Managing ovarian masses

Borderline ovarian tumors (BOTs) are epithelial tumors with low grade of malignancy.  BOTs account for 10–15% of epithelial ovarian tumors. These tumors occur in younger women, with almost 30% of patients younger than 40 years, and are often diagnosed at an earlier stage than invasive carcinomas.

Brenner tumors are surface epithelial–stromal tumors of the ovary, which were first described in detail by Fritz Brenner in 1907. Brenner tumors represent 3.2 % of all ovarian tumors. About 99% of them are benign and most patients are postmenopausal. Brenner tumors are usually unilateral.

Endometrioid carcinoma represents 10-15% of ovarian epithelial carcinomas. In 15-20% of cases endometrial carcinoma is diagnosed at the same time. Tumors are solid or cystic with a mass protruding into the lumen. The most common microscopic pattern is characterised by a confluent glandular epithelial proliferation.

A granulosa cell tumor is a rare malignancy with a low malignant potential and therefore it has a relatively good prognosis. Due the intratumoral estrogen production it can cause endometrial pathology and abnormal bleeding as the first presenting symptom. On ultrasound they present as large unilateral solid.

Struma ovarii is a rare form of ovarian mature teratoma that contains mostly thyroid tissue. Malignant transformation is uncommon, only about 5% of struma ovarii being malignant. The variable sonographic features of struma ovarii and its rare occurrence makes the sonographic diagnosis very challenging.

The ovary is a common site of metastases from malignant tumors. Most metastases in the ovaries originate in the gastrointestinal tract or the breast. The distinction between primary and metastatic ovarian neoplasm is of critical importance, since surgical cytoreduction is the treatment of choice for the former.

Dysgerminomas are malignant ovarian germ-cell tumors. Malignant germ-cell tumors of the ovary occur in young women, 75% being diagnosed in the second and third decades of life. At macroscopic evaluation, ovarian dysgerminomas are characteristically solid and well-encapsulated with an average diameter of 15 cm.

Ovarian fibromas and fibrothecomas are benign stromal tumors. They account for approximately 4-6% of all ovarian pathology and occur both in pre- and in postmenopausal women, with their malign counterpart being less than 1%. Ovarian fibromas and fibrothecomas are solid masses, usually unilateral.