Ovarian cancer classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Huda A. Karman, M.D.

Overview

Ovarian cancer is classified according to the histology of the tumor, obtained in a pathology report. Based on the classification, the management of ovarian cancer is directed and determined. The main four types of ovarian cancer are Surface epithelial-stromal tumour, Sex cord-stromal tumor, Germ cell tumor, and Mixed tumors.

Classification

Ovarian cancer Types	Ovarian cancer subtypes
Surface epithelial-stromal tumour	Ovarian serous tumor
Ovarian serous cystadenoma: ~60% of serous tumor
Ovarian borderline serous cystadenoma: ~15% of serous tumor
Ovarian serous cystadenocarcinoma: ~25% of serous tumor; commonest malignant ovarian tumour
Ovarian mucinous tumor
Ovarian mucinous cystadenoma: ~80% of mucinous tumor
Ovarian borderline mucinous cystadenoma: 10-15% of mucinous tumor
Ovarian mucinous cystadenocarcinoma: ~5-10% of serous tumor
Ovarian endometrioid tumour
8-15% of all ovarian tumor
Brenner tumour
~2.5% of ovarian epithelial neoplasms
Squamous cell carcinoma of the ovary
~5% of ovarian cancer
Ovarian cystadenofibroma / ovarian adenofibroma
can be serous, mucinous, endometrioid, clear cell or mixed
Ovarian cystadenocarcinofibroma
extremely rare
Undifferentiated carcinoma of the ovary
~4% of all ovarian tumor
Germ cell ovarian tumor (~20%)	Ovarian teratoma: commonest primary benign tumour of ovary
Immature ovarian teratoma
Mature ovarian (cystic) teratoma
Specialised teratomas of the ovary
Struma ovarii tumour
Ovarian carcinoid tumor
Ovarian dysgerminoma
Ovarian yolk sac tumour
endodermal sinus tumour
Ovarian embryonal carcinoma
Ovarian choriocarcinoma
<1% of ovarian tumor
Pure primary ovarian choriocarcinoma
extremely rare
Malignant mixed germ cell tumour of the ovary
Sex cord / stromal ovarian tumor (8-10%)	Ovarian fibrothecoma
~5% of ovarian tumor
Ovarian fibroma
~4% of ovarian tumor

Ovarian cancer Types	Ovarian cancer subtypes	Ovarian cancer sub- subtypes	Characterestics
Surface epithelial-stromal tumour	Ovarian serous tumor	Ovarian serous cystadenoma	~60% of serous tumor
Ovarian borderline serous cystadenoma	~15% of serous tumor
Ovarian serous cystadenocarcinoma	~25% of serous tumor; commonest malignant ovarian tumour
Ovarian mucinous tumor	Ovarian mucinous cystadenoma	~80% of mucinous tumor
Ovarian borderline mucinous cystadenoma	10-15% of mucinous tumor
Ovarian mucinous cystadenocarcinoma	~5-10% of serous tumor
Ovarian endometrioid tumour		8-15% of all ovarian tumor
Brenner tumour		~2.5% of ovarian epithelial neoplasms
Squamous cell carcinoma of the ovary		~5% of ovarian cancer
Ovarian cystadenofibroma / ovarian adenofibroma	can be serous, mucinous, endometrioid, clear cell or mixed
Ovarian cystadenocarcinofibroma:		extremely rare
Undifferentiated carcinoma of the ovary:		~4% of all ovarian tumor:
Undifferentiated carcinoma of the ovary:		~4% of all ovarian tumor:
Germ cell ovarian tumor (~20%)	Ovarian teratoma: commonest primary benign tumour of ovary	Mature ovarian (cystic) teratoma
Immature ovarian teratoma
Specialised teratomas of the ovary
Struma ovarii tumour
Ovarian carcinoid tumor
Ovarian dysgerminoma
Ovarian yolk sac tumour:		endodermal sinus tumour
Ovarian embryonal carcinoma
Ovarian choriocarcinoma: <1% of ovarian tumor
Pure primary ovarian choriocarcinoma:		extremely rare
Malignant mixed germ cell tumour of the ovary
Sex cord / stromal ovarian tumor (8-10%)	Ovarian fibrothecoma		~5% of ovarian tumor
Ovarian fibroma		~4% of ovarian tumor
Sclerosing stromal tumour of the ovary:		rare
Ovarian Sertoli-Leydig cell tumour - ovarian androblastoma:		~0.5% of ovarian tumor
Granulosa cell tumour of ovary:		commonest malignant sex cord tumour
Juvenile granulosa cell tumour of ovary
Adult granulosa cell tumour of ovary
Mixed
Others)	Ovarian carcinosarcoma <1%
Ovarian lymphoma	Primary ovarian lymphoma
Secondary involvement of the ovary with lymphoma
Metastases to the ovary)	Krukenburg tumour
Other metastatic lesions to ovary		Other

Ovarian cancer Types	Ovarian cancer subtypes	Characterestics
Surface epithelial-stromal tumour	Ovarian serous tumor	Ovarian serous cystadenoma: ~60% of serous tumor Ovarian borderline serous cystadenoma: ~15% of serous tumor Ovarian serous cystadenocarcinoma: ~25% of serous tumor; commonest malignant ovarian tumour
	Ovarian mucinous tumor: ~20% of all ovarian tumor	Ovarian mucinous cystadenoma: ~80% of mucinous tumor Ovarian bordeline mucinous cystadenoma: 10-15% of mucinous tumor Ovarian mucinous cystadenocarcinoma: 5-10% of mucinous tumor

Histology dictates many aspects of clinical treatment, management, and prognosis.

• Surface epithelial-stromal tumor, including serous and mucinous cystadenocarcinoma, is the most common type of ovarian cancer.
• Sex cord-stromal tumor, including estrogen-producing granulosa cell tumor and virilizing Sertoli-Leydig cell tumor or arrhenoblastoma, accounts for 8% of ovarian cancers.
• Germ cell tumor accounts for approximately 5% of ovarian cancers. It tends to occur in young women and girls, and has a better prognosis than other ovarian tumors.
• Mixed tumors, containing elements of more than one tumor histology

Ovarian cancer often is primary, but can also be secondary, the result of metastasis from a primary cancer elsewhere in the body. For example, from breast cancer, or from gastrointestinal cancer (in which case the ovarian cancer is a Krukenberg cancer). Surface epithelial-stromal tumor can originate in the lining of the abdominal cavity, in which case the ovarian cancer is secondary to primary peritoneal cancer, but treatment is basically the same as for primary ovarian cancer of this type.

Cellular Classification of Ovarian tumor http://radiopaedia.org/articles/ovarian-tumours

Ovarian tumor

• Surface epithelial stromal ovarian tumor (60-70%)

• Ovarian serous tumor

• Ovarian serous cystadenoma: ~60% of serous tumor
• Ovarian borderline serous cystadenoma: ~15% of serous tumor
• Ovarian serous cystadenocarcinoma: ~25% of serous tumor; commonest malignant ovarian tumour

• Ovarian mucinous tumor: ~20% of all ovarian tumor

• Ovarian mucinous cystadenoma: ~80% of mucinous tumor
• Ovarian bordeline mucinous cystadenoma: 10-15% of mucinous tumor
• Ovarian mucinous cystadenocarcinoma: 5-10% of mucinous tumor

• Ovarian endometrioid tumour: 8-15% of all ovarian tumor
• Clear cell ovarian carcinoma: ~5% of ovarian cancer
• Brenner tumour: ~2.5% of ovarian epithelial neoplasms
• Squamous cell carcinoma of the ovary
• Ovarian cystadenofibroma / ovarian adenofibroma: can be serous, mucinous, endometrioid, clear cell or mixed
• Ovarian cystadenocarcinofibroma: extremely rare
• Undifferentiated carcinoma of the ovary: ~4% of all ovarian tumor

• Germ cell ovarian tumor (~20%)

• Ovarian teratoma: commonest primary benign tumour of ovary

• Mature ovarian (cystic) teratoma
• Immature ovarian teratoma
• Specialised teratomas of the ovary
• Struma ovarii tumour
• Ovarian carcinoid tumor

• Ovarian dysgerminoma
• Ovarian yolk sac tumour: endodermal sinus tumour
• Ovarian embryonal carcinoma
• Ovarian choriocarcinoma: <1% of ovarian tumor
• Pure primary ovarian choriocarcinoma: extremely rare
• Malignant mixed germ cell tumour of the ovary

• Sex cord / stromal ovarian tumor (8-10%)

• Ovarian fibrothecoma: ~5% of ovarian tumor
• Ovarian fibroma: ~4% of ovarian tumor
• Ovarian thecoma: ~1% of ovarian tumor
• Sclerosing stromal tumour of the ovary: rare
• Ovarian Sertoli-Leydig cell tumour - ovarian androblastoma: ~0.5% of ovarian tumor
• Granulosa cell tumour of ovary: commonest malignant sex cord tumour
• Juvenile granulosa cell tumour of ovary
• Adult granulosa cell tumour of ovary
• Mixed

• Uncommon:
• Ovarian carcinosarcoma <1%
• Other

• Ovarian lymphoma
• Primary ovarian lymphoma
• Secondary involvement of the ovary with lymphoma

• Metastases to the ovary

• Krukenburg tumour
• Other metastatic lesions to ovary

References

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