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Introduction

The ovary is composed of the surface epithelium, ovarian cortex (containing connective tissue stroma and follicles with oocytes), and the inner medulla (containing major blood vessels and connective tissue).  Ovarian masses can arise from each of these ovarian tissues due to various processes, including hormonal stimulation, infection/inflammation, and neoplasias.

Ovarian masses are common gynecologic findings that can be discovered incidentally on imaging or during the evaluation of pelvic pain, bloating, or menstrual irregularities.  Most masses are benign, but their evaluation requires a systematic approach to differentiate between functional cysts, benign tumors, and ovarian cancer.

Common ovarian masses

Benign ovarian masses
  • Functional cysts:  Hormonal variations within the menstrual cycle lead to the growth and development of an ovarian follicle in preparation for ovulation ( Figure 1

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