Serous Ovarian Tumors
 

Submitted By Ron Gefen, MSIV

General
 

·         Most common of six types of epithelial tumors which derive from surface mesothelial cells of the ovary

·         70% are benign (serous cystadenoma)

o       10% have low malignant potential

o       20% are malignant (serous cystadenocarcinoma)

·         Transabdominal and/or transvaginal ultrasound is the most valuable diagnostic study in determining area of origin, size, and cystic versus solid make-up

o       Screening finds adnexal cysts in up to 15% of postmenopausal woman

§         Only 3% of ovarian cysts are malignant

o       Doppler color flow imaging can be helpful in differentiating malignant from benign masses

§         Malignancies are rich in neovascularization and therefore have lower resistive and pulsatile indices

o       Gray-scale ultrasound for diagnosis of ovarian malignancy is 62 – 100% sensitive and 77 – 95% specific

·         Treatment involves surgical removal for all serous tumors
 

Serous Cystadenoma

• 20% of all benign ovarian tumors
• Women usually between 20 - 60 years
• Present clinically as cystic adnexal masses
  • Increasing abdominal girth
• 15% are bilateral
• Imaging findings
  • Average 5-10cm (frequently grow larger)
  • May be indistinguishable from simple cysts
    • Or they may have thin septations and occasionally papillary projections
  • Tend to be unilocular, but may also be multilocular

CT of lower abdomen demonstrates a
large, fluid-filled and septated mass arising from the pelvis

• Lined by a single layer of non-ciliated cuboidal to tall columnar epithelium

• Straw-colored fluid within them is usually blood tinged
   

Serous Cystadenocarcinoma

• Most common malignant tumor of the ovary
  • 40% of ovarian cancers
• Up to 50% are derived from malignant transformation of serous cystadenomas
• 30% bilateral at time of diagnosis
• Occur mostly from age 40 – 60 years
  • Rare under age 35
• Histological characterization
  • Cells vary from well-differentiated to poorly differentiated tumors
  • Ciliated cells common
  • Psammoma bodies (calcified concretions) present in 33%
• Imaging findings
  • Predominantly cystic but with variable solid component
  • Usually multi-loculated
  • Solid areas can have areas of necrosis and hemorrhage
  • Many >10cm at time of diagnosis
  • May produce ascites and omental caking if metastases
• Intra-abdominal dissemination at initial time of surgery common
  • “Omental cake” on CT
• Staging for Primary Carcinoma of the Ovary
  • Stage I.  Growth limited to the ovaries
    • Ia.  One ovary involved
    • Ib.  Both ovaries involved
    • Ic.  Ia or Ib and ovarian surface tumor, ruptured capsule, malignant ascites, or malignant peritoneal cytology
  • Stage II.  Disease extension from the ovary to the pelvis
    • IIa.  Extension to the uterus or fallopian tube
    • IIb.  Extension to other pelvic tissues
    • IIc.  IIa or IIb and ovarian surface tumor, ruptured capsule, malignant ascites, or malignant peritoneal cytology
  • Stage III.  Disease extension to the abdominal cavity
    • IIIa.  Abdominal peritoneal surfaces with microscopic metastases
    • IIIb.  Tumor metastases <2 cm
    • IIIc.  Tumor metastases >2 cm, or metastatic disease in the pelvic, para-aortic or inguinal lymph nodes
  • Stage IV.  Distant metastatic disease
    • Malignant pleural effusion
    • Pulmonary parenchymal metastases
    • Liver or splenic parenchymal metastases
    • Metastases to the supraclavicular lymph nodes or skin
• Cancer staging dictates treatment and predicts prognosis
  • Stage 1
    • Usually TAH and BSO
    • With or without chemotherapy
  • > Stage 1
    • Usually TAH and BSO
    • Surgical debulking of tumor, if needed
    • Chemotherapy
• 5-year survival rate for all types is 20 - 35%