Patients with ovarian tumors account for less than 3% of gynecological admissions in hospitals. Out of all ovarian tumors, 80-90% are benign, and 20-25% are premalignant and malignant tumors. Benign tumors are divided into germ cell tumors such as dermoid cyst (mature cystic teratoma), mature solid teratoma, epithelial tumors, which include adenomas (serous, mucinous, endometrioid) and Brenner tumor, as well as benign sex cord-stromal tumors such as Sertoli-Leydig cell tumor, and fibromas. The most common benign tumors are epithelial tumors, and the second in frequency are the germ cell tumors.
Malignant ovarian tumors are classified as epithelial tumors and non-epithelial ovarian malignant tumors. The former include adenocarcinoma (serous, endometrioid, and mucinous), and clear cell carcinomas. The latter include immature teratoma, dysgerminoma, androblastoma, choriocarcinoma, and gonadoblastoma. Serous adenocarcinoma is the most common malignant tumor of the ovaries. Out of all ovarian malignancies, non-epithelial ovarian tumors account for less than 10%. Gonadoblastoma occurs in intersex patients.
Borderline malignant tumors are intermediate in features between benign and malignant tumors of the ovary, and they are also known as semi-malignant.
Benign germ cell tumors are mostly found during an early age, while epithelial tumors are commonly seen in late reproductive ages. Dermoid cyst and mucinous cystadenomas are very common during reproductive age. During pregnancy, dermoid is common. Malignant ovarian tumors are more common in nulliparous older women. Epithelial Malignant tumors peak at 50 to 70 years of age, and non-epithelial malignancies of ovary occur before 40 years of age. Teratomas occur in teenagers and even before that age.
Ovarian cancer can have the following clinical features:
When the benign tumors are symptomatic, they typically feature lower abdominal/pelvic pain, which on most occasions, is acute and may be due to rupture, bleeding, infection and/or torsion of the tumor mass. The pain can be chronic as well due to the pressure effects of the tumor. The pain is usually described as dull aching if it is due to pressure effects. The tumor mass is usually not tender.
In malignant ovarian tumors, the most common presenting complaint is lower abdominal discomfort. Pain is dull initially and later becomes severe when the tumor infiltrates nerve terminals. In these cases, they are tender on palpation.