Diagnostic ultrasound ( PDFDrive )

580 PART II Abdominal and Pelvic Sonography
of the malignant tumors is primarily intraperitoneal, although
direct extension to contiguous structures can occur. Lymphatic
spread is predominantly to the paraortic nodes. Hematogenous
spread usually occurs late in the course of the disease.
Serous Cystadenoma and Cystadenocarcinoma
Serous tumors are the most common surface epithelial–stromal
tumors, representing 30% of all ovarian neoplasms. Approximately
50% to 70% of serous tumors are benign. Serous cystadenomas
account for about 25% of all benign ovarian neoplasms, and
serous cystadenocarcinomas account for about 50% of all
malignant ovarian neoplasms. 50 he peak incidence of serous
cystadenomas is in the fourth and ith decades, whereas serous
cystadenocarcinomas most frequently occur in perimenopausal
and postmenopausal women. Approximately 20% of benign
serous tumors and 50% of malignant serous tumors are bilateral.
heir sizes vary greatly, but in general they are smaller than
mucinous tumors.
Sonographically, serous cystadenomas are usually large,
thin-walled cysts. hey are typically unilocular, but may contain
thin septations (Fig. 16.15A and B). Papillary projections are
occasionally seen. Serous cystadenocarcinomas may be quite
large and usually present as multilocular cystic masses containing
multiple papillary projections arising from the cyst walls and
septa (Fig. 16.15G-I) he septa and walls may be thick. Echogenic
solid material may be seen within the loculations. Papillary
A B C
D E F
+15.3
5
10
G H I
–15.3
cm/s
60
30
cm/s
–30
FIG. 16.15 Epithelial Ovarian Neoplasms: Spectrum of Appearances. (A) and (B) Serous cystadenomas. (A) Septations within a cystic
mass are fairly thin. (B) Septations are thicker. (C) Serous cystadenoma of low malignant potential. Low-level echogenic particles and mural
nodules. (D) and (E) Mucinous cystadenomas. (F) Mucinous cystadenocarcinoma. Large size and septations are characteristic; septal nodularity
is marked (arrows). (G)-(I) Patient with serous cystadenocarcinoma. Extensive nodularity shows vascularity, conirming the morphologic suspicion
of a malignant mass. There is high diastolic low resulting in a low resistive index.