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 as 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 be functional (producing hormones) or nonfunctional.
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 frame 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 (1)
    • 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
    • Incidence of an ovarian tumor (benign or malignant) in a postmenopausal woman is 7% (2).
    • The risk of malignancy in an ovarian tumor in postmenopausal women is 29–35%.

Etiology and Pathophysiology

  • Functional cysts
    • Dysregulation of ovarian follicles during the menstrual cycle results in functional cysts.
    • Bleeding into a functional cyst will result in a hemorrhagic cyst.
    • Benign follicular cysts do not appear to be precursor lesions to epithelial ovarian malignancies.
  • Endometrioma
  • Endometriosis causes localized, repeated ovarian hemorrhage benign neoplasms.
    • May arise from stem cells; genetics poorly defined
  • 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 (3)[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 (4).
    • Risk factors for ovarian cancer include age >60 years; early menarche; late menopause; nulligravidity; infertility; endometriosis; polycystic ovarian syndrome; family history of ovarian, breast, or 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 (5)[B].

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Citation

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TY - ELEC T1 - Ovarian Tumor (Benign) ID - 116429 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116429/all/Ovarian_Tumor__Benign_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -