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Surface epithelial-stromal tumor



Reproductive system


Male and female reproductive system disorders
Male reproductive system disorders
Female reproductive system disorders
Reproductive system pathology review

Surface epithelial-stromal tumor


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High Yield Notes
13 pages

Surface epithelial-stromal tumor

10 flashcards

USMLE® Step 1 style questions USMLE

4 questions

A 56-year-old woman comes to the clinic due to progressive pelvic discomfort over the past few months. Medical history is noncontributory, and she is in good health. The patient does not have a family history of malignancy, history of sexually transmitted disease, urinary symptoms, or bleeding. Last menstrual cycle was 5 years ago, and the last Pap smear 6 months ago was normal. Temperature is 37 °C (98.6°F), pulse is 84/min, and blood pressure is 125/85 mmHg. Physical examination is within normal limits, other than a right adnexal mass upon palpation. Ultrasonography shows a solid right adnexal mass. The patient subsequently undergoes laparoscopy with excision of the mass. The specimen and histopathological analysis are shown below:

Reproduced from: Wikimedia Commons

Reproduced from: Wikimedia Commons

This patient’s lesion most likely arose from which of the following structures of the ovary?  


Content Reviewers:

Rishi Desai, MD, MPH

Epithelial refers to the surface lining, and ovarian refers to ovary, of which women have two that sit along either side of the uterus so epithelial ovarian cancer, is a cancer that forms along the surface of an ovary.

Now, each ovary contains multiple follicles.

And, each follicle is made up of a germ cell, also known as an oocyte, which is the immature egg.

Between the follicles is the stromal or connective tissue cells, and lining the ovary is a layer of epithelial cells.

Ovarian tumors are generally grouped based on these three types of cells in the ovaries, and the majority of ovarian cancers are epithelial kind.

Now, if an epithelial cell starts to divide uncontrollably, it can either be a benign tumor which means that it does not invade nearby tissue or spread to other parts of the body, or it can be a malignant tumor which means that it might invade or spread to other tissues.

Compared with benign tumor cells, a distinguishing feature of malignant tumor cells have slightly less organized nuclei.

A third class of tumors are called borderline tumors because they have features that are intermediate between the other benign and malignant tumors.

Epithelial ovarian cancers can be subdivided into four types: serous, mucinous, endometrioid and transitional.

Serous and mucinous tumors arise from epithelial cells that line the outside of ovaries, whereas even though the tumors are found in the epithelium, the endometrioid and transitional cell tumors arise from other cell types.

Serous tumors have fluid-filled cysts, typically a single cyst, and can be benign, malignant, or borderline.

Benign serous tumors are called serous cystadenomas, and are the most common type, and often develop on both ovaries, and typically affect premenopausal women.

Mucinous tumors, on the other hand, have mucus-filled cysts that often involve large multiloculated cysts, but can also be benign, malignant, or borderline.

Benign mucinous tumors are called mucinous cystadenomas, and often develop on only one ovary.

The malignant type of serous tumors are called serous cystadenocarcinomas, and malignant mucinous tumors are called mucinous cystadenocarcinomas.

Both serous and malignant cystadenocarcinomas are cysts with an inflamed and swollen lining, and they commonly arise in postmenopausal women.

An interesting feature of serous cystadenocarcinomas is that they often contain psammoma bodies which are plaques with calcium and cellular debris.

Next are endometrioid tumors which come from endometrium-like cells which is ectopic, meaning they’re out of place, because those sorts of cells are usually found in the endometrium.

Benign endometrioid tumors often have cysts filled with dark blood, so although these are called endometriomas, they are sometimes referred to as chocolate cysts.

Endometrioid tumors can be malignant, and the endometrium-like cells can spread out to other areas including the fallopian tubes and the peritoneal cavity.

Finally there are transitional cell tumors which are also called Brenner tumors, named after the german pathologist, Fritz Brenner who first discovered them.


Surface epithelial-stromal tumors (SESTs), are tumors that arise from the ovarian surface epithelium, ectopic endometrial tissue, fallopian tube epithelium, or the endocervix. They can occur in many organs and tissues, including the ovaries, uterus, and other parts of the reproductive tract. These tumors can vary in size and type and can have variable clinical behaviors depending on the type. Treatment may include surgery, chemotherapy, radiation, and other therapies, depending on the type and severity of the tumor.

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