Ovarian serous cystadenocarcinoma
They account for the largest proportion of malignant ovarian tumours 1, representing over 50-80% of all malignant epithelial ovarian tumours 4. The prevalence peaks around the 6th to 7th decades of life 2. Serous ovarian cystadenocarcinomas account for ~25% of serous tumours ref.
Macroscopically serous cystadenocarcinoma appears as a multilocular cystic ovarian tumour with papillary projections. Due to this reason, it can also be termed a papillary serous cystadenocarcinoma of the ovary. Psammomatous bodies may be present in ~30% of cases on histology.
Recognised risk factors include:
- early menarche
- late menopause
- positive family history
- elevated serum CA-125 (>90% of cases 6)
See: ovarian cancer staging.
Lesions are typically mixed solid/cystic masses, which are frequently bilateral.
- more heterogeneous in appearance than a serous cystadenoma
- papillary projections, thick septations, and/or solid components
- presence of ascites
- concerning for peritoneal metastatic spread
- discrete peritoneal deposits may be seen
- colour Doppler is useful to confirm vascularity of the solid components
- quantitative parameters (resistive index and pulsatility index) do not reliably predict malignancy
Calcification is detected in ~12% of tumours on CT 4 but is nonspecific as calcification can also be seen in benign serous tumours and other neoplasms.
CT can be used for preoperative staging to look for lymphadenopathy, peritoneal, and distant metastases.
MRI is the modality of choice in the characterisation of ovarian malignancy and the detection of lymphatic, peritoneal, and distant metastases, both for preoperative planning and post-treatment follow up.
The cystic components are high T2, low T1 signal, unless there has been intralesional haemorrhage (c.f. mucinous cystadenocarcinoma, where there is typically slightly increased T1 signal of the cystic component).
Solid malignant components demonstrate intermediate T1 and T2 signal, restricted diffusion, and gadolinium enhancement.
DWI is useful for detection of distant metastases.
Ultrasound - gynaecology
- ultrasound (introduction)
- acute pelvic pain
- chronic pelvic pain
- Mullerian duct anomalies
- ovarian follicle
- ovarian torsion
- pelvic inflammatory disease
- ovarian cysts and masses
- ovarian cyst
- corpus luteum
- haemorrhagic ovarian cyst
- ruptured ovarian cyst
- ovarian epithelial tumours
- granulosa cell tumours of the ovary
- paraovarian cyst
- polycystic ovaries
- ovarian hyperstimulation syndrome
- post-hysterectomy ovary
- fallopian tube
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