PAPILLOMA, SEROUS ADENOFIBROMA, AND CYSTADENOFIBROMA
The serous epithelial tumors of the ovary include three subgroups in which the fibromatous elements over-shadow the proliferation of “serous” epithelium. Although histogenetically similar, they present gross and microscopic differences. These variants may be classified as surface papillomas, adenofibromas, and cystadenofibromas. Adenofibromas are most commonly found as ovarian masses but may also occur in the cervix or uterine body. Adenofibromas are also closely related to cystadenofibromas that contain cystic areas but still contain more than 25% fibrous connective tissue.
Surface papillomas are solid fibromatous papillomas covered by “serous”
epithelium. They may appear as a localized accumulation of minute, fine, warty
excres-cences; as conspicuous, multiple, fingerlike, polypoid projections; or as
large cauliflower growths, completely enveloping the ovary and filling the
pelvis. Microscopi- cally, the papillae are composed of fibrous tissue with
varying degrees of cellularity and hyalinization, covered by a single layer of
mesothelial or cuboidal cells. Surface papillomas may occur singly or in
conjunction with other forms of serous epithelial tumors. They are benign and,
usually, of no clinical significance. However, the marked proliferative
activity, evidenced in large exophytic papillary growths, makes a gross
decision as to their benign or malignant character most difficult.
Serous adenofibromas of the ovary are benign, fibromatous tumors containing
serous adenomatous elements. They represent a variation of serous epithelial
neoplasms. They have also been referred to as fibroadenomas, fibromas with
inclusion cysts, cystic fibromas, serous cystadenomas, solid adenomas, and
adenocystic ovarian fibromas. The lesion is rare and occurs most often after the
age of 40 years. The tumors are usually encountered accidentally on pelvic
examination or as incidental findings at laparotomy. Occasionally, if
suf-ficiently large, they may give rise to local discomfort or pressure
symptoms. Grossly, these neoplasms are solid, slightly irregular in contour,
smooth-surfaced, and firm. On section, they are composed of gray-white, compact,
interlacing bundles of connective tissue. Minute cystic spaces may be visible.
The tumors vary considerably in size. They may be unilateral or bilateral
(15%), single or multiple. An early lesion may appear as a tiny, firm, white,
flat, oval, or serrated structure on the surface of the ovary or as a small
nodule in the ovarian cortex. Growing, the tumor may replace most of the ovary.
Grossly, the serous cystadenofibroma resembles the Brenner tumor, fibroma,
fibromyoma, or theca cell tumor. Histologically, the neoplasm is composed of a
dense connective tissue matrix in which are embedded numerous small cystic
spaces. The latter are lined by compact, single-layered, cuboidal or
low-columnar, often ciliated epithelium. The fibromatous tissue is predominant.
It manifests a whorl-like arrangement of spindle cells, with varying degrees of
hyalinization. The epithelial glands are round, oval, irregular, or slitlike.
Psammoma bodies are frequently found.
Serous cystadenofibromas are adenofibromas in which the cystic spaces are conspicuously
enlarged. They may also be regarded as cystadenomas in which at least one
quarter of the tumor mass is solid and fibromatous. The neoplasms possess all
the gross and microscopic features of adenofibromas, except that they are
usually larger, more irregular, and semicystic. Within the cystic spaces,
papillations may occur.
Serous adenofibroma and cystadenofibroma are benign. Malignancy has not
been observed, despite the fact that such potentialities would be expected to
be similar to those of serous cystadenomas. Therapy consists of surgical
excision. This is in contrast to pure serous tumors, which are more likely to
be found with poorer differentiation. Papillary surface carcinomas of the ovary
are most likely to be serous in type. A frozen-section histologic evaluation
should be considered for any ovarian mass that appears suspicious for
malignancy.
