Fact-sheet: Serous ovarian tumor
Updated on 10/07/2017 at 7:43 AM
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Definition
Subgroup of epithelial ovarian lesions (arising from the ovarian surface epithelium = 70% of ovarian lesions).
Papillary projection = pathognomonic of an epithelial lesion.
5 types of serous tumor:
- Benign serous cystadenoma (pure cystic lesion)
- Benign papillary serous cystadenoma (cystic lesion with avascular papillary projections)
- Borderline serous cystadenoma (cystic lesion with vascularized papillary projection)
- Serous cystadenocarcinoma = cancer
- Cystadenofibroma (mixed benign cystic and fibrous lesion)
Clinical features
Pelvic pain, heaviness.
Pelvic-abdominal mass if the lesion is large.
Ultrasound
- Benign serous cystadenoma:
ovarian cyst = purely fluid lesion (unilocular, thin wall, anechoic) greater than 3 cm in women of reproductive age
persisting on follow-up at 3 months, to differentiate it from a functional cyst
no solid component
no papillary projection
no Doppler vascularity
residual healthy ovarian parenchyma
if the cyst is large >7cm: MRI indicated (looking for papillary projections and solid components)
- Benign papillary serous cystadenoma
uni- or bilocular cyst
echogenic endocystic papillary projection in 50% of benign papillary cystadenomas, may be multiple
avascular papillary projection on Doppler +++
no solid component
residual healthy ovarian parenchyma
- Borderline serous cystadenoma
same as benign serous cystadenoma but central Doppler vascularity of the papillary projections
rare form: exophytic papillary projections without cystic component = nearly pathognomonic of borderline serous cystadenoma
- Serous cystadenocarcinoma = cancer
mixed tumor predominantly cystic
bilateral in 60%
echogenic solid component
+/- papillary projections
Doppler vascularity of the solid component
peritoneal extension: ascites, peritoneal implants
- Cystadenofibroma
mixed multilocular cystic lesion
with regular echogenic solid component
+/- calcifications
variable Doppler
CT
CT has no role in the characterization of ovarian tumors
MRI
MRI indicated if the ovarian lesion is large > 7cm (difficult sonographic characterization), or if the lesion is complex and indeterminate (thick and irregular septum, solid component, papillary projection). - Benign serous cystadenoma: ovarian cyst = purely fluid lesion (T2 hyperintense, T1 hypointense) greater than 3 cm in women of reproductive age persisting on follow-up at 3 months, to differentiate it from a functional cyst no solid component no papillary projection thin wall without enhancement after gadolinium injection residual healthy ovarian parenchyma - Benign papillary serous cystadenoma uni- or bilocular cyst small endocystic papillary projections in 50% of benign papillary cystadenomas, may be multiple, intermediate T2 signal and T1 hypointense, mild enhancement after injection with a type 1 curve. no solid component residual healthy ovarian parenchyma - Borderline serous cystadenoma same as benign serous cystadenoma but larger papillary projections and contrast uptake of the papillary projections with a type 2 curve. rare form: exophytic papillary projections without cystic component = nearly pathognomonic of borderline serous cystadenoma - Serous cystadenocarcinoma = cancer mixed tumor predominantly cystic bilateral in 60% solid component with variable T2 and T1 signal, diffusion hyperintensity, heterogeneous contrast enhancement with a type 3 curve. +/- papillary projections peritoneal extension: ascites, peritoneal implants - Cystadenofibroma mixed multilocular cystic lesion with regular solid component markedly T2 hypointense +++, T1 hypointense, mild enhancement (type 1 curve), negative diffusion imaging +/- calcifications variable Doppler
Differential diagnosis
The other epithelial lesions (mucinous tumors, endometrioid tumors, clear cell tumors, Brenner tumor)
germ cell tumors (20-30% of ovarian lesions)
sex cord-stromal tumors (10%)