Ovary-nontumor
Non-neoplastic cysts / other
Calcification

Author: Aurelia Busca, M.D., Ph.D. (see Authors page)
Editor: Carlos Parra-Herran, M.D.

Revised: 8 August 2016, last major update August 2016

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Calcification [title] ovary

Definition / General
  • Ovarian calcifications are commonly found in the context of a mass (mature teratoma, mucinous cystadenoma, serous neoplasia) but also in grossly normal ovaries (mostly within corpora albicantia)
  • Often identified by radiologists on ultrasound or other pelvic imaging modalities
  • By itself, ovarian calcification is not an indication for biopsy or oophorectomy; pathologic evaluation of calcifications is usually seen in the setting of a mass or in prophylactic oophorectomies
  • Calcifications are divided into psammomatous (psammoma bodies) and non-psammomatous
  • Identifying psammomatous calcifications is important; their presence in an otherwise normal ovarian specimen should raise the possibility of an underlying serous neoplasm and prompt additional sampling and correlation with intraoperative findings
Pathophysiology
  • Ovarian calcifications are considered dystrophic (associated with cellular degeneration)
  • Impaired metabolism elevates the pH and induces intracellular precipitation of calcium salts within epithelial cells or hystiocytes
  • Large extracellular calcifications result from fused calcific bodies which have been extruded from calcified cells (Cancer 1977;39:2451)
Clinical Features
  • Asymptomatic, usually identified by ultrasound in otherwise normal ovaries
Diagnosis
  • Most ovarian calcifications are composed of calcium phosphate, which stains as intensely / darkly eosinophilic in routine H&E preparations and are non-polarizable
  • Psammomatous calcifications: round with concentric laminations (onion-like appearance)
  • Non-psammomatous: irregular shape, dense, non-laminated
  • Non-psammomatous calcifications and psammomatous calcifications within a serous neoplasm do not need to be reported
  • Psammomatous calcifications in the absence of a serous neoplasm should prompt additional sampling and correlation with previous history and intraoperative findings; their presence should be mentioned in the report if a serous tumor cannot be identified
Radiology Description
Prognostic Factors
  • In a study of 17 otherwise normal ovaries, presence of calcifications by ultrasound was associated with benign neoplasms in 24% of cases (Radiology 1996;198:415)
  • In a study of 28 patients, the presence of large ovarian calcifications (> 5 mm) identified by imaging in otherwise normal ovaries remained stable and was not associated with ovarian neoplasms (Ultrasound Obstet Gynecol 2007;29:438)
Case Reports
Gross Images

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Dermoid cyst

Micro Images

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Papillary serous carcinoma

Ovarian calcification associated with an inclusion cyst

Differential Diagnosis
  • Calcifications are detected by CT in 34.1% and by histology in 56.8% of mucinous cystic tumors; calcifications are found in two locations, intramural and intra-cystic (J Nippon Med Sch 2005;72:29)
  • Calcifications may be associated with neoplastic disease, either benign (teratoma, mucinous cystadenoma) or malignant (serous carcinoma)
  • Cystic teratoma: 56% show evidence of calcification (Radiology 1989;171:697)
  • Serous carcinomas: calcifications are both stromal and epithelial, with the stromal component predominating (Mod Pathol 2003;16:219)