Surface epithelial-stromal tumor

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Surface epithelial-stromal tumor

Reproductive system


Surface epithelial-stromal tumor


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Surface epithelial-stromal tumor

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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?  


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.


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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  2. "Harrison’s principles of internal medicine" McGraw Hill Education/ Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Mucinous Tumors of the Ovary: Current Thoughts on Diagnosis and Management" Current Oncology Reports (2014)
  6. "A case of small cell carcinoma of the ovary hypercalcemic variant in a teenager" Gynecologic Oncology Case Reports (2012)
  7. "Epithelial Ovarian Cancer Metastasizing to the Brain: A Late Manifestation of the Disease With an Increasing Incidence" Journal of Clinical Oncology (2002)
  8. "Fertility and borderline ovarian tumor: a systematic review of conservative management, risk of recurrence and alternative options" Human Reproduction Update (2012)

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