Epithelial ovarian tumors
Ovarian epithelial tumors account for the majority of all ovarian tumors (60-70%) and their malignant forms represent >90% of ovarian cancers . They can range from being benign to highly malignant.
Epidemiology
There is a difference in frequency of ovarian tumor subtypes depending on menopausal status :
- 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%)
Pathology
The origin and pathogenesis of epithelial ovarian cancer are poorly understood . Despite extensive studies, no precursor lesions have been found .
Classification
Ovarian epithelial neoplasms are histologically classified according to:
- 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
- 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:
- ovarian serous tumors
- ovarian serous cystadenoma: ~60% of serous tumors
- ovarian borderline serous cystadenoma: ~15% of serous tumors
- ovarian serous cystadenocarcinoma: ~25% of serous tumors (most common malignant ovarian tumor)
- ovarian mucinous tumors: ~20% of all ovarian tumors
- ovarian mucinous cystadenoma: ~80% of mucinous tumors
- ovarian borderline mucinous cystadenoma: 10-15% of mucinous tumors
- ovarian mucinous cystadenocarcinoma: ~5-10% of mucinous tumors
- ovarian endometrioid tumor: 8-15% of all ovarian tumors
- ovarian cystadenofibroma* / ovarian adenofibroma: can be serous, mucinous, endometrioid, clear cell, or mixed
- ovarian cystadenocarcinofibroma: extremely rare
- clear cell ovarian carcinoma: ~5% of ovarian cancer
- Brenner tumor: 2-3% of ovarian epithelial neoplasms
- undifferentiated carcinoma of the ovary: ~4% of all ovarian tumors
- squamous cell carcinoma of the ovary
* sometimes classified as a separate category rather than under epithelial
Markers
Radiographic features
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 . 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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