A serous tumour is a

neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

that typically has papillary to solid formations of tumor cells with crowded nuclei, and which typically arises on the modified Müllerian-derived

serous membrane The serous membrane (or serosa) is a smooth epithelial membrane of mesothelium lining the contents and inner walls of body cavity, body cavities, which secrete serous fluid to allow lubricated sliding (motion), sliding movements between opposing ...

s that surround the

ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...

in females. Such ovarian tumors are part of the

surface epithelial-stromal tumour Surface epithelial-stromal tumors are a class of ovarian neoplasms that may be benign or malignant. Neoplasms in this group are thought to be derived from the ovarian surface epithelium (modified peritoneum) or from :wikt:ectopic, ectopic endometri ...

group of

ovarian tumor Ovarian tumors, or ovarian neoplasms, are tumors in the ovary. Not all are ovarian cancer. They consist of mainly solid tissue, while ovarian cysts contain fluid. In 2020, the World Health Organization (WHO) divided ovarian tumours as 90% epithe ...

s. They are common neoplasms with a strong tendency to occur bilaterally, and they account for approximately a quarter of all ovarian tumors. Rarely, serous tumors arise from within the uterus, notably

uterine serous carcinoma Uterine serous carcinoma is a malignant form of serous tumor that originates in the uterus. It is an uncommon form of endometrial cancer that typically arises in postmenopausal women. It is typically diagnosed on endometrial biopsy, prompted by ...

, which typically arises in postmenopausal women. Rarely, serous tumors arise from other parts of the

peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesotheli ...

, including serous primary peritoneal carcinomas. Even more rarely they arise in other body locations, such as the

lungs The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syste ...

Ovarian serous tumours

Low grade

The "low grade" classification of serous tumors includes benign and borderline tumors, as well as low grade malignant tumors. Benign serous tumors are distinguished from borderline tumors by the absence of cellular stratification. Stromal invasion distinguishes borderline tumors from low grade malignant tumors. Surgery is curative for benign tumors, and likely curative for other low grade tumors. Benign serous tumors include serous cystadenomas, cystadenofibromas, and adenofibromas. Benign and borderline serous tumours are commonly unilocular. Benign tumors contain clear fluid and have a smooth lining composed of

columnar epithelial cell Epithelium or epithelial tissue is a thin, continuous, protective layer of cells with little extracellular matrix. An example is the epidermis, the outermost layer of the skin. Epithelial ( mesothelial) tissues line the outer surfaces of many ...

s with

cilia The cilium (: cilia; ; in Medieval Latin and in anatomy, ''cilium'') is a short hair-like membrane protrusion from many types of eukaryotic cell. (Cilia are absent in bacteria and archaea.) The cilium has the shape of a slender threadlike proj ...

. On gross examination, the serous tumor may present as either a cystic lesion in which the papillary epithelium is contained within a few fibrous walled cysts, or the papillary projections may be away from the surface epithelium. File:Histopathology of serous cystadenoma.jpg, Histopathology of serous cystadenoma of the ovary, which is benign. It shows admixed scattered ciliated cells. This case closely resembles normal surface endometrial epithelium of the uterus. File:Histopathology of ovarian serous borderline tumor.jpg, Histopathology of the typical features of an ovarian serous

borderline tumor A borderline tumor, sometimes called low malignant potential (LMP) tumor, is a distinct but yet heterogeneous group of tumors defined by their histopathology as atypical epithelial proliferation without stromal invasion. This topic last updated: Fe ...

: Hierarchical branching, exfoliated cell clusters, calcifications, up to moderate atypia, and pseudostratified, crowded epithelium with hobnailing. H&E stain. In borderline lesions, the cyst or surface is lined by papillary structures, which are often very complex.

Microscopically Microscopy is the technical field of using microscopes to view subjects too small to be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of microscopy: optical, e ...

, stromal papillae are covered by atypical

epithelial cell Epithelium or epithelial tissue is a thin, continuous, protective layer of Cell (biology), cells with little extracellular matrix. An example is the epidermis, the outermost layer of the skin. Epithelial (Mesothelium, mesothelial) tissues line ...

s, but stromal invasion is absent, and nuclear stratification is present. Approximately 15% of serous tumors are borderline. In borderline tumors and low grade carcinomas,

psammoma bodies A psammoma body is a round collection of calcium, seen microscopically. The term is derived . Cause Psammoma bodies are associated with the papillary (nipple-like) histomorphology and are thought to arise from, # Infarction and calcification of ...

are often found. Serous psammocarcinoma is a low grade variant in which massive psammoma bodies are present.

High grade

High grade serous tumors often involve both ovaries. The tumors are solid and cystic with

haemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

and

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...

. They are morphologically heterogenous. Serous carcinomas often have bulky

peritoneal The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesotheli ...

and omental

metastases Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...

, and spread to the

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

s is frequent. Beginning in the year 2000, the fallopian tube, specifically the fimbriated end, has emerged as an origin for many "ovarian" high-grade serous carcinomas. This discovery has been facilitated by pathology dissection protocols such as the

SEE-FIM Protocol The SEE-FIM protocol is a pathology dissection protocol for Sectioning and Extensively Examining the Fimbria (SEE-FIM). This protocol is intended to provide for the optimal microscopic examination of the distal fallopian tube (fimbria) to identi ...

, which play close attention to the distal fallopian tube and have revealed early serous cancers and precancers in this region. Unsurprisingly, 5-year survival decreases as the stage increases. There is a 25%

survival rate Survival rate is a part of survival analysis. It is the proportion of people in a study or treatment group still alive at a given period of time after diagnosis. It is a method of describing prognosis in certain disease conditions, and can be use ...

with a stage III serous carcinoma. Staging: * Stage I - Tumour growth limited to ovaries. * Stage II - Growth involving one or both ovaries with pelvic extension. * Stage III - Tumour involving one or both ovaries with implants outside pelvis. * Stage IV- Tumour involving one or both ovaries with presence of distant metastasis.

Epidemiology

25% of ovarian tumors and 40% of

ovarian cancer Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...

s are serous tumors. Family history and

nulliparity In biology and medicine, gravidity and parity are the number of times a female has been pregnant (gravidity) and carried the pregnancies to a viable gestational age (parity). These two terms are usually coupled, sometimes with additional terms, t ...

have been identified as risk factors for the disease.

Uterine serous carcinoma

''Uterine serous carcinoma'' is an uncommon form of

endometrial cancer Endometrial cancer is a cancer that arises from the endometrium (the epithelium, lining of the uterus or womb). It is the result of the abnormal growth of cells (biology), cells that can invade or spread to other parts of the body. The first s ...

that typically arises in postmenopausal women. It is typically diagnosed on

endometrial biopsy The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis. Medical uses There are a ...

, prompted by

post-menopausal bleeding Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductiv ...

. Unlike the more common low-grade endometrioid endometrial adenocarcinoma, uterine serous carcinoma does not develop from

endometrial hyperplasia Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus. Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of th ...

and is not hormone-sensitive. It arises in the setting of endometrial

atrophy Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), malnutrition, poor nourishment, poor circulatory system, circulation, loss of hormone, ...

and is classified as a type II endometrial cancer.

References

External links

{{Medical resources , DiseasesDB = , ICD10 = , ICD9 = , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , eMedicine_mult = , MeshID = Gynaecological cancer