Medical researches have reported that unobvious symptoms in the early stage of ovarian cancer results in the very low survival rate of patients. It is often in the last stage of ovarian cancer when patients discover the illness. Distinguishing early stage's cancer cells between benign and malignant tumors is quite different from one doctor to another such that diagnostic results are often varied. It is mainly due to the lack of unified diagnosis systems on ovarian tumors. In this paper we present a sonography ovarian tumor system with case exchange, called SOT-CE. SOTS, the front end of the SOTS-CE, provide drawing and text tools to annotate critical tumor features on sonography. The blood condition of each annotated suspected tumor area can be statistically analyzed to trace the growth of a tumor by the skewness and kurtosis of the distribution of the Color Doppler Vascularity Indices (CDVI). A scoring system is also developed in SOTS to definitely differentiate between benign and malignant tumors based on values of the various tumor features. In addition, we exploit ISO/IEC Multimedia Content Description Interface MPEG-7 to develop standard case descriptions of sonography ovarian tumors, in which unified tags for searching ovarian tumor cases are defined. We also present the case exchange system, the back-end of SOT-CE, to support inter/intra hospital case sharing. The case exchange mechanism is established based on Web Services. The SOTS-CE is aimed at providing the mechanism and standard exchange interface to expedite collecting clinical ovarian tumor cases so that the Positive Predictive Value (PPV) of diagnosing ovarian tumors can be further improved.