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Non-Neoplastic and Functional Ovarian Cysts

Follicle and luteal cysts are extremely common, usually multiple and less than 2 cm in size. Lined by follicular or luteinized cells, these cysts contain clear, serous fluid and arise from unruptured Graafian follicles or resealed follicles. While typically asymptomatic, rupture can cause peritoneal inflammation and pain.

Polycystic Ovarian Disease (PCOD) affects 3-6% of reproductive-age women, presenting with numerous cystic follicles, often accompanied by oligomenorrhea, anovulation, obesity, hirsutism, and insulin resistance. Disturbances in androgen biosynthesis are implicated, leading to enlarged ovaries with cortical fibrosis and numerous subcortical cysts (up to 1 cm) exhibiting theca interna hyperplasia.

Stromal hyperthecosis, a disorder of ovarian stroma primarily in postmenopausal women, is characterized by stromal hypercellularity and luteinization, manifesting as nests of cells with vacuolated cytoplasm. Clinically, it resembles PCOD, but virilization can be more severe.

Ovarian Tumors

Ovarian tumors originate from epithelium, germ cells, or sex cord stroma. 80% are benign, most occurring in women aged 20-45. Malignant tumors, primarily affecting women aged 45-65, represent 3% of all female cancers. Due to late detection and spread beyond the ovary, they contribute disproportionately to cancer deaths.

Tumors of Surface (Müllerian) Epithelium

This category encompasses most primary ovarian neoplasms, classified based on epithelial proliferation and differentiation. Increased proliferation generally indicates greater malignant potential. These tumors ultimately arise from transformed Müllerian epithelium.

Non-Neoplastic and Functional Cysts (p. 1039) Follicle and Luteal Cysts (p. 1039) Extremely common findings, these are typically multiple and usually less than 2 cm; they are lined by follicular or luteinized cells with a clear, serous fluid. Cysts derive from unruptured Graafian follicles, or follicles that have resealed after rupture. While typically asymptomatic, they can rupture with ensuing peritoneal inflammation and pain. Polycystic Ovarian Disease and Stromal Hyperthecosis (p. 1039) Polycystic ovarian disease (PCOD) (Stein-Leventhal syndrome) affects 3% to 6% of reproductive-age women; it presents with numerous cystic follicles, often with associated oligomenorrhea, persistent anovulation, obesity, hirsuitism, and insulin resistance. Disturbances in androgen biosynthesis are causally implicated. The ovaries are enlarged with cortical fibrosis; innumerable subcortical cysts (i.e., up to 1 cm) exhibit theca interna hyperplasia. Stromal hyperthecosis is a disorder of ovarian stroma typically in postmenopausal women; it is reflected by stromal hypercellularity and luteinization visible as discrete nests of cells with vacuolated cytoplasm. The clinical manifestations are similar to PCOD, although virilization can be profound. Ovarian Tumors (p. 1040) Ovarian tumors can arise from the epithelium, germ cells, or sex cord stroma; overall, 80% are benign, and most occur in women aged 20 to 45 years (Table 22-2; Fig. 22-1). Malignant tumors typically occur in older women (45 to 65 years) and represent 3% of all female cancers; because most are detected only after spreading beyond the ovary, they account for a disproportionate number of cancer deaths. Tumors of Surface (Mu¨llerian) Epithelium (p. 1041) Most primary ovarian neoplasms fall in this category. Classification is based on the proliferation and differentiation of the epithelium; greater proliferation generally connotes greater malignant potential. Most of these tumors ultimately derive from transformed