovary syndrome, family history of ovarian/breast/colon cancer, a personal history of breast/colon cancer, or a deleterious BRCA mutation.
    • Risk for ovarian cancer is decreased in women who have used oral contraceptive pills (OCPs) for at least 5 years, are multiparous, have a history of a tubal ligation or salpingectomy, or who have breastfed.
    • Limited studies show no clear evidence that fertility treatment increases the risk of a woman developing invasive ovarian cancer.

General Prevention

  • OCPs do not increase rates of cyst resolution, but they do decrease the risk of forming new ovarian cysts.
  • Continuous or cyclic use of oral contraceptives can reduce or delay recurrence of endometriomas following surgical excision (3)[B].

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Citation

Stephens, Mark B., et al., editors. "Ovarian Tumor (Benign)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116429/1.1/Ovarian_Tumor__Benign_.
Ovarian Tumor (Benign). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116429/1.1/Ovarian_Tumor__Benign_. Accessed June 24, 2019.
Ovarian Tumor (Benign). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116429/1.1/Ovarian_Tumor__Benign_
Ovarian Tumor (Benign) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116429/1.1/Ovarian_Tumor__Benign_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ovarian Tumor (Benign) ID - 116429 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116429/1.1/Ovarian_Tumor__Benign_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -