Transitional cell tumor of the ovary: computed tomographic and magnetic resonance imaging features with pathological correlation

Brenner tumors

Brenner tumors are rare ovarian neoplasms composed of ovarian transition cells surrounded by dense fibrous tissue. Most of them are small tumors (<2 cm), detected incidentally in asymptomatic women. Its predominantly fibrous content results in relatively low signal on T₂ weighted images, establishing differential diagnosis with ovarian fibroma and thecoma. Their imaging features are very similar, the differentiation is based on secondary characteristics, such as signs or symptoms of estrogen excess and the presence of a second ovarian neoplasm, which has been reported in up to 30% of patients with Brenner tumor. Although originally thought to be universally benign, there have been scattered reports in the past decades of borderline and malignant forms of Brenner tumors.

Serous borderline ovarian tumours: an extensive review on MR imaging features

Serous borderline ovarian tumours (SBOTs) are an intermediate group of neoplasms, which have features between benign and malignant ovarian tumours and for which, fertility-sparing surgery can be offered. MRI in imaging of SBOTs is, therefore, crucial in raising the possibility of the diagnosis, in order to present the patient with the most appropriate treatment options. There are characteristic MRI features that SBOTs demonstrate. In addition, recent advanced techniques, and further classification into subtypes within the borderline group have been developed. The aim of this article is to review the MRI features of SBOT and provide the reporter with an awareness of the imaging tips and tricks in the differential diagnosis of SBOT.

Benign Brenner tumour of the ovary: CT and MRI features

AIM

To evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) features of benign Brenner tumours (BBT) of the ovary.

MATERIAL AND METHODS

This was a retrospective two-centre study comprising 35 female patients with a definitive diagnosis of BBT at histology in whom CT and/or MRI examinations had been performed. Two experienced radiologists reviewed the CT and MRI features of 39 ovarian BBT retrospectively with consensus reading. The morphological appearance and size of each tumour were recorded. The presence or absence of calcifications within the solid portion was noted at CT. The reviewed characteristics at MRI included qualitative assessment of the signal intensity of the solid portion on diffusion sequence and contrast enhancement, compared to that of the myometrium.

RESULTS

CT and MRI images were available for 27 and 28 lesions, respectively. Sixteen patients had both CT and MRI examinations. BBT were unilateral in 89% of patients, and 49% of lesions were solid and 51% were mixed. Calcifications were depicted at CT in 70.4% of lesions. When present, the cystic portion was multilocular in 85% of cases and corresponded to a mucinous lesion in 74% of cases. Enhancement of the solid portion at MRI was inferior or equal to that of the myometrium in 89% of cases and signal on high b-values diffusion images was deemed low or moderate in 93% of cases.

CONCLUSION

The combined CT and MRI findings of a unilateral fibrous ovarian mass containing punctate calcifications often associated with a multilocular cyst suggest the diagnosis of ovarian BBT.

MRI and FDG PET/CT Findings for Borderline Brenner Tumor of the Ovary: A Case Report and Literature Review

The imaging features of borderline Brenner tumor (BT) of the ovary are very limited, especially regarding apparent diffusion coefficient (ADC) value and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT. We report a case of borderline BT in a 54-year-old woman with diffusion-weighted imaging (DWI) and FDG-PET/CT findings. Furthermore, ADC values and maximum standardized uptake value (SUV max) in the present case were compared with those of an additional 7 cases of benign BT in this institution in addition to literature reviews. Magnetic resonance imaging (MRI) revealed a pelvic unilocular cystic tumor with two solid components. The solid mass showing a low signal intensity (SI) in T2-weighted images (T2WI) and DWI was diagnosed as a benign BT histologically. The papillary tumor adjacent to the solid mass showing intermediate SI in T2WIs and high SI on DWI was a borderline BT. The mean ADC value (×10⁻³ mm²/s) of benign BTs (n = 7) and benign component in this case (n = 1) was 1.13, and the range of ADC values was broad (0.51–1.8). While, the ADC value of borderline Brenner component in this case was 1.10. The mean SUVmax of the benign BTs (n = 4) demonstrated mild FDG uptakes (2.3, range 1.9–2.6) in contrast with moderate FDG uptake (SUVmax: 5.8) of borderline Brenner component in this case and high FDG uptake (SUVmax: 9.6) of a malignant BT in a previous report. ADC values for the solid component of BTs are not useful for differentiating benign from malignant or borderline components, whereas PET/CT could be useful.

Primary ovarian leiomyoma with predominant cystic change

Ovarian leiomyoma is a rare benign tumor, seen mostly in women 20-65 years old. The case of a 51-year-old woman with a large tumor in the pelvic cavity is reported. The dominant feature of the tumor was its cystic component, but an irregular, solid component was recognized along the dorsal margin of the tumor. The latter area showed signal intensity as low as muscle on T2-weighted images and significant contrast enhancement; however, it did not show restricted diffusion, which implied that it was benign. The large tumor was resected because malignancy could not be ruled out, and it was pathologically diagnosed as ovarian leiomyoma with predominant necrosis. When a low-intensity component without malignant features is seen on magnetic resonance imaging, leiomyoma should be included in the differential diagnosis despite its rare occurrence in the ovary.

Ovarian mucinous cystadenoma coexisting with benign Brenner tumor: MR imaging findings

PURPOSE

The purpose of this study was to describe the MR imaging findings of ovarian mucinous cystadenomas coexisting with benign Brenner tumors.

MATERIALS AND METHODS

MR images with a 1.5-T unit obtained in five consecutive patients (age range, 51-72 years; mean age, 61 years) with surgically confirmed ovarian mucinous cystadenomas coexisting with benign Brenner tumors were retrospectively reviewed for the presence, configuration, and signal intensity of cystic and solid components of the lesions.

RESULTS

Tumors ranged in size from 7.5 to 22.1 cm (mean, 13.5 cm). In four patients (80%), the size of mucinous cystadenoma (range 6.4-22.1 cm; mean, 12.5 cm) was larger than that of Brenner tumor (range 0.2-9.1 cm; mean, 2.8 cm). All patients (100%) had cystic, and three (60%) had solid components. Four patients (80%) showed multilocular cystic, and one (20%) showed unilocular cystic appearance. MR imaging findings were classified into three patterns: (1) a bulky solid mass adjacent to the cystic component, (2) a mural nodule at the periphery of the cystic component, and (3) a cystic component without a detectable solid component. All four multilocular cystic areas exhibited "stained glass" appearances on both T1- and T2-weighted images, and all three solid areas showed homogeneous hypointensity on T2-weighted images.

CONCLUSION

Mucinous cystadenomas were often larger than the coexisting benign Brenner tumors. Mucinous cystadenomas coexisting with benign Brenner tumors should be considered when multilocular or unilocular cystic components are accompanied by homogeneously hypointense solid components on T2-weighted images.

Diffusion-weighted imaging of a malignant brenner tumor

Microscopically, ovarian malignant Brenner tumor shows components of malignant transitional cell tumor intermixed with benign and borderline elements. We report a case of this tumor with components that transition from benign to malignant on diffusion-weighted images (DWI) and in histologic findings. The benign component showed low signal intensity on T(2)-weighted images, whereas the malignant component showed high signal intensity on T(2)-weighted images and high signal intensity on DWI with low apparent diffusion coefficient (ADC) value.

Transitional cell carcinoma of the ovary (Review)

Transitional cell carcinoma (TCC) of the ovary is a rare recently recognized subtype of ovarian epithelial cancer. Ovarian TCC has a modest response to chemotherapy, and metastatic TCC from the renal pelvis results in mortality. The clinical presentation is indistinguishable from other types of ovarian carcinoma. Histopathological examination remains the first tool used in the diagnosis of these heterogeneous tumors and in the separation of closely related tumors. Since it is generally accepted that surgical resection is the primary therapeutic approach, and patient outcomes following chemotherapy are better than for other types of ovarian cancers, it is a reasonable concept to detect tumors when they are still confined within the ovaries. Thus, the aim of this review was to describe typical cases of primary TCC, and to review the medical literature for information on TCC management in order to determine appropriate diagnostic methods and therapy.

Virilising ovarian tumour: a case associating a Sertoli-Leydig cell tumour and a Brenner tumour

Ovarian Sertoli-Leydig cell tumours (SLCT), also termed arrhenoblastomas, are the most frequent virilising tumours in women of reproductive age. Very rare secretory Brenner tumours (BT) have been described, generally after the menopause. A 31-year-old woman sought medical advice for secondary amenorrhoea, progressive hirsutism and a 5-year history of virilisation syndrome with clitoromegaly. Testosterone was markedly high (285 ng/dl, N<85) with moderate elevation of delta 4-androstenedione (D4AD) (311 ng/dl, N <270), dehydroepiandrosterone sulfate (DHEAS) (366 μg/dl, N <340) and 17-hydroxyprogesterone (17OHP) (275 ng/dl). LH was 9 IU/l, FSH 4.3 IU/l, estradiol 60 pg/ml and progesterone 314 ng/100 ml. Cortisol was decreased (1.3 μg/dl) after the dexamethasone suppression test. Pelvic MRI showed a 5-cm right ovarian tumour with a 2.5 cm nodular component and cystic areas, and two nodules measuring 11 mm and 15 mm above the right and left ovaries. After right ovariectomy by laparoscopy, pathological examination concluded on a 3-cm SLCT and a 2-cm BT; the nodules above the ovaries were dysembryoplastic cysts. Postoperatively, testosterone level was normal after 24 h (26 ng/dl), estradiol and progesterone rapidly decreased, cyclic secretion then resumed and the patient menstruated at day 27. To our knowledge, this is the first report of an ovarian tumour associating a Sertoli-Leydig cell tumour and a Brenner tumour in a patient with virilisation syndrome which resolved after ovariectomy.

High-field magnetic resonance imaging of the pelvis: uterus, ovary, and prostate gland

Today, magnetic resonance imaging (MRI) is a standard imaging modality for various pathologic disorders in the human pelvis. It has given proof of its usefulness in the diagnosis of several benign and malignant disorders, and it is routinely used for the local staging of different tumors even when confined to specific parts of a pelvic organ. Signal-to-noise ratio and motion artifacts of the examined organ and adjacent bowel structures are major factors for image quality. Setting at 3 T with surface coils avoids technical limitations and discomfort of additional endovaginal or endorectal coils. Definition of high field seems fuzzy because of the availability of MRI machines with 3, 7 T, or higher; therefore, the general aspects of MRI of pelvic structures with emphasis on uterus, ovary, and prostate gland and attention to promising newer techniques such as 3 T, dynamic contrast imaging, and diffusion-weighted imaging are reviewed in this article.