Ovarian Tumor: Symptoms And Types

 

 

 

     The Ovary is a female reproductive organ measuring approximately 2-3 cm, located on both sides of the uterus. Its two primary functions are egg production (ovulation)—where the egg meets sperm to form an embryo before implanting in the uterine cavity for pregnancy—and the production of female sex hormones, estrogen and progesterone. "Ovarian Tumors" are among the most common abnormalities found in this organ.

 

 

 

 

Pathology of 'Ovarian Tumors'

The ovaries develop from three types of precursor cells:

 

• Coelomic epithelium (lining cells of the early female embryo)
• Primordial germ cells (migrating from the yolk sac)
• Mesenchyme at the Genital ridge

 

 

Therefore, ovarian tumors can be classified into 5 major groups based on histogenesis:

 

 

Classification of Ovarian Tumors

• Derived from Coelomic epithelium: Also known as epithelial tumors. This is the most common type of ovarian cancer, accounting for approximately 90-95%.
• Derived from Germ cells (details to follow).
• Derived from Specialized gonadal stroma: Known as sex-cord stromal tumors.
• Derived from Nonspecific mesenchyme: Such as Fibroma, Hemangioma, Leiomyoma, Lipoma, Lymphoma, and Sarcoma.
• Metastatic tumors from other organs: Such as the gastrointestinal tract (Krukenberg tumor), breast, endometrium, and Lymphoma.

 

 

 

 

Common Types of Ovarian Tumors

     The most common type of ovarian tumor is epithelial tumors, which account for 60-65% of all ovarian tumors, and approximately 90% of these are malignant. Germ cell tumors represent about 30% of all ovarian tumors, with the majority being mature cystic teratomas (dermoid cysts). Although germ cell tumors only account for 1-3% of all malignant ovarian tumors, they constitute 60% of ovarian cancers in children and adolescents. Sex-cord stromal tumors account for 8% of all ovarian tumors.

 

Germ Cell Ovarian Tumors

Approximately 30% of all ovarian tumors originate from germ cells. However, less than 5% of ovarian cancers are of this type. Nevertheless, in women under 20 years of age, germ cell tumors are the most common type. The World Health Organization (WHO) classifies these tumors into:

 

• Teratoma (immature, mature, and monodermal)
• Dysgerminoma
• Yolk sac tumor (endodermal sinus tumor)
• Embryonal carcinoma
• Polyembryoma
• Choriocarcinoma
• Mixed germ-cell tumors

 

 

 

 

 

Teratoma, Mature Teratoma, or Dermoid Cyst

     This is a tumor composed of embryonic tissues. Mature cystic teratomas are the most common and typically benign type of germ cell tumor. Most occur on one side, but 15-20% are bilateral. This type of tumor is the most frequent cause of ovarian torsion. Hair and teeth may be found inside the mass, which can be seen on abdominal X-rays. Malignant transformation occurs in up to 2%, most commonly into squamous cell carcinoma. A specific type containing prominent thyroid tissue is called "struma ovarii." Primary ovarian carcinoid tumors are also classified as specialized monodermal teratomas and usually have a good prognosis, whereas secondary ovarian carcinoid tumors typically spread from the GI tract and have a poor prognosis. The mature cystic teratoma or "dermoid cyst" accounts for approximately 10-15% of all ovarian tumors. It is the most common tumor in females under 20 (up to 70%) and is found in 20% of postmenopausal women. The mass usually consists of tissues from the ectoderm, mesoderm, and/or endoderm layers; therefore, it may contain cysts, hair, thick sebum, teeth, bone, and cartilage. The cause is believed to be abnormal germ cell division during Meiosis II or failure of premeiotic cells in Meiosis I. Put simply, it results from abnormal reproductive stem cell division.

 

 

Bilateral masses occur in about 10-15%. Most masses do not exceed 15 cm in diameter. They are typically round with a smooth, shiny surface and a thick wall lined with squamous cells. Inside, skin components like sebaceous and sweat glands are present. Upon dissection, yellow sebum, hair, and sometimes teeth or bone are found.

 

 

Common Symptoms of Ovarian Tumors

• Symptoms may arise from the mass pressing on pelvic organs, leading to frequent urination, constipation, or a feeling of heaviness in the lower abdomen.
• Acute abdominal pain due to complications like torsion (twisting), rupture, or infection.
• Abnormal uterine bleeding occurs in 15%, sometimes without a clear secondary cause.
• Other symptoms include loss of appetite and bloating.
• Often asymptomatic. Many cases are discovered during pelvic exams or pelvic ultrasounds.

 

 

 

 

 

Complications of Ovarian Tumors

     Physical examination may reveal a mass in the lower abdomen or adnexa during a pelvic exam. The mass is usually cystic, firm, smooth, and mobile. Complications of dermoid cysts include:

 

1. Torsion

     Torsion is the most common complication, occurring in about 16% of tumors. It is more common in small to medium-sized tumors. Initial twisting causes venous congestion and swelling, leading to pain. If the twisting persists, arterial blood flow stops, resulting in ischemia. Pain ranges from mild to severe, often accompanied by nausea, vomiting, rapid pulse, fever, and tenderness in the lower abdomen with guarding/rigidity. This is a surgical emergency as the mass could rupture and become life-threatening.

 

2. Rupture

     Rupture or leaking is rare (about 1%) but more common during pregnancy. If it ruptures, internal fluids like cholesterol-laden debris cause severe peritonitis, granulomatous reactions, and dense adhesions. Symptoms include abdominal pain and sometimes anemia if internal bleeding occurs. Urgent surgery is required to wash out the fluids.

 

3. Infection

     Infection is rare (about 1%). Symptoms include fever and pelvic pain combined with a palpable mass. Most infections are caused by coliform bacteria, though others like Salmonella may occur.

 

4. Malignant Transformation

     This occurs in 1-2% of dermoid cysts. 80% of these become squamous cell carcinomas, though other types like sarcoma or malignant melanoma can occur.

 

Treatment of Ovarian Tumors

• Ovarian tumors are treated with surgery to obtain tissue for diagnosis and to avoid complications like rupture or torsion.
• Cystectomy (removing only the cyst) is considered if there are no complications, especially for younger patients wishing to maintain fertility.
• Oophorectomy (removing the ovary) is considered if cancer is suspected or severe complications occur.

 

 

Get checked before it's too late. Being asymptomatic doesn't mean you are disease-free. If a cyst grows larger, it can cause severe complications that may lead to the removal of the ovary.

 

 

Last Updated: 15/12/2020