Imaging of gynecological disease: clinical and ultrasound characteristics of serous cystadenofibromas in the adnexa.

OBJECTIVES: To describe the clinical and ultrasound characteristics of serous cystadenofibromas in the adnexa.

METHODS: This is a retrospective study. From the International ovarian tumor analysis (IOTA) database we identified patients with a histological diagnosis of serous cystadenofibroma, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2012. In the IOTA database containing prospectively collected data, the tumors were described using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed, first independently and then together, ultrasound images of serous cystadenofibromas and described them using pattern recognition.

RESULTS: We identified 233 women with a histological diagnosis of serous cystadenofibroma. In the IOTA database, most (67.4%) were described as containing solid components (157/233) but 19.3% (45/233) were described as multilocular cysts and 13.3% (31/233) as unilocular cysts. Papillary projections were described in 52.4% (122/233) of the cystadenofibromas. In 79.5% (97/122) of the cysts with papillary projections color Doppler signals were absent in the papillary projections. Most cystadenofibromas (83.7%, 195/233) manifested no or minimal color Doppler signals. On retrospective analysis of 201 ultrasound images of serous cystadenofibromas using pattern recognition we identified 10 major types of ultrasound appearance. The most common pattern was a unilocular solid cyst with one or more papillary projections (25.9%, 52/201). The second most common pattern was a multilocular solid mass with small solid component(s) but no papillary projections (19.4%, 39/201). The third and fourth most common patterns were multilocular cyst (16.9%, 34/201) and unilocular cyst (11.9%, 24/201). Using pattern recognition, shadowing was identified in 39.8% (80/201) of the tumors, and microcystic appearance of the papillary projections was observed in 35 (39.8%) of the 88 tumors containing papillary projections.

CONCLUSIONS: The ultrasound features of serous cystadenofibromas vary. The most common pattern is a unilocular solid cyst with one or more papillary projections with absent color Doppler signals. Most serous cystadenofibromas are poorly vascularized on color Doppler and many manifest acoustic shadowing. This article is protected by copyright. All rights reserved.