| Tumor | Age at presentation | Characteristic features of the ovarian mass | Hormonal effects* | Other potential tumor markers | Behavior |
| Fibroma | - Usually postmenopausal women (average age 48)
| - Gross: Firm white tumor.
- U/S: Usually unilateral hyper- or hypoechoic mass, which may be calcified and/or exhibit cystic degeneration. Ascites is present in 10 to 15% of cases and hydrothorax in 1%, especially with larger lesions.
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| Thecoma | | - Gross: Yellow, can be very large (40 cm).
- U/S: Unilateral and solid. Ascites is rare.
| - Signs/symptoms of excess estrogen. Endometrial hyperplasia and carcinoma are present in approximately 15 and 20 to 25% of cases, respectively.
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| Fibrosarcoma | | - Gross: Lobulated.
- U/S: Unilateral, solid but may have areas of hemorrhage and necrosis.
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| Luteinized thecoma associated with sclerosing peritonitis | | - Gross: Surface may be smooth, polypoid, lobulated, or cerebriform.
- U/S: Bilateral and solid. Massive ascites is common.
| - Hormonal manifestations are usually absent. Rare cases associated with estrogen or androgen production.
| | - Benign. However, it can be associated with significant morbidity and occasional death due to severe adhesive disease and bowel obstruction.
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| Granulosa cell tumor | - Adult subtype occurs most commonly in middle-aged and older women (median age 50 to 54 years) and comprises 95% of these neoplasms
- Juvenile subtype typically develops before puberty, and comprises 5% of all granulosa cell tumors
| - Gross: Appearance is variable; usually large (mean diameter 12 cm but may be as large as 30 cm), tan or yellow, and either soft or firm.
- U/S: Usually unilateral, echogenic, septated cystic, or solid mass. May resemble a mucinous cystadenoma or be filled with serous fluid or clotted blood. Ascites may be present. Torsion, intraneoplasmal hemorrhage, or tumor rupture with hemoperitoneum may be seen.
| - Signs/symptoms of excess estrogen in over one-half of patients. Endometrial hyperplasia/intraepithelial neoplasia in 25 to 50% and endometrial carcinoma in 5 to 10%. The endometrial adenocarcinomas are usually early stage and well differentiated.
- Virilization is possible, but rare.
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| Sertoli-Leydig cell tumor | - Usually in the second and third decades of life
- Approximately 75% occur in women under age 40 years (mean age at diagnosis is 25), but they occur in all age groups
| - Gross: Yellow and lobulated, with a smooth external surface. Well-differentiated neoplasms with retiform components are often soft and spongy, while poorly differentiated subtypes may have areas of hemorrhage and necrosis.
- U/S: Often large (average 16 cm in maximal diameter but may be >20 cm). Most are unilateral and solid but may contain areas of closely packed small cysts.
| - At least one-third of patients have virilization. Less than one-third of patients have signs/symptoms of excess estrogen.
| - AFP◊
- Inhibin¶
- CA 125 (rare)
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| Sex cord tumor with annular tubules (sporadic) | | - Gross: Often large.
- U/S: Unilateral, uncalcified.
| - Almost all patients have signs/symptoms of excess estrogen.
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| Sex cord tumor with annular tubules (associated with Peutz-Jeghers syndrome) | - Average age 27 (ie, younger than sporadic SCTAT)
| - Gross: Usually small (<3 cm).
- U/S: Bilateral, multifocal, calcified.
| - Almost all patients have signs/symptoms of excess estrogen.
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| Sertoli cell tumor | - Usually women of reproductive age, but may occur in children as young as age 2 and postmenopausal women
| - Gross: Yellow to brown.
- U/S: Usually unilateral, solid, but may have several cystic areas.
| - Approximately one-half produce functional hormones. Most commonly signs/symptoms of excess estrogen, but virilization can occur. Rarely both estrogens and androgens are produced.
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