Ovarian serous cystadenocarcinoma

Radswiki et al.

Ovarian serous cystadenocarcinoma is an ovarian epithelial tumour at the malignant end of the spectrum of ovarian serous tumours.

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.

Risk factors

Recognised risk factors include:

  • nulliparity
  • early menarche 
  • late menopause
  • positive family history
  • infertility
Markers
Staging

See: ovarian cancer staging.

Lesions are typically mixed solid/cystic masses,  which are frequently bilateral.

General features of advanced malignancy such as ascites, peritoneal nodularity and lymphadenopathy may be present. Often the volume of ascites is disproportionately large 3.

Ultrasound
  • 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
CT

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

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.

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Article Information

rID: 14495
System: Gynaecology
Section: Pathology
Synonyms or Alternate Spellings:
  • Serous cystadenocarcinoma of the ovary
  • Serous cystadenocarcinoma of ovary
  • Ovarian serous adenocarcinoma
  • Ovarian papillary serous cystadenocarcinoma
  • Papillary serous cystadenocarcinoma of ovary

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Cases and Figures

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    Serous cystadenoc...
    Case 1
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    Bilateral complex...
    Case 2: bilateral serous cystadenocarcinomas
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    Case 3: bilateral serous cystadenocarcinomas
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