Ovarian Tumor (Benign)
- 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%).
- Malignant ovarian tumors
- Lifetime risk of ovarian cancer is 1.3%, and the average age of diagnosis is 63 years.
- 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.
- OCPs do not increase rates of cyst resolution, but they do decrease the risk of forming new ovarian cysts.
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Domino, Frank J., et al., editors. "Ovarian Tumor (Benign)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116429/all/Ovarian_Tumor__Benign_.
Ovarian Tumor (Benign). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116429/all/Ovarian_Tumor__Benign_. Accessed June 7, 2023.
Ovarian Tumor (Benign). (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116429/all/Ovarian_Tumor__Benign_
Ovarian Tumor (Benign) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 07]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116429/all/Ovarian_Tumor__Benign_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ovarian Tumor (Benign) ID - 116429 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116429/all/Ovarian_Tumor__Benign_ PB - Wolters Kluwer ET - 27 DB - 5-Minute Clinical Consult DP - Unbound Medicine ER -