Ovarian serous neoplasms

Ovarian serous neoplasms 

Updated: 07/03/2023

© Jun Wang, MD, PhD

General feature
  • 25% of all ovarian tumors
  • 60% benign, 15% borderline, 30% malignant
  • May occur as primary tumors of peritoneal surface
  •  If cystic, name as serous "cystadeno..."
  • If prominent fibrous component, name as adenofibroma or adenocarcinofibroma
Benign serous tumors
  • Includes cystadenoma, cystadenofibroma, adenofibroma, papillary cystadenoma, papillary cystadenofibroma, papillary adenofibroma
  • 10-20% bilateral
  • Usually partially or completely cystic
  • > 1 cm in size (If < 1 cm, likely inclusion cyst or endosalpingiosis)
Serous borderline tumor
  • AKA serous tumors of low malignant potential
  • Younger women
  • May have microinvasion, but rarely has malignant behavior
  • May be bilateral
  • May have delayed recurrence or transformation to invasive carcinoma
  • Death usually due to bowel obstruction, ureteral obstruction, invasive carcinoma, sepsis and treatment complications
Serous carcinoma
  • Most common malignant tumor of ovary
  • Commonly bilateral
  • Peaks around 6th to 7th decades
  • Elevated serum CA-125
  • Low-grade: BRAF and KRAS mutations
  • High grade: Lose heterozygosity of p53 and BRCA1 loci
Key morphological features
  • Benign
Smooth glistening surface
Usually watery clear to pale yellow cyst fluid
Benign stroma covered by a single layer of tall, columnar, ciliated cells
NO atypia
  • Borderline
Soft papillary excrescences
Broad, branching papillae (hierarchicalbranching)
Focally stratified epithelium
Mild to moderate atypia with few mitoses
Might have early invasion
  • Malignant
Solid growth
Necrosis
Low grade: Papillary growth, flat to cuboid cells, invading stroma, mild to moderate atypia
High grade: Markedly atypical cells infiltrating stroma, atypical mitosis
Markers
  • Positive for WT1, CA125
Treatment
  • Benign: surgery
  • Borderline: staging, surgery
  • Malignant: staging, surgery, chemotherapy

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