Ovarian serous cystadenocarcinoma

Ovarian serous cystadenocarcinoma is an ovarian epithelial tumor at the malignant end of the spectrum of ovarian serous tumors.

They account for the largest proportion of malignant ovarian tumors 1, representing over 50-80% of all malignant epithelial ovarian tumors 4. The prevalence peaks around the 6th to 7th decades of life 2. Serous ovarian cystadenocarcinomas account for ~25% of serous tumors ref

Macroscopically serous cystadenocarcinoma appears as a multilocular cystic ovarian tumor 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.

Recognized risk factors include:

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

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.

  • 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
  • color Doppler is useful to confirm vascularity of the solid components
    • quantitative parameters (resistive index and pulsatility index) do not reliably predict malignancy

Calcification is detected in ~12% of tumors on CT 4 but is nonspecific as calcification can also be seen in benign serous tumors and other neoplasms.   

CT can be used for preoperative staging to look for lymphadenopathy, peritoneal, and distant metastases. 

MRI is the modality of choice in the characterization 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 hemorrhage (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.

Ultrasound - gynaecology
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Article information

rID: 14495
System: Gynaecology
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

  • 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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