Ovarian masses (tumors) are very often in gynaecological daily practice. Almost 5%-10% of the women worldwide receive operative procedures for ovarian pathology. The risk related to ovarian cancer is increased from 3d to 8th decade of woman's life. However, in 80% of the ovarian pathology, the etiology will be of benign origin (cystic, solid, or mixed). The accurate follow-up of patients with adnexal pathology may contribute the early diagnosis of the disease and the improvement of prognosis in a case of malignancy. Optimal management of cysts in postmenopausal women remains challenging. The chapter aims to summarize current clinical evidence regarding diagnosis and treatment of such a pathology.
TopIntroduction
Ovarian masses (cystic, solid or mixed) are often in Gynaecological daily practice. Almost 5%-15% of the women worldwide receive operative procedure for ovarian pathology (Dorum, Blom, Ekerhovd, & Granberg, 2005). However, the 80% of the ovarian masses is of benign origin. In addition, the risk related to ovarian cancer increasing from the 3d to 8th decade of woman’s life. The accurate follow-up of adnexal pathology may contribute to the patient’s early diagnosis of ovarian cancer and the prognosis as well.
Ovarian mass can be cystic (clear liquid, clear round margin), cystic mass with additional solid part in the internal area of the cyst (mixed type), or solid ovarian mass. Functional cystic masses are more often in premenopausal period and the etiology of those cysts is the hormonal status of the women during the menstrual cycle. Almost 40% of them are diagnosed by transvaginal ultrasonography (TVUS), duo to routine Gynaecological examination. More often functional cysts are unilateral and the maximal diameter is not more than 4-5cm.
In postmenopausal period ovarian cysts are less common. Although, the majority of those tumors in this group of women is of benign origin, ovarian cancer (incidence 6.0-11.4/100.000) could not be excluded, especially in case of mixed type (solid & cystic) masses (Ferlay et al., 2013).
Histopathology
Ovarian tumors are classified according to the histological nature as:
Epithelial ovarian masses (cystic, solid or mixed) are the most common almost 90% of the ovarian tumors (Bristow et al., 2015). The formers are further classified according to the clinical behavior as:
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Benign tumors
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Malignant tumors
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Borderline tumors.
Furthermore, the epithelial masses are classified according to the histological type as: serous, mucinous, clear cell, endometrioid, Brener and mixed epithelial tumors (Table 1). Serous and mucinous ovarian masses are the commoner types.
Table 1. Histopathology and clinical behavior of Epithelial Ovarian Tumors according the WHO classification
| Epithelial Ovarian Tumors |
Serous
Benign
Malignant
Borderline |
Mucinous
Benign
Malignant
Borderline |
Endometrioid
Benign
Malignant
Borderline |
Clear cell “Mesonephroid”
Benign
Malignant
Borderline |
Brenner
Benign
Malignant
Borderline |
Mixed Epithelial tumors
Benign
Malignant
Borderline |
| Undifferentiated - Unclassified tumors |