Ovarian tumors

Ovarian tumors can be divided into three main groups:

1. Functional.
2. Benign.
3. Malignant.

In particular, functional cysts account for about 24% of all ovarian tumors, benign tumors - 70% and malignant tumors - 6%.

Epidemiology

Ovarian tumors are the second most common neoplasm of the female reproductive organs, after uterine fibroids. They occur at any age, but mainly after 40 years. Benign forms prevail among them (75–80%), while malignant forms occur in 20–25%. Over the past 10 years, the incidence of reproductive cancer has increased by 15%.

The frequency of cysts among ovarian tumors is 35%. First of all, these are follicular cysts, corpus luteum cysts, endometriomas. Ovarian cysts most often occur during puberty and reproductive age.

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Risk factors

• Obesity.
• Early menarche.
• Infertility.

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Pathogenesis

Ovarian tumors are divided according to their clinical course into benign, borderline and malignant.

Sources of ovarian tumors:

• normal components of the ovary;
• embryonic remnants and dystopias;
• postnatal growths, heterotopias, epithelial metaplasias.

Among practicing physicians, the terms ovarian cyst and cystoma are still widely used to define ovarian tumors:

An ovarian cyst is a non-proliferating retention formation.

Ovarian cystoma is a true proliferating formation.

In modern oncogynecology, ovarian "cysts and cystomas" are commonly called cystadenoma.

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Forms

The histological classification and terminology of ovarian tumors was approved by WHO in 1973, but taking into account its complexity for the practicing physician, S.K. Serov (1978) developed a more simplified and compact classification, including all forms of tumors presented in the WHO classification.

I. Epithelial tumors

A. Serous, mucinous, endometrioid, mesonephroid and mixed:

1. benign: cystadenoma, adenofibroma, superficial papilloma;
2. borderline: intermediate forms of cystadenomas and adenofibromas;
3. malignant: adenocarcinoma, cystadenocarcinoma, papillary carcinoma.

B. Brenner tumor:

1. benign;
2. borderline;
3. malignant.

II. Sex cord stromal tumors

• A. Granulosa-theca cell tumors: granulosa cell, thecoma-fibroma groups, unclassifiable tumors.
• B. Androblastomas, Sertoli and Leydig cell tumors (differentiated, intermediate, poorly differentiated).
• C. Gynandroblastoma.
• D. Unclassified tumors.

III. Lipid cell tumors

IV. Germ cell tumors

• A. Dysgerminoma.
• B. Endodermal sinus tumor.
• C. Embryonal carcinoma.
• D. Polyembrinoma.
• E. Chorionic carcinoma.
• F. Teratomas (mature, immature).
• G. Mixed germ cell tumors.

V. Gonadoblastoma

VI. Soft tissue tumors (non-specific for ovaries)

VII. Unclassified tumors

VIII. Secondary (metastatic) tumors

IX. Tumor-like and precancerous processes: luteoma of pregnancy, hyperthecosis, follicular cysts, corpus luteum cyst, endometriosis, inflammatory processes, paraovarian cyst.

Based on this classification, it can be concluded that ovarian tumors are very diverse in their histological structure.

Based on their clinical course, ovarian tumors are divided into benign, borderline and malignant.

Benign ovarian tumors include tumors with minimal proliferation of epithelial cells or a small degree of their atypicality.

Borderline tumors are a kind of transitional biological stage of blastomogenesis and belong to the group of potentially low-grade malignancy, there is no obvious invasion of the adjacent stroma. However, borderline tumors can sometimes be implanted along the peritoneum and cause distant metastases. A high survival rate of patients with borderline ovarian tumors has been clinically proven.

Malignant ovarian tumors are tumors of varying degrees of maturity of the cellular structure, they grow rapidly, spread, and metastasize to various organs; their prognosis depends on early detection and completeness of the treatment.

To understand the clinical features of some complications that occur in patients with ovarian cystadenomas, as well as during surgical treatment of this pathology, it is important to clearly define the concepts of the anatomical and surgical pedicle of an ovarian tumor.

Anatomical pedicle of the ovarian tumor: proper ligament, infundibulopelvic ligament, part of the broad ligament.

Surgical pedicle of the tumor: proper ovarian ligament, infundibulopelvic ligament, part of the broad ligament, fallopian tube.