Ovarian Tumor (Benign)
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- 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.
- 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.
- 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.
The risk of malignancy is greatly increased in women age >50 years. Postmenopausal patients warrant comprehensive evaluation and follow-up.
- 2–5% in prepubertal girls
- Premenarchal girls have a 6–11% risk of malignancy in an ovarian tumor.
- 30% in women with regular menses and 50% in women without regular menses
- 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.
- Endometriosis causes localized, repeated ovarian hemorrhage.
- May arise from retrograde menstruation
- Hormone mediated
- Theca lutein cysts develop in response to β-hCG.
- 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.