Epithelial ovarian tumors classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]

Classification

General Classification

• Epithelial ovarian tumors can broadly be classified on the bases of histopathology and clinical behavior as:
  • Benign
  • Borderline
  • Malignant tumors

• Table below provides a summary of this classification:

Epithelial ovarian tumors
Benign	Borderline	Malignant
Serous cystadenoma Mucinous cystadenoma Endometrioid cystadenoma Clear cell tumor Brenner tumor	Serous borderline tumor Mucinous borderline tumor Endometrioid borderline tumors Clear cell tumor Brenner tumor of borderline malignancy	Serous adenocarcinoma Mucinous adenocarcinoma Endometrioid adenocarcinoma Clear cell adenocarcinoma Malignant Brenner tumor Carcinosarcoma

WHO Classification of Ovarian Epithelial Tumors

• WHO classifies epithelial ovarian tumors on the basis of histology as follows:
  • Serous tumors:
    • Benign (cystadenoma)
    • Borderline tumors (serous borderline tumor)
    • Malignant (serous adenocarcinoma)
  • Mucinous tumors:
    • Benign (cystadenoma)
    • Borderline tumors (mucinous borderline tumor)
    • Malignant (mucinous adenocarcinoma)
  • Endometrioid tumors:
    • Benign (cystadenoma)
    • Borderline tumors (endometrioid borderline tumor)
    • Malignant (endometrioid adenocarcinoma)
  • Clear cell tumors:
    • Benign
    • Borderline tumors
    • Malignant (clear cell adenocarcinoma)
  • Transitional cell tumors:
    • Brenner tumor
    • Brenner tumor of borderline malignancy
    • Malignant Brenner tumor
    • Transitional cell carcinoma (non-Brenner type)
  • Epithelial-stromal:
    • Adenosarcoma
    • Carcinosarcoma (formerly mixed Müllerian tumors)

Ovarian epithelial tumors
Serous tumors	Mucinous tumors	Endometrioid tumors	Clear cell tumors	Transitional cell tumors	Epithelial-stromal
Benign (cystadenoma) Borderline tumors (serous borderline tumor) Malignant (serous adenocarcinoma)	Benign (cystadenoma) Borderline tumors (mucinous borderline tumor) Malignant (mucinous adenocarcinoma)	Benign (cystadenoma) Borderline tumors (endometrioid borderline tumor) Malignant (endometrioid adenocarcinoma)	Benign Borderline tumors Malignant (clear cell adenocarcinoma)	Brenner tumor Brenner tumor of borderline malignancy Malignant Brenner tumor Transitional cell carcinoma (non-Brenner type)	Adenosarcoma Carcinosarcoma (formerly mixed Müllerian tumors)

Epithelial Ovarian Cancer Classification Based on Clinicopathologic and Molecular Evidence

• Recent advances in histopathology and a better understanding of clinicopathologic characteristics have led to a classification system that correlates histology and clinical characteristics;
• This classification subdivides malignant ovarian tumors in two types.
• Type I tumors generally arise from endometriosis or fallopian tubal related serous epithelium. They exhibit less aggressive clinical course and a different genetic profile relative to Type II.
• Type II tumors generally arise from fallopian tubal epithelium. They exhibit more aggressive clinical course and a different genetic profile relative to Type I.

Epithelial Ovarian Cancer
Type I	Type II
Low-grade serous carcinoma Endometrioid carcinoma Clear cell carcinoma Mucinous carcinoma Malignant Brenner tumor Seromucinous carcinoma	High-grade serous carcinoma Undifferentiated carcinoma Carcinosarcoma

WHO Classification of Ovarian Tumors

Ovarian Cancer
Epithelial	Sex-cord stromal	Germ cell	Mixed-cell type
Serous tumors: Benign (cystadenoma) Borderline tumors (serous borderline tumor) Malignant (serous adenocarcinoma) Mucinous tumors: Benign (cystadenoma) Borderline tumors (mucinous borderline tumor) Malignant (mucinous adenocarcinoma) Endometrioid tumors: Benign (cystadenoma) Borderline tumors (endometrioid borderline tumor) Malignant (endometrioid adenocarcinoma) Clear cell tumors: Benign Borderline tumors Malignant (clear cell adenocarcinoma) Transitional cell tumors: Brenner tumor Brenner tumor of borderline malignancy Malignant Brenner tumor Transitional cell carcinoma (non-Brenner type) Epithelial-stromal: Adenosarcoma Carcinosarcoma (formerly mixed Müllerian tumors)	Pure stromal tumors: Fibroma Cellular fibroma Thecoma Luteinized thecoma associated with sclerosing peritonitis Fibrosarcoma Sclerosing stromal tumor Signet-ring stromal tumor Microcystic stromal tumor Leydig cell tumor Steroid cell tumor Steroid cell tumor, malignant Pure sex cord tumors: Adult granulosa cell tumor Juvenile granulosa cell tumor Sertoli cell tumor Sex cord tumor with annular tubules Mixed sex cord-stromal tumors Sertoli-Leydig cell tumors - Well-differentiated - Moderately differentiated with heterologous elements - Poorly differentiated with heterologous elements - Retiform with heterologous elements Sex cord-stromal tumours, NOS*	Teratoma Immature Mature Solid Cystic (dermoid cyst) Dysgerminoma Endometrial Sinus tumors Embryonal carcinoma Polyembryoma Choriocarcinoma Mixed germ cell tumors tumors