Many women are found to have ovarian masses during medical checkups. Some patients hear this news like experiencing a bolt from the blue, thinking that they have ovarian cancer and their lives are threatened. Are ovarian masses tumors or not? What is the relationship between ovarian masses and ovarian cancer? Now this article will briefly introduce it to you.
First of all, in terms of texture, ovarian masses can be divided into cystic, cystic solid and solid, of which cystic masses are commonly known as ovarian cysts. The majority of ovarian cysts are mostly benign lesions, while cystic and solid masses have the potential to be malignant.
Secondly, ovarian masses are not necessarily ovarian tumors, and even if they are ovarian tumors, they are not necessarily ovarian malignant tumors or ovarian cancer. Ovarian masses are the general term for masses growing on the surface of the ovary or inside the ovary, which includes two categories of non-redundant ovarian masses and redundant ovarian masses. Non-redundant masses are non-tumorigenic and are benign lesions. The superfluous masses are ovarian tumors, which can be classified as benign, junctional or malignant according to their benignity or malignancy, of which the malignant tumor is ovarian cancer. The prognosis of ovarian tumors varies according to their degree of benignity and malignancy.
The specific classification of ovarian masses is as follows.
I. Non-redundant ovarian masses (i.e. non-tumor ovarian masses)
Non-redundant masses are benign ovarian lesions. They are usually small in diameter, not more than 5 cm, and usually do not require treatment and often disappear on their own. Non-redundant ovarian masses are divided into functional ovarian masses, ovarian endometriosis masses (i.e. chocolate masses) and inflammatory ovarian masses.
1.Functional ovarian masses
Functional masses are obviously related to gynecological endocrine function and can be divided into follicular masses, corpus luteum masses, and follicular membrane flavin masses.
(1) Follicular cysts: The normal ovarian cycle includes three stages: follicular development, ovulation and luteal formation, and requires normal regulation of the complete hypothalamic-pituitary-ovarian functional axis. When the hypothalamic-pituitary-ovarian axis is dysfunctional, the follicles that are close to maturity do not rupture and continue to grow, or the follicles overgrow due to increasing fluid accumulation in the cavity after oocyte degeneration, resulting in retention cysts. The cystic expansion of the follicle is called a cystic follicle when it is more than 1-2 cm in diameter, and the further increase of the cystic follicle to 3-6 cm in diameter is called a follicular cyst. Follicular cysts are more common in adolescents and during the menopausal transition, and less common in postmenopausal women and in young women taking birth control pills. Follicular cysts do not require treatment and often resolve on their own within a few weeks. If the hypothalamic-pituitary-ovarian axis continues to function abnormally, cysts can recur.
(2) Luteal cysts: after ovulation, the corpus luteum is formed in the mature follicle, and if there is more fluid left in the corpus luteum up to 2-3 cm in diameter, it is called cystic corpus luteum. Luteal cysts can occur in pregnancy or non-pregnancy. Luteal cysts in early pregnancy are often palpable during gynecological examination and are generally asymptomatic. In non-pregnancy, luteal cysts are endocrinologically active and can cause prolonged periods, excessive menstrual bleeding, and even amenorrhea. Like follicular cysts, luteal cysts usually disappear on their own without treatment.
(3) Follicular membrane luteinizing cysts: Follicular membrane luteinizing cysts are formed by the luteinization of follicular membrane cells of multiple atretic follicles, often occurring in both ovaries, and are often large, ranging from 6-20 cm in diameter or even larger. The formation of these cysts is mainly due to increased levels of human chorionic gonadotropin (hCG) or increased sensitivity of the follicles to hCG. It is commonly seen in patients with staphyloma and choriocarcinoma, but also in patients with multiple pregnancies, combined diabetic pregnancies, and hypertensive disorders of pregnancy. Follicular membrane flavin cysts do not require special treatment and will disappear on their own when the cause is eliminated, such as termination of pregnancy or cure of trophoblastic disease.
2, ovarian endometriosis cysts
Ovarian endometriosis is the appearance of endometrial tissue (glandular and mesenchymal) with growth function in the ovarian tissue. About 80% of patients have lesions involving one ovary and 50% have bilateral ovarian involvement. The ectopic endometrial tissue grows and bleeds periodically within the ovarian cortex to the point of forming single or multiple cysts, called ovarian endometriotic cysts. The accumulation of old bleeding in the cysts forms a thick, coffee-colored fluid that resembles chocolate, commonly referred to as ovarian “chocolate cysts” or “coeliacs”. The size of the cyst varies, usually under 5-6 cm in diameter, but the larger ones can be about 25 cm in diameter. Although these masses are benign, they have the potential to become malignant. Large cysts with obvious symptoms require surgery and have a high recurrence rate after surgery.
3. Inflammatory ovarian cysts
Inflammatory ovarian cysts are formed when inflammation of the fallopian tubes spreads to the ovaries and causes them to adhere to each other, or when the umbilical end of the fallopian tubes penetrates the ovaries and causes exudate to accumulate, or when pus from a tubo-ovarian abscess is absorbed and liquefied. These cysts are a consequence of chronic inflammation of the fallopian tubes and not true ovarian cysts. For inflammatory ovarian cysts, anti-inflammatory treatment with medication or infusion is available, and surgical exploration is possible if necessary. The prognosis is better.
2. Superfluous ovarian masses (i.e. tumorigenic masses)
Ovarian tumors can be divided into four major categories according to their histological components.
① ovarian epithelial tumors;
② ovarian germ cell tumors;
(iii) interstitial tumors of the ovarian cords;
④metastatic tumors of the ovary.
Among them, the first two are mainly manifested by ovarian cysts (the other two types of tumors are mostly manifested by solid masses in the adnexal area). Ovarian tumors can be divided into benign, junctional and malignant according to their benignity and malignancy. Benign ovarian tumors are generally curable by surgery and have a good prognosis. Junctional ovarian tumors, such as junctional plasmacytoid cystadenoma and junctional mucinous cystadenoma, are a kind of tumor between benign and malignant with low malignant potential. It is characterized by slow growth, low metastasis rate and late recurrence, and generally has a good prognosis. Ovarian malignant tumors (mainly ovarian cancer) mostly require surgery and comprehensive treatment with radiotherapy and chemotherapy according to their clinical stages, and generally have a poor prognosis, with 5-year survival rate hovering at 30-40%.
1.Ovarian epithelial tumor
Ovarian epithelial tumors are the most common ovarian tumors, accounting for 50-70% of primary ovarian tumors and 85-90% of ovarian malignant tumors. They are more common in middle-aged and older women, with those aged 50-60 years old, and rarely occur in prepubescent and infants. Ovarian epithelial tumors can be divided into the following categories according to their histology.
(1) Plasmacytoma
(1) Plasmacytoid cystadenoma: it accounts for about 25% of benign ovarian tumors. They are mostly unilateral, spherical, varying in size, with smooth surface, cystic, thin wall, and filled with yellowish clear liquid. Surgical treatment is effective and the prognosis is good.
(2) Junctional plasmacytoid cystadenoma: medium size, mostly bilateral, less papillary growth in the capsule. The nuclei are mildly heterogeneous, with few nuclear schisms and no interstitial infiltration, and the prognosis is good.
Plasmacytoid cystic adenocarcinoma: It accounts for 40%-50% of ovarian malignant tumors, mostly bilateral, with large, cystic masses. It is nodular or lobulated, brittle and prone to hemorrhage and necrosis, with obvious cellular heterogeneity and infiltration into the interstitium. The 5-year survival rate is only about 20-30%.
(2) Mucinous tumors
Mucinous cystadenoma: It accounts for 20% of benign ovarian tumors, mostly unilateral, large or huge, with jelly-like liquid contents. Occasionally, it may rupture on its own, and after rupture, the tumor cells may be planted on the peritoneum and continue to grow and secrete mucus (called peritoneal mucinous tumor), but generally does not infiltrate the organ parenchyma. The disease is effectively treated surgically and has a good prognosis.
(2) Junctional mucinous cystadenoma: generally larger in size, mostly unilateral, with papillae on the cut surface, mild heterogeneity, a few nuclear divisions, and no interstitial infiltration. It can be treated by surgery and has a better prognosis.
Mucinous cystic adenocarcinoma: The incidence of mucinous cystic adenocarcinoma is lower than that of plasma cystic adenocarcinoma, accounting for about 10%-20% of ovarian malignant tumors. It can be solid or cystic, with turbid mucous fluid in the cystic cavity, mostly bloody. The prognosis of mucinous cystic adenocarcinoma is better than that of plasmacytic cystic adenocarcinoma, with a 5-year survival rate of 40%-60%.
(3) Ovarian endometrioid tumor
Benign and junctional tumors are rare, while malignant ones are endometrioid carcinoma of the ovary, accounting for about 10%-20% of primary ovarian malignant tumors, mostly unilateral and of medium size. The microscopic features are similar to those of endometrial cancer, which is often complicated by endometrial cancer, but it is not easy to identify which one is primary or secondary. The prognosis is good, with a five-year survival rate of 40%-55%.
(4) Clear cell tumor
Clear cell carcinoma accounts for 5%-10% of ovarian malignant tumors, mostly unilateral large solid or cystic masses, with a diameter of 10-20 cm, sometimes more than 30 cm. Hypercalcemia is found in 10% of patients and endometriosis in 25%-50% of patients. It is easy to metastasize to retroperitoneal lymph nodes and liver, and the prognosis is poor.
(5) Undifferentiated carcinoma
Undifferentiated carcinoma of the ovary often occurs in young and middle-aged women. They are usually unilateral, large, cystic or solid masses, soft, brittle, lobulated or nodular, mostly with necrotic bleeding, and 70% of patients have hypercalcemia. These tumors are extremely malignant and have a very poor prognosis, with 90% of patients dying within a year.
2. Ovarian germ cell tumors
Ovarian germ cell tumors are a group of tumors that originate from the primitive germ cells of the embryonic gonads and have different histological features. The incidence is second only to epithelial tumors, accounting for 20%-40% of ovarian tumors. They are more common in children and adolescents, with adolescence accounting for 60%-90% of cases and menopause for only 4% of cases. Germ cells have the function to differentiate into various tissues. Undifferentiated tumors are asexual cell tumors, embryonic pluripotent tumors are embryonal tumors, teratomas are differentiated into embryonic structures, and endodermal sinus tumors and choriocarcinoma are differentiated into extraembryonic structures. (Among them, asexual cell tumors, embryonal carcinomas and choriocarcinomas are solid ovarian masses and will not be discussed here.)
(1) Teratoma
Tumors consisting of polyembryonic tissue, occasionally containing one embryonic component. Most of the tumors are mature and a few are immature; most are cystic and a few are solid. The benignity and malignancy of the tumor depend on the degree of tissue differentiation and not on the texture of the tumor.
Mature teratomas, also known as dermatomal cysts, are benign tumors, accounting for 10%-20% of ovarian tumors and more than 95% of teratomas. It can occur at any age, but is more common in the age of 20-40 years. They are mostly unilateral, medium sized, filled with grease and hair, and sometimes teeth and bone are visible inside the sac. The prognosis of mature teratoma is good after surgical treatment, and its malignant rate is 2%-4%, mostly seen in postmenopausal women.
Immature teratomas, which account for 1%-3% of ovarian teratomas, are composed of immature embryonic tissues with different degrees of differentiation, mainly primitive neural tissue. They occur in adolescents. The tumor is almost always unilateral, and is mostly solid or cystic in nature. The envelope is not solid and often ruptures on its own. The degree of malignancy of the tumor depends on the proportion of immature tissue, the degree of differentiation and the neuroepithelial content. The recurrence and metastasis rate of this tumor is high, and the 5-year survival rate is 20%.
(2) Endodermal sinus tumor: also known as yolk sac tumor, which originates from extra-embryonic structure of yolk sac, is relatively rare and accounts for 1% of ovarian malignant tumors. It is a highly malignant tumor that occurs in children and young women, mostly unilateral, with large tumors and partially cystic sections. The tumor may produce the tumor marker alpha-fetoprotein (AFP). These tumors grow rapidly, are prone to early metastasis, and have a poor prognosis.
In summary, ovarian masses include non-bulky and bulky masses (i.e. ovarian tumors). Ovarian tumors are divided into benign ovarian tumors, junctional ovarian tumors and malignant ovarian tumors. Benign ovarian tumors, such as plasmacytoma, mucinous cystadenoma and mature teratoma, can be cured after surgery and have a good prognosis. Junctional ovarian tumors such as junctional plasmacytoma and junctional mucinous tumor, whose malignant degree is between benign and malignant lesions, have better surgical treatment and better prognosis. Malignant ovarian tumors such as plasmacytoma, mucinous cystic adenocarcinoma, endometrioid carcinoma, clear cell carcinoma, undifferentiated carcinoma, immature teratoma and endodermal sinus tumor are more malignant and require comprehensive treatment such as surgery, chemotherapy and radiotherapy, with poorer prognosis.
After the above introduction, it is easy to see that ovarian masses contain a wide variety of diseases, ovarian tumors are only a part of them, and ovarian malignant tumors are a small part of them. The best choice is to go to the hospital and get a professional physician to determine the benignity and malignancy of the ovarian masses as soon as possible. However, you should not ignore the existence of ovarian masses because they do not give you any discomfort, because they have the potential to be malignant or develop into malignant.