Overview of ovarian tumors

Last updated: May 24, 2023

Summarytoggle arrow icon

The ovaries consist of different types of tissue (epithelial, germ cells, and sex cord tissue), which may give rise to benign or malignant tumors. Epithelial ovarian tumors are the most common tumor subtype.

For information about ovarian cancer, see “Ovarian cancer”.

Classification of ovarian tumorstoggle arrow icon

Classification of ovarian tumors

Epithelial ovarian tumorstoggle arrow icon

  • Frequency [3]
  • Histological classification
    • Benign: lack hyperproliferative and invasive behavior
    • Borderline ovarian tumors: a histopathological term that describes an ovarian tumor of low malignant potential that expresses cytologic features of malignancy without frank invasion
    • Malignant: evidence of invasion
  • Clinicopathological classification [4]
Types of epithelial ovarian tumors
Type Cystadenoma Brenner tumor [5] Cystadenocarcinoma Endometrioid carcinoma [3][6] Clear cell tumors [3][7]
Ovarian serous cystadenoma Ovarian mucinous cystadenoma Serous Mucinous [8]
  • Benign
  • Malignant
  • Rare
  • Peak age: 40–60 years
Clinical features
  • Typically asymptomatic
  • Symptoms of abdominal displacement may be present (e.g., pain, ↑ urinary frequency)
Ultrasound appearance
  • Unilocular cystic mass
  • Absent flow on Doppler
  • Large, multilocular cystic tumor
  • Mostly small tumors with a solid component and calcifications
  • Absent or only minimal flow on Doppler
  • Mostly large, unilateral, solid or multilocular-solid tumor with papillary projections
  • Large (up to 30 cm in diameter), cystic/solid unilateral masses
  • Tumor with mixed cystic/solid components and heterogeneous texture
  • May contain papillary projections and/or thick septations
  • Similar to mucinous cystadenoma
  • Additional solid components and signs of malignancy (e.g., invasion of adjacent structures) may be present
  • Mural thickening


Gross examination
  • Cysts with watery fluid
  • Smooth or bosselated appearance
  • Cyst is loculated; loculi contain gelatinous material
  • Encapsulated, pale yellow solid tumor
  • Cysts filled with mucoid material, cellular debris, and/or blood
  • Possible appearances are:
    • Smooth surface with cystic spaces filled with blood-stained fluid
    • Completely solid with necrosis/hemorrhage
  • Endometriosis-associated tumors are filled with chocolate-colored fluid
  • Cystic or colloid type, depending on intracellular or extracellular mucin deposition
    • Cystic type: > 50% of intracellular mucin in ≥ 90% of tumor cells
    • Colloid type: large quantities of extracellular mucin (≥ 50% of tumor volume)
  • Characteristic confluent glandular/expansile pattern
    • Tightly packed, back-to-back glands lined with tumor cells
    • Absent intervening stroma
  • Variable appearance: tubulocystic, papillary, and solid
Tumor marker

CA-125 is used as a tumor marker for epithelial ovarian cancer but can also be elevated in endometriosis, cirrhosis, and malignancies (e.g., uterine leiomyoma).

Most ovarian tumors are benign, not malignant.

Ovarian germ cell tumorstoggle arrow icon

Types of ovarian germ cell tumors
Type Teratoma Yolk sac tumor of the ovary (endodermal sinus tumor) [11] Dysgerminoma [12] Nongestational choriocarcinoma [13] Embryonal carcinoma of the ovary
Dermoid cysts (mature cystic teratoma) Struma ovarii (mature teratoma) [14] Immature teratoma [15]
  • Benign
  • Malignant, aggressive
  • Rare
  • Peak age: women < 20 years of age [18]
Clinical features
  • Mostly asymptomatic
  • Unspecific symptoms, including:
  • Rapid growth; acute onset of symptoms (pelvic mass and pain)
  • Larger tumors may cause:
    • ↑ Abdominal girth
    • Pressure symptoms (e.g., ↑ urinary frequency)
    • Lower abdominal pain
Ultrasound appearance
  • Heterogeneous mass
  • Hyperechoic nodule
  • Echogenic shadowing
  • Absent internal vascularity and/or fluid-fluid levels
  • Multilocular solid appearance
  • Struma pearl may be present.
  • Large tumor with a solid component
  • Solid component arises from the wall of the cyst and makes up ≥ 15% of total cyst size; contains smaller, fluid-filled cysts (e.g., blood, mucus).
  • Small areas of calcification
  • Large, solid, well- vascularized, multilobulated tumor that is well-defined relative to its surroundings
  • Heterogeneous internal echogenicity
  • Well-vascularized mass with inhomogeneous texture
  • Irregular contour
  • Ovarian crescent sign may be present
  • Large, solid, well-defined tumor
Tumor markers
  • None
  • LDH (rare) [20]
Risk of malignant transformation
  • N/A

Sex cord-stromal tumors of the ovarytoggle arrow icon

Types of sex cord-stromal tumors of the ovary

Ovarian fibroma [26]

Theca cell tumor (thecoma) [27] Sertoli-Leydig cell tumor [28][29][30][31] Granulosa cell tumor [28][32][33]
  • Benign
  • Usually benign
  • Malignant
  • Rare
  • Peak age: 30–40 years
  • Most common type of sex cord-stromal malignancy (∼ 90%)
  • Peak age: 50–55 years
Clinical features
  • No hormonal activity
  • Lower abdominal discomfort and/or a pulling-sensation in the inguinal area
  • May be associated with Meigs syndrome: ascites and pleural effusion in association with a benign ovarian tumor; surgical removal of the tumor leads to complete resolution of symptoms. [35]
  • Abnormal postmenstrual bleeding due to estrogen production
Ultrasound appearance
  • Round or oval solid tumor with minimal to moderate vascularization
  • Regular to slightly irregular internal echogenicity
  • Cystic spaces may be present.
  • Most commonly between 5 and 15 cm in diameter
  • Large papillary projections may be visible.
  • Typically, large tumor with multilocular solid appearance with > 10 small locules
  • Typically mixed or low level echogenicity
Pathology Gross examination
  • Smooth, lobulated
  • Cut surface: chalky, firm, yellow-to-white color
  • Solid yellow-orange tumor
  • Small, yellow-brown tumor
  • Tan/yellow color
  • Encapsulated; smooth lobulated surface, possibly with areas of necrosis/hemorrhage
  • Ovarian stromal cells filled with lipids on microscopy
  • Call-Exner bodies: granulosa cells arranged in clusters surrounding a central cavity with eosinophilic secretions, resembling primordial follicles
Tumor markers
  • None

Call-Exner bodies are characteristic of Granulosa cell tumors: “Call your Ex and Grandparents!”

Referencestoggle arrow icon

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