Adnexal Masses and Malignancies of Importance to the Colorectal Surgeon

Abstract

In this article, the authors review both benign and malignant ovarian masses, as the colorectal surgeon who encounters an adnexal mass at the time of surgery should be aware of the steps necessary for surgical staging and optimal tumor resection.Ovarian tumors-most of which are benign-are divided into three major categories, in order of frequency: epithelial, germ cell, and sex cord-stromal tumors. Nonneoplastic conditions of the ovary that may present as adnexal masses include the following, according to World Health Organization (WHO) classification: pregnancy luteoma, hyperplasia of ovarian stroma, hyperthecosis, massive edema, solitary follicle cysts and corpus luteal cysts, multiple follicle cysts, and endometriosis.Epithelial ovarian tumors arise from the surface epithelium and can be benign or malignant. Histologic types are serous, mucinous, endometrioid, clear cell, or Brenner. Germ cell tumors are more likely to appear in females under 20 years, accounting for 70% of ovarian tumors in this age group. Approximately 3% are malignant. Teratomas are the most common germ cell tumors. Malignancies, in addition to malignant teratomas, include dysgerminomas, endodermal sinus tumors, and embryonal carcinomas. The more common sex cord-stromal tumors include granulosa stromal cell tumors, Sertoli-Leydig cell tumors, and gynandroblastomas.Surgical staging and optimal tumor resection are also addressed, with a focus on epithelial malignancies, as they are the most relevant to colorectal surgeons.