Epithelial Stromal Ovarian Tumors

Introduction

• Description: The most common type of ovarian tumors (65% of ovarian tumors, 95% of ovarian malignancies). Epithelial stromal tumors are derived from the surface (celomic) epithelium and the ovarian stroma and include serous (20%–50%), mucinous (15%–25%), endometrioid (5%), clear cell (<5%), and Brenner (2%–3%) types. Epithelial tumors are categorized as benign (adenoma), malignant (adenocarcinoma), or of an intermediate form (borderline malignant adenocarcinoma or tumors of low malignant potential). Some have proposed that these tumors originate in the fallopian tubes (unproven).

• Prevalence: Two of three ovarian tumors and 95% of ovarian malignancies; 12.7/100,000 women.

• Predominant Age: Benign tumors—age 20–29 years; malignant tumors—half are in women older than 50 years (average age is 63 years).

• Genetics: No genetic pattern, though mutations of the BRCA1 and BRCA2 genes impart a 2- to 3-fold increase in risk. Other genes have been implicated but represent a small number of cases.

Etiology and Pathogenesis

• Causes: Unknown.

• Risk Factors: Family history, high-fat diet, advanced age, endometriosis, nulliparity, early menarche, late menopause, White race, higher economic status, cigarette smoking (mucinous type only). Oral contraception, high parity, and breastfeeding reduce risk.

Signs and Symptoms

• Asymptomatic

• Weight loss

• Increasing abdominal girth despite constant or reduced caloric intake

• Ascites

• Adnexal mass (multilocular or partly solid masses in patients older than 40 years are likely to be malignant; the risk of a mass being malignant is one in three for women older than 45 years versus less than 1% for women 20–45 years of age)

• Vague lower abdominal discomfort

• Pleural effusion and shortness of breath

Diagnostic Approach