Table 17-4. Ovarian functional and neoplastic tumors

Tumor	Incidence	Size	Consistency	Menstrual Irregularities	Endocrine Effects	Potential for Malignancy	Special Remarks
Follicle cysts	Rare in childhood; frequent in menstrual years; never in post-menopausal years	< 6 cm, often bilateral	Moderate	Occasional	Occasional anovulation with persistently proliferative endometrium	None	Often disappear after a 2-month regimen of oral contraceptives
Corpus luteum cysts	Occasional, in menstrual years	4-6 cm, unilateral	Moderate	Occasional delayed period	Prolonged secretory phase	None	Functional cysts. Intraperitoneal bleeding occasionally
Theca lutein cysts	Occurs with hydatidiform mole, choriocarcinoma; also with gonadotropin or clomiphene therapy	To 4-5 cm, multiple, bilateral. (Ovaries may be = 20 cm in diameter.)	Tense	Amenorrhea	hCG elevated as a result of trophoblastic proliferation	None	Functional cysts. Hematoperitoneum or torsion of ovary may occur. Surgery is to be avoided.
Inflammatory (tubo-ovarian abscess)	Concomitant with acute salpingitis	To 15-20 cm, often bilateral	Variable, painful	Menometrorrhagia	Anovulation usual	None	Unilateral removal indicated if possible
Endometriotic cysts	Never in preadolescent or postmenopausal years. Most common in women aged 20-40 years	To 10-12 cm, occasionally bilateral	Moderate to softened	Rare	None	Very rare	Associated pelvic endometriosis. Medical treatment or conservative surgery recommended
Teratoid tumors:
Benign teratomas (dermoid cysts)	Childhood to post-menopause	< 15 cm; 15% are bilateral	Moderate to softened	None	None	Rare	Torsion can occur. Partial oophorectomy recommended
Malignant teratomas	< 1% of ovarian tumors. Usually in infants and young adults	> 20 cm, unilateral	Irregularly firm	None	Occasionally, hCG elevated	All	Unresponsive to any therapy
Cystadenoma, cyst-adenocarcinoma	Common in reproductive years	Serous: < 25 cm, 33% bilateral; mucinous: up to 1 cm, 10% bilateral	Moderate to softened	None	None	> 50% for serous, about 5% for mucinous	Peritoneal implants often occur with serous, rarely with mucinous. If mucinous tumor is ruptured, pseudomyxoma peritonei may occur.
Endometrioid carcinoma	15% of ovarian carcinomas	Moderate, 13% bilateral	Firm	None	None	All	Adenocarcinoma of endometrium coexists in 15-30% of cases
Fibroma	< 5% of ovarian tumors	Usually < 15 cm	Very firm	None	None	Rare	Ascites in 20% (rarely, pleural fluid)
Arrhenoblastoma	Rare. Average age 30 years or more	Often small (< 10 cm), unilateral	Firm to softened	Amenorrhea	Androgens elevated	< 20%	Recurrences are moderately sensitive to irradiation
Theca cell tumor (thecoma)	Uncommon	< 10 cm, unilateral	Firm	Occasional irregularity	Estrogens or androgens elevated	< 1%
Granulosa cell tumor	Uncommon. Usually in prepubertal girls or women older than 50 years	May be very small	Firm to softened	Menometrorrhagia	Estrogens elevated	15-20%	Recurrences are moderately sensitive to irradiation
Dysgerminoma	About 1-2% of ovarian tumors	< 30 cm, bilateral in 33%	Moderate to softened	None	-	All	Very radiosensitive
Brenner tumor	About 1% of ovarian tumors	< 30 cm, unilateral	Firm	None	-	Very rare	> 50% occur in postmenopausal years
Secondary ovarian tumors	10% of fatal malignant disease in women	Varies; often bilateral	Firm to softened	Occasional	Very rare (thyroid, adrenocortical origin)	All	Bowel or breast metastases to ovary common