Pitfalls of Frozen Section in Gynecological Pathology: A Case of Ovarian Serous Surface Papillary Adenofibroma Imitating Malignancy

Serous cystadenofibromas are uncommon benign ovarian lesions, consisting of both fibrous and epithelial components, that are usually cystic but may contain solid or papillary architecture that can be confused with a malignancy on imaging. Papillary architecture seen on frozen section may also falsely steer the pathologist in the direction of a diagnosis of a borderline serous tumor. Overcalling the lesion may lead to more aggressive surgery than necessary, so extensive tissue sampling and consideration of this entity is important in possibly avoiding this mistake.

Ovarian cystadenofibroma: A masquerader of malignancy

Ovarian cystadenofibroma is a relatively rare benign ovarian tumor that contains both epithelial and fibrous stromal components. The appearance of cystadenofibroma on imaging is often complex; cystic- to solid-appearing masses may be visualized and it often resembles a malignant tumor. Owing to the fibrous component of this tumor, MRI shows low-signal intensity on T2W images. This finding may help a radiologist make a preoperative diagnosis of this tumor and thus perhaps avoid aggressive surgical management.