Figure 5b. Local spread of ovarian carcinoma in a 77-year-old woman. (a) Transverse US image through the pelvis shows an enlarged, predominantly solid left ovary (arrow). (b) Axial CT image shows an irregular interface between the left ovary and the uterus (black arrow), a finding that suggests direct invasion. Irregular nodularity seen in the surrounding soft tissues (curved arrow) and a small amount of ascites (straight white arrow) are suggestive of stage IIC or higher disease. (c) Photograph of the uterus shows extensive implants involving the serosal surface (cf the normal uterine serosal surface in Fig 2). (d) Low-power photomicrograph (original magnification, x2; hematoxylin-eosin stain) of serous papillary carcinoma involving the paratubal and paraovarian soft tissues shows a prominent papillary growth pattern lined by cytologically malignant serous epithelium with destructive stromal invasion. The fallopian tube is seen in cross section (arrow).