To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women.
observational cohort study comprising 99 women (mean age, 58.2 years,
ranging from 50 to 77 years) diagnosed as having a purely solid ovarian
lesion at transvaginal ultrasound between April 2001 and October 2015.
Inclusion criteria were as follows: asymptomatic postmenopausal women
with a well-defined purely solid ovarian lesion with International
Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs
of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and
histologic data (in case of surgery) were retrieved for analysis.
Patients who were managed conservatively were assessed by transvaginal
sonography every 6 months for a minimum of a year. In case of bilateral
lesions we used the largest one for analysis.
women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9 cm
(range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic
shadowing was present in 59.6% of cases. International Ovarian Tumor
Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases,
respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL).
Forty-two women underwent surgery after diagnosis (histologic diagnoses
were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid
(n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1),
primary invasive cancer (n = 2). One case of invasive cancer CA-125 was
403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were
stage 1. Fifty-seven women were managed with serial follow-up. With a
median follow-up time of 36 months (range, 12-142 months) all these
lesions had no change and women remain asymptomatic. Considering all 99
cases the risk of malignancy is 2% (95% CI, 0.1-7.5).
risk of malignancy of benign appearing purely solid adnexal masses in
asymptomatic postmenopausal women is low. Conservative management of
these lesions might be an option.