Borderline papillary serous cystadenoma

Case contributed by Dr Mahmoud Ibrahim Mekhaimar

Presentation

Progressive abdominal distention.

Patient Data

Age: 20 years
Gender: Female
  • large pelvi-abdominal multilocular complex cystic lesion seen measuring about 10 x 19.5 x 25.5 cm along its maximum axial and CC dimensions respectively
  • it is seen eliciting low T1 and bright T2/SPAIR signal with thick internal septations (measuring 0.34 cm) and multiple papillary projections eliciting intermediate signal in T1 and T2 images with restricted diffusion in the DWI. They show heterogeneous enhancement in the post-contrast series
  • it is seen exerting a mass effect in the form of stretching and indenting the uterus as well as the urinary bladder anteriorly yet with preserved fat planes in between
  •  inconspicuous ovaries

Histopathology

  1. Gross: two flattened membranous tissue pieces; 6 cm across, wall thickness; 0.5 cm, together with multiple papillary projections; 8 x 8 cm collectively.
  2. Microscopic: examination of the specimen received revealed picture of borderline papillary serous cystadenoma.

Case Discussion

Borderline ovarian serous cystadenomas lie in the intermediate range in the spectrum of ovarian serous tumors and represent approximately 15% of all serous tumors. They present at a younger age group than the more malignant serous cystadenocarcinoma with a peak age of presentation of ~45 years.

The tumors are often clinically silent until they achieve an advanced size or stage. The most frequent initial manifestations were abdominal pain, increasing abdominal girth or distension, or as an abdominal mass.

In the presence of abundant papillary projections especially in a young patient, low-grade malignancy should be considered. ​Low-grade malignancy represents about 15% of all ovarian serous tumors.

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Case information

rID: 69808
Published: 25th Jul 2019
Last edited: 21st Aug 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: kasr al ainy medical school

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