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Ovarian tumors

Last revised by Assoc Prof Craig Hacking on 12 May 2021

Ovarian tumors are relatively common and account for ~6% of female malignancies. This article focuses on the general classification of ovarian tumors. For specific tumor features, please refer to the relevant subarticles.

Pathology

Subtypes
Primary ovarian tumors

Surface epithelial-stromal ovarian tumors (60-70%):

* sometimes classified as a separate category rather than under epithelial 7

Germ cell ovarian tumors (~20%):

Sex cord / stromal ovarian tumors (8-10%):

Mixed

These are uncommon:

Other
Classification according to morphology
Predominantly cystic
Predominantly solid
Serological tests
  • CA-125 levels: elevated in most ovarian malignancies (~80% in general); some mucinous and germ cell tumors may not secrete this marker
  • AFP levels: elevated particularly with immature ovarian teratomas (~50% of cases) and ovarian yolk sac tumors
  • β HCG: in a small number of dysgerminomas
  • human epididymis protein 4 (HE4): elevated in malignant ovarian diseases, being helpful to complement the Ca-125 in premenopausal women 
Risk factors
General risk factors include
  • nulliparity
  • early menopause 
  • gonadal dysgenesis
  • family history: contributes to 24% of cases of epithelial ovarian cancer14
    • BRCA1/BRCA2 mutations: particularly for serous types
    • Lynch syndrome-associated ovarian cancers most often have an endometrioid or serous type histology 14
  • smoking: especially for mucinous adenocarcinoma
  • previous history of breast, endometrial or colon cancer (Lynch II)
  • certain ethnic groups
Protective factors
  • oral contraceptives (OCP)
  • breastfeeding (however this is controversial)
Risk assessment

Staging

The FIGO staging system is used for almost all of ovarian cancers: see ovarian cancer staging.

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Cases and figures

  • Figure 1: gross pathology: mucinous cystadenoma
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  • Case 1: ovarian mature cystic teratoma
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  • Figure 2: gross pathology: Brenner tumor
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  • Case 2: mucinous ovarian tumor
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  • Figure 3: gross pathology: ovarian fibroma
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  • Case 3: ovarian cancer with peritoneal carcinomatosis
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  • Figure 4: gross pathology: Krukenburg tumor
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  • Case 4: ovarian serous cystadenoma
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  • Figure 5: gross pathology: sclerosing stromal tumor of the ovary (SST)
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  • Case 5: ovarian teratoma
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  • Case 6: ovarian mucinous cystadenoma
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  • Case 7: ovarian serous cystadenofibroma
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  • Case 8: ovarian serous cystadenocarcinoma
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  • Case 9: endometrioid adenocarcinoma of ovary
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  • Case 10: Ovarian dysgerminoma
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  • Case 11: ovarian fibroma
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