Description

• The ovaries are a source of many tumor types (benign and malignant) because of the histologic variety of their constituent cell.
• Benign ovarian tumors create difficulties in differential diagnosis because of the need to identify malignancy and discriminate tumor from cysts, infectious lesions, ectopic pregnancy, and endometriomas.
• Tumors are often clinically silent until well developed; may be solid, cystic, or mixed; and they may be functional (producing sex steroids, as with arrhenoblastomas and gynandroblastomas) or nonfunctional.
• System(s) affected: Endocrine/Metabolic; Reproductive

Geriatric Considerations
Because incidence of malignancy increases with age, postmenopausal patients warrant comprehensive evaluation and follow-up.

Pediatric Considerations
Malignancy must be ruled out in premenarchal patients. Early neonatal cysts are rare.

Epidemiology

• 30% of regularly cycling females
• 50% of women without regular cycles
• Predominant age: Premenarchal girls have a 6–11% risk of cancer in an ovarian tumor, and postmenopausal women have a 29–35% risk: High percentage of ovarian tumors are malignant in girls <15 years of age.

Risk Factors

• As yet poorly characterized for benign tumors; cigarette smoking doubles the relative risk for developing functional ovarian cysts.
• Possible contributory factors are early menarche, obesity, infertility, and hypothyroidism.
• Tamoxifen increases risk of ovarian cyst formation (15–30%).
• Risks 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 BRCA mutation.
• Risk for ovarian cancer is decreased in women who have used oral contraceptive pills (OCPs), multiparity, history of a tubal ligation, or have breast-fed.

General Prevention

• Although OCPs do not appear to increase rates of cyst resolution, they do decrease risk for forming new ovarian cysts.
• A large British cohort of 5,479 women demonstrated that the resection of benign cysts has no impact on future risk for ovarian cancer.
• A case-control study of 299 women found no evidence that ovulation-induction treatment predisposes women to the development of borderline ovarian growths (1).

Etiology

• Endometriosis with localized, repeated ovarian hemorrhage
• Physiologic cysts
• Tumorigenesis, with genetics as yet poorly defined