1. neoplastic
   • benign:
   • malignant: carcinoma, lymphoma, sarcoma
2. nonneoplastic:
   • endosalpingiosis cysts
   • cystic Walthard cell rests
   • endometriosis (can be cysts and masses.
   • did stents or devices cause inflamatory pain? [L10-2047]

Ovarian diseases:

1. neoplastic (see JHU website):

ovarian surface epithelial masses (coelomic, Mullerian origin): [benign or malignant adenofibromatous ovarian lesions...especially the glandular-cystic rather than papillary dominant patterns...have a 14% association with breast cancer, usually already diagnosed, and a significant association with various thyroid disorders5] Benign & borderline: serous (tubal-like): adenoma vs. cystadenoma vs cystadenofibroma (see below) vs. adenofibroma; interior cyst fluid can seem mucinous grossly in serous tumors & cells may be ciliated. mucinous (endocervix-like): adenoma vs. cystadenoma vs cystadenofibroma vs. adenofibroma. endometrioid (tubular glands resembling proliferative endometrium): usually a cystadenofibroma. transitional cells (Brenner): fibroepithelial histology & often with a minor component of mucinous glands; solid vs. cystic vs. cystadenofibromatous; most are benign & rare "proliferative Brenner" (borderline). mesothelial (coelomic) inclusion cysts (cortical mullerian inclusion cysts). Malignant: serous: solid vs. cystic vs. cystadenofibromatous & be sure to consider primary peritoneal serous carcinoma [L-04-8307]. mucinous: solid vs. cystic vs. cystadenofibromatous & can be associated with (or cause) pseudomyxoma peritonei & if with bilateral ovarian mucinous tumors, look for an extra-ovarian primary6. A benign appendicular mucocoel can rupture and release localized to massive quantities of non-cellular mucous to mimmic pseudomyxoma peritonei. endometrioid (resembling adenoca. endometrium): solid vs. cystic vs. cystadenofibromatous; clear cell adenocarcinoma is an aggressive variant. transitional cells (Brenner): solid vs. cystic vs. cystadenofibromatous & only rarely malignant; metastatic endometrial or other to ovary can sclerose & nest in such a way as to mimic a malignant Brenner [L07-7293]. mesothelioma

ovarian stromal sex cord masses: thecoma: usual vs. luteinized thecoma: [LMC-02-40] fibroma (stroma dominates any epithelial component): solid ordinary cellular [LMC-04-4795, mitotic rate was 1 per 10 hpfs ] cystadenofibroma: papillary dominant vs. glandular/cystic dominant [LMC-04-6513; L07-9116; L07-11817; S07-13135; L08-1324]...this latter variant, especially when bilateral and over age 60, is associated with a 20+% risk of breast cancer and an increased risk of thyroid disorders5. granulosa cell tumor (has more discrete nests of cells than fibroma or sclerosing stromal tumor): adult type juvenile type Sertoli-Leydig cell tumor Sertoli cell tumor SCTAT (sex cord tumor with annular tubules) Leydig cell tumor steroid cell tumor gynandroblastoma sclerosing stromal tumor stromal luteoma

ovarian oocyte follicular germ cell masses: benign: mature teratoma, dermoid, struma ovarii malignant: immature teratoma dysgerminoma (a seminoma counterpart). yolk sac adenocarcinoma (yolk sac tumor; endodermal sinus tumor). Can see microscopic Schiller-Duval body which resembles a stuctures in the yolk sac of rat placentas...tumor cells rdiating around a small vascular lumen and set apart by peripheral tissue clefts. AFP positive by IHC. choriocarcinoma. embryonal carcinoma (looks similar to testicular). polyembryoma (contains embryoid bodies). mixed malignant germ cell tumor.

malignant, metastatic: mucinous: stomach, large bowel, breast, and carcinoid-adenocarcinoma [LMC-02-1598]; called Krukenberg tumor if signet ring infiltrate and multinodular enlargement (usually bilateral) are present. other: (see ref.3  page 1523) for excellent 2 paragraphs

2. non-neoplastic:

endosalpingiosis cysts cystic Walthard cell rests endometriosis (can be cysts and masses.

Associated peri-ovarian tissues:

1. neoplastic: various soft tissue or mesothelial lesions.
   • mesothelial adenomatoid tumor
2. non-neoplastic:
   • endosalpingiosis, see above
   • ectopic adrenal tissue [LMC-04-1488]
     • PCOS: we fairly commonly see ovaries with multiple 5-8 mm cortical cysts
     • endosalpingiosis: multiple vessicle-like, small cysts scattered over the tubo-ovarian serosal-cortical surface.
     • mesothelial inclusion cysts.
     • ovarian hyperthecosis (medullary stromal hyperplasia)...maybe with obesity, hypertension, and some hirsuitism [LMC-03-4444].
     • variably luteinized multicystic folliculo-stromal " hyperreactio luteinalis".
   • nonneoplastic:
     • PCOS: we fairly commonly see ovaries with multiple 5-8 mm cortical cysts
     • endosalpingiosis: multiple vessicle-like, small cysts scattered over the tubo-ovarian serosal-cortical surface
     • ovarian hyperthecosis (medullary stromal hyperplasia)...maybe with obesity, hypertension, and some hirsuitism [LMC-03-4444].
   • Associated peri-ovarian tissues:
     1. neoplastic: various soft tissue or mesothelial lesions.
        • mesothelial adenomatoid tumor.
     2. non-neoplastic:
        • endosalpingiosis, see above
        • ectopic adrenal tissue [LMC-04-1488].
        • peritoneal inclusion cyst [L07-10163].

References:

1. expert consultant's report
2. Ovarian Tumors...., Robert H. Young guest editor, Seminars in Diagnostic Pathology 18(3):151-235, 8/2001.
3. Ackerman's Surgical Pathology, vol. II, 8th Ed. 1996.
4. Charles Zaloudek, Ovarian Pathology: Germ Cell Tumors, Sex-cord Stromal Tumors, and Non-neoplastic Lesions, MUSC McKee-PT Seminar, 7 April 2005.
5. Silva EG, et. al. [@ M. D. Anderson & SUNY Stony Brook], "The Association of Benign and Malignant Ovarian Adenofibromas with Breast Cancer and Thyroid Disorders", International J. Surg. Path 10(1):33-39, 2002.
6. Kumar V, et. al., Robbins & Cotran Pathologic Basis of Disease, 7th Ed. 2005, 1525 pages.