Introduction Description: Tubo-ovarian abscess is an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs. These abscesses most often occur as a complication of pelvic inflammatory disease (PID), though spread from other sites is possible. Rupture of a tubo-ovarian abscess (15% of cases) represents a life-threatening surgical emergency. The presence of active infection differentiates tubo-ovarian abscesses from a sterile hydrosalpinx. Prevalence: Roughly…

Introduction Description: A Sertoli-Leydig cell tumor is a rare sex cord tumor of the ovary that comprises male elements and may be associated with virilization. Tumors vary in size but are generally 5–15 cm in diameter when incidentally found. Prevalence: Very rare (<0.5% of ovarian tumors). Predominant Age: Younger than 40 years (75%); mean age is 25 years; <10% of women are older than 50 years.…

Introduction Description: Serous ovarian cysts are a group of benign and malignant epithelial tumors of the ovary that are characterized as serous cells. These tumors are the most commonly encountered epithelial ovarian tumors. When malignant, these tumors tend to be high grade and virulent. Prevalence: 20% of all benign ovarian neoplasms. Predominant Age: Reproductive age. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Unknown. Risk Factors:…

Introduction Description: Pseudomyxoma peritonei is the intraperitoneal spread of a mucin-secreting tumor (either a mucinous cystadenoma or carcinoma), which results in recurrent abdominal masses, often-massive ascites, and multiple bowel obstructions. This tumor most frequently begins in the appendix. Prevalence: Roughly 3500 cases per year (male and female). 2/10,000 laparotomies and 2%–5% of ovarian mucinous tumors (16% in mucinous cystadenocarcinomas). Predominant Age: Middle to late reproductive age…

Introduction Description: Pelvic inflammatory disease (PID) is a serious, diffuse, frequently multiorganism infection of the pelvic organs that results in significant morbidity. The term refers to a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Prevalence: 1%–3% of women; most common gynecologic reason for emergency visits for women aged 15–44 years. Approximately 106,000…

Introduction Description: Ovarian torsion involves the twisting of a part or all of the adnexa on its mesentery, resulting in tissue ischemia and frank infarction. This usually involves the ovary but may also include the fallopian tube. Prevalence: Uncommon; 2%–3% of gynecologic operative emergencies; fifth most common gynecologic emergency; 5/100,000 in ages 1–20 years. Slightly more common on the right side (64%). Predominant Age: Mid- to…

Introduction Description: The most common benign ovarian tumor is the ovarian fibroma, which is composed of stromal cells (fibroblasts). Although benign, these tumors are sometimes associated with ascites and hydrothorax (Demons syndrome, Meigs syndrome, 1% of patients). Prevalence: 4% of all ovarian tumors, most common solid tumor. Predominant Age: Any; most common in perimenopausal and menopausal women; average age is 48 years; less than 10% are…

The Challenge Description: An ovarian cyst is a cystic growth within the ovary, generally arising from epithelial components and most often benign. Scope of the Problem: Benign ovarian tumors are most frequently diagnosed at the time of routine examination and are asymptomatic. When symptoms do occur, they generally are either catastrophic (as when bleeding, rupture, or torsion occur) or indolent and nonspecific (such as a vague…

Introduction Description: Ovarian cancer is a malignancy that arises in the ovary and generally has an epithelial origin. This represents the second most common malignancy of the genital tract (after endometrial cancer), but it is the most common fatal gynecologic cancer. Prevalence: Annually, 19,880 women will receive a new diagnosis of ovarian cancer, with 12,810 deaths in the United States (estimated for 2022). Ovarian cancer is…

Introduction Description: A group of benign and malignant epithelial tumors of the ovary that are characterized by mucin secretion. These tumors tend to be the largest types of ovarian masses encountered and may be 30 cm or greater in size. Prevalence: 15%–25% of ovarian cysts and 6%–10% of ovarian cancers. Although ovarian cysts are common in younger women, mucinous cysts account for approximately 50% of those…

Introduction Description: A Krukenberg tumor is a metastatic tumor (generally from the gastrointestinal tract) that is characterized by large signet-ring cells. The most common site of origin is the stomach or large intestine. Named after Friedrich Ernst Krukenberg (1871–1946), who reported the ovarian malignancy in 1896. Prevalence: Constitutes 1%–2% of all ovarian neoplasms. Predominant Age: Late reproductive to postmenopausal, average age 45 years. Genetics: No genetic…

Introduction Description: Recurrent or chronic adnexal infections may result in a cystic dilation of the fallopian tube (hydrosalpinx), which may present as an adnexal mass. Prevalence: 40% of female infertility is a result of tubal damage, including the most severe form, hydrosalpinx. Predominant Age: 15–25 years. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Recurrent or chronic adnexal infection. This is the end stage condition of…

Introduction Description: A granulosa cell tumor is a sex cord stromal tumor of the ovary made up of granulosa cells (sex cord) and stromal cells (thecal cells or fibroblasts). The tumor often secretes estrogen. Prevalence: 2%–5% of ovarian neoplasms and the majority of hormonally active tumors. Absolute rate of less than 0.2/100,000 women. Predominant Age: Any; 5% before puberty; most before the age of 40 years.…

Introduction Description: Germ cell tumors contain cells that echo the three layers of embryonic tissue (ectoderm, mesoderm, and endoderm) or extraembryonic elements. Prevalence: Second most frequent ovarian neoplasm (25% of tumors) and the most common ovarian tumor in women younger than 30 years (70%). Predominant Age: Younger than 30 years; most common malignancy in women in their teens and 20s (75% of cases are in this…

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…

Introduction Description: Endometriosis is a benign but progressive condition characterized by endometrial glands and stroma that are found in locations other than the endometrium (may be found outside of the pelvis in the abdomen, thorax, brain, and skin). Prevalence: 5%–15% of women; 20% of gynecologic laparotomies; 30% of patients with chronic pain (50% of teens with pain); 30%–50% of patients experiencing infertility. Predominant Age: Third and…

Introduction Description: An ectopic pregnancy is one in which the fertilized egg is implanted outside of the endometrial cavity (fallopian tube [98%], ovary, abdominal cavity, or cervix). This is the leading cause of pregnancy-related maternal death in the first trimester (4%–10% of all pregnancy-related deaths). Prevalence: 10–20/1000 pregnancies; varies with age, race, and location (highest in Jamaica and Vietnam). The risk of simultaneous intrauterine and extrauterine…

Introduction Description: A dysgerminoma is an ovarian tumor that is made up of germ cells and stroma that appears analogous in structure to the seminomas found in the male testes. Although rare, these tumors are the most common malignant germ cell tumors. Prevalence: Rare; 1%–2% of ovarian malignancies; one-third of ovarian germ cell tumors. Predominant Age: Older than 30 years (10% in prepubertal girls). Genetics: No…

Introduction Description: The most common ovarian tumor in young, reproductive-aged women is the cystic teratoma or dermoid, which originates from a germ cell and contains elements from all three germ cell layers. These tumors may be benign or malignant (1%–2% malignant, usually in women older than 40 years). Dermatoid cysts account for 20%–25% of all ovarian tumors, one-third of all benign tumors, and 70% of tumors…

Introduction Description: A clear cell carcinoma is an ovarian epithelial tumor comprising cells containing large amounts of glycogen, giving them a clear or “hobnailed” appearance. These tumors may also arise in the endocervix, endometrium, and vagina. Cervical and vaginal tumors have been linked to in utero exposure to diethylstilbestrol (DES). Prevalence: 5%–11% of ovarian cancers. Predominant Age: 40–78 years. Genetics: No genetic pattern. The AT-rich interactive…