Ovarian serous neoplasms are the commonest subtypes of the epithelial ovarian tumours, being more prevalent than the mucinous ovarian tumours. They are subdivided according to their malignant potential and clinical behaviour into:
- benign serous cystadenoma / serous cystadenofibroma
- borderline cystadenoma
- malignant serous cystadenocarcinoma
Approximately 60% are benign and ~15% of borderline malignancy; These occur most commonly in women of reproductive age. The malignant tumours comprise of 25% of cases and tend to occur in older patients.
Like all ovarian epithelial neoplasms, they are derived from coelomic mesothelium. In the case of the serous tumours, this differentiates into the tubal epithelium.
In contrast, the formation of mucinous tumours results from the coelomic mesothelium evolving into cervix epithelium, and the formation of endometrioid tumours – into endometrial epithelium.
Imaging evaluation may be performed preferably with ultrasound or MRI, with CT usually reserved for staging purposes. In general, the cell type (e.g. serous, mucinous) often cannot be determined on the imaging basis of appearances.
Serous ovarian tumours are typically smaller than mucinous tumours on presentation. They are typically unilocular and homogeneous. They are often bilateral, and this is particularly so for the malignant subtypes. Psammomatous calcification is a feature of serous, but not mucinous subtypes.
Features that suggest a malignant over a benign cystic neoplasm include:
- large cystic mass
- thick irregular walls and septa
- papillary projections
- large soft tissue component
- evidence of invasive spread or adenopathy
ovarian functional cyst
- usually smaller
- thin walls with no septations
- tend to change or resolve in the next menstrual cycle
- ovaries can be individualised apart from the cyst
ovarian mucinous tumours
- tend to be multiseptated
- often larger than serous tumours
- monolateral rather than bilateral
- cystic loculi with variable signal intensities on MRI giving the appearances of "stained glass"
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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