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:
- early menarche
- late menopause
- positive family history
- elevated serum CA-125 (>90% of cases 6)
Lesions are typically mixed solid/cystic masses, which are frequently bilateral.
- 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.
- 1. Hamm B, Forstner R, Beinder E et-al. MRI and CT of the Female Pelvis. Springer Verlag. (2007) ISBN:3540222898. Read it at Google Books - Find it at Amazon
- 2. Ros PR, Mortele KJ. CT and MRI of the abdomen and pelvis, a teaching file. Lippincott Williams & Wilkins. (2006) ISBN:0781772370. Read it at Google Books - Find it at Amazon
- 3. Gourtsoyiannis N. Clinical MRI of the Abdomen, Why, How, When. Springer Verlag. (2011) ISBN:3540856889. Read it at Google Books - Find it at Amazon
- 4. Kawamoto S, Urban BA, Fishman EK. CT of epithelial ovarian tumors. Radiographics. 1999;19 Spec No : S85-102. - Pubmed citation
- 5. Jung SE, Lee JM, Rha SE et-al. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 22 (6): 1305-25. doi:10.1148/rg.226025033 - Pubmed citation
- 6. Imaoka I, Wada A, Kaji Y et-al. Developing an MR imaging strategy for diagnosis of ovarian masses. Radiographics. 26 (5): 1431-48. doi:10.1148/rg.265045206 - Pubmed citation
- 7. Outwater EK, Huang AB, Dunton CJ et-al. Papillary projections in ovarian neoplasms: appearance on MRI. J Magn Reson Imaging. 7 (4): 689-95. - Pubmed citation
- 8. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 20 (5): 1445-70. Radiographics (full text) - Pubmed citation
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