Ovarian serous tumors
Citation, DOI & article data
Serous ovarian neoplasms are subdivided into benign, borderline, and malignant lesions according to their malignant potential and clinical behavior (see Pathology - Classification section below).
Approximately 60% are benign and ~15% of borderline malignancy; These occur most commonly in women of reproductive age. The malignant tumors comprise of 25% of cases and tend to occur in older patients.
Serous ovarian tumors are defined by a histologic resemblance to normal Fallopian tubal epithelium 5.
The most recent 2014 WHO classification system for serous ovarian neoplasia identifies three categories of tumor:
- benign - no cellular proliferation or invasion
- borderline - cellular proliferation + minor nuclear atypia without invasion
- malignant - cellular proliferation + nuclear atypia + stromal invasion
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 tumors are typically smaller than mucinous tumors 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
para ovarian cyst
- ovaries can be individualized apart from the cyst
ovarian mucinous tumors
- tend to be multiseptated
- often larger than serous tumors
- monolateral rather than bilateral
- cystic loculi with variable signal intensities on MRI giving the appearances of "stained glass"
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