Epithelial ovarian tumors

Last revised by Jeremy Jones on 20 Sep 2021

Ovarian epithelial tumors account for the majority of all ovarian tumors (60-70%) and their malignant forms represent >90% of ovarian cancers 1. They can range from being benign to highly malignant.

There is a difference in frequency of ovarian tumor subtypes depending on menopausal status 6:

  • premenopausal
    • serous (~60%)
    • mucinous (~20%)
    • endometrioid (~10%)
    • clear cell  (~5%)
    • other (~5%)
  • postmenopausal
    • serous (~60%)
    • endometrioid (~12.5%)
    • clear cell (~10%)
    • mucinous (~7.5%)
    • other (~10%)

The origin and pathogenesis of epithelial ovarian cancer are poorly understood 5. Despite extensive studies, no precursor lesions have been found 5.

Ovarian epithelial neoplasms are histologically classified according to:

  1. resemblance to normal gynecological cell line 7
    • serous - resembling epithelium lining the Fallopian tubes
    • mucinous - resembling epithelium lining endocervix, containing intracytoplasmic mucin
    • endometrioid - resembling epithelium/stroma of uterine corpus
    • clear cell - comprising clear cells and hobnail cells
  2. grade of aggressiveness 7,8
    • several grading systems exist, and grading may differ according to histologic type
    • e.g. three-tier FIGO system, two-tier MDACC system for serous tumors

A more complete list of ovarian epithelial tumors is as follows:

* sometimes classified as a separate category rather than under epithelial 

These can range from being cystic, to solid, to anything in between. As a crude rule, the likelihood of malignancy increases with increasing solid-tissue elements and thicker septae 2. While there are some common features, there are also many variations and it may be best to refer to subarticles for specific imaging features. 

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Cases and figures

  • Case 1: ovarian mucinous cystadenoma
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  • Case 2: ovarian serous cystadenoma
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  • Case 3: ovarian serous cystadenocarcinoma
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  • Case 4: ovarian serous cystadenofibroma
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  • Case 5: ovarian endometrioid carcinoma
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  • Case 6: bilateral ovarian serous cystadenocarcinoma
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  • Case 7: left ovarian serous cystadenocarcinoma and right ovarian cystadenofibroma
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