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Laothamatas I, Fang E, Lee J, Abbas SMH, Ding J, Kagen A, Zakashansky K, Taouli B, Kamath A, King MJ. Benign and Malignant Ovarian Teratomas: Multimodality Imaging Findings With Histopathologic Correlation. J Comput Assist Tomogr 2023; 47:882-889. [PMID: 37948362 DOI: 10.1097/rct.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
ABSTRACT The purpose of this article is to provide a comprehensive review of the imaging findings along with histopathologic correlation of mature (benign) teratomas and malignant ovarian teratomas, which include both immature teratomas and malignant degeneration of mature teratomas. The radiologist's ability to provide an accurate diagnosis plays an essential role in guiding the interdisciplinary care of patients with malignant teratomas and improving their outcomes.
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Affiliation(s)
- Indira Laothamatas
- From the Department of Diagnostic, Molecular and Interventional Radiology
| | - Eric Fang
- From the Department of Diagnostic, Molecular and Interventional Radiology
| | - Justine Lee
- From the Department of Diagnostic, Molecular and Interventional Radiology
| | - Syed Muhammad Hashim Abbas
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan Ding
- Parkview Regional Medical Center, Fort Wayne, IN
| | - Alexander Kagen
- From the Department of Diagnostic, Molecular and Interventional Radiology
| | - Konstantin Zakashansky
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Amita Kamath
- From the Department of Diagnostic, Molecular and Interventional Radiology
| | - Michael J King
- From the Department of Diagnostic, Molecular and Interventional Radiology
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M SC, Peethambar BA. Mature cystic teratoma without intratumoral fat: A diagnostic dilemma. Radiol Case Rep 2023; 18:3109-3112. [PMID: 37416320 PMCID: PMC10319638 DOI: 10.1016/j.radcr.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Teratomas are the most common benign ovarian neoplasms in young women. Typical computed tomography imaging findings include fat, fat fluid level, tooth or calcification, rokitansky nodule, floating balls sign, and tufts of hair. They can have unusual imaging features leading to diagnostic dilemmas. Studies have shown the presence of intratumoral fat to be specific to ovarian cystic teratoma. However, there are reports in the literature of mature cystic teratoma that do not contain fat in the lumen of the cyst which can hinder an accurate diagnosis. They can be associated with various complications like torsion, rupture, malignant transformation, infection, and autoimmune hemolytic anemias. Presented here is a case of mature cystic teratoma without visible intracystic fat which underwent torsion.
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Affiliation(s)
- Sandra C M
- Department of Radiology, MES Medical College, Palachode Post, Perinthalmanna, Kerala, India
| | - Breman Anil Peethambar
- Madras Medical College and Government General Hospital, Emergency Department, Chennai, Tamil Nadu, India
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Vulasala SS, Singareddy A, Gopireddy D, Kumar S, Desai K. Peritonitis From Ruptured Lipid-Poor Dermoid: Struma Ovarii. Cureus 2021; 13:e16903. [PMID: 34513476 PMCID: PMC8412338 DOI: 10.7759/cureus.16903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/05/2022] Open
Abstract
Mature cystic teratoma (MCT) is a common benign ovarian germ cell tumor. It is more predominantly seen in premenopausal women and contains at least two or more well-differentiated germ cell layers. It is termed a dermoid cyst if the ectodermal tissue is the predominant component. The complications of a dermoid cyst include torsion, malignant degeneration, rupture, and infection. The incidence of a ruptured dermoid cyst is around 1%-2% resulting in chemical aseptic peritonitis from spillage of the cyst contents. Usual clinical presentation is with diffuse abdominal or pelvic pain and abdominal distension. Around 93-96% of dermoid cysts demonstrate fat in the cyst cavity however, minimal or no fat poses diagnostic challenges. In this case, we discuss a rare case of spontaneously ruptured lipid-poor and thyroid tissue-rich left ovarian dermoid presenting with chemical peritonitis. Special magnetic resonance (MR) Imaging sequences such as fat saturation imaging, chemical shift imaging, and gradient-echo imaging assist in detecting scant amounts of fat in the cyst cavity or cyst wall.
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Affiliation(s)
- Sai Swarupa Vulasala
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Anastasia Singareddy
- Skin Biology and Dermatological Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Dheeraj Gopireddy
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Sindhu Kumar
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Ketav Desai
- Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Kawaguchi M, Kato H, Noda Y, Suzui N, Miyazaki T, Furui T, Morishige KI, Matsuo M. CT and MRI characteristics of ovarian mature teratoma in patients with anti-N-methyl-D-aspartate receptor encephalitis. Diagn Interv Imaging 2021; 102:447-453. [PMID: 33785312 DOI: 10.1016/j.diii.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was to determine the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of ovarian mature teratoma in patients with anti-N-methyl-d-aspartate receptor encephalitis (NMDAR-E). MATERIALS AND METHODS A total of 125 women (mean age, 40.9±17.8 [SD] years; age range: 12-85 years) with 146 histopathologically or radiologically proven ovarian mature teratomas who underwent preoperative CT and MRI examinations were retrospectively included. Eight patients with 11 teratomas had NMDAR-E, whereas 117 patients with 135 teratomas did not have NMDAR-E. CT and MRI examinations were retrospectively reviewed and teratomas in patients with NMDAR-E were compared to those in patients without NMDAR-E. Comparisons were performed using Mann-Whitney U test or Fisher exact test. RESULTS In patients with NMDAR-E, maximum diameter of teratomas (26.1±9.3 [SD] mm), prevalence of teeth/calcification (36%) and rate of occupation by fat components (26%) were lower than those in patients without NMDAR-E (67.0±37.6 [SD] mm [P<0.01]; 75% [P<0.05]; and 65%[P<0.01], respectively). More than 75% of space was occupied by fat components in 76/135 teratomas (56%) in patients without NMDAR-E, whereas this was not observed in any teratoma in patients without NMDAR-E. CONCLUSION By comparison with teratomas in patients without NMDAR-E, teratomas in patients with NMDAR-E are smaller, have few teeth/calcification, and the amount of space occupied by fat components is smaller.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University, Gifu, 501-1194, Japan
| | | | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University, Gifu, 501-1194, Japan
| | | | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Taylor EC, Irshaid L, Mathur M. Multimodality Imaging Approach to Ovarian Neoplasms with Pathologic Correlation. Radiographics 2020; 41:289-315. [PMID: 33186060 DOI: 10.1148/rg.2021200086] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ovarian neoplasms can be categorized on the basis of histopathologic features into epithelial surface cell tumors, germ cell tumors, sex cord-stromal tumors, and metastases. While their imaging appearance is often nonspecific, it closely parallels the gross pathologic appearance, and radiologic-pathologic correlation is helpful to aid in a deeper understanding of the subtypes. Epithelial cell neoplasms are the most common category, and they can be benign, borderline, or malignant. Specific subtypes include serous (most common), mucinous, seromucinous, endometrioid, clear cell, Brenner, and undifferentiated. High-grade serous cystadenocarcinoma accounts for the majority of malignant ovarian tumors and the most ovarian cancer deaths. While serous neoplasms are often unilocular and bilateral, mucinous neoplasms are larger, unilateral, and multilocular. Solid components, thickened septa, and papillary projections, particularly with vascularity, indicate borderline or malignant varieties. Endometrioid and clear cell carcinomas can arise within endometriomas. Fibrous tumors (cystadenofibroma, adenofibroma, fibroma or fibrothecoma, and Brenner tumors) demonstrate low T2-weighted signal intensity of their solid components, while teratomas contain lipid. The nonspecific imaging appearance of additional malignant ovarian germ cell tumors can be narrowed with tumor marker profiles. Sex cord-stromal tumors are often solid, and secondary signs from their hormonal secretion can be a clue to their diagnosis. The authors review the anatomy of the ovary and distal fallopian tube, the proposed origins of the histologic subtypes of tumors, the clinical features and epidemiology of ovarian neoplasms, and the applications of US, CT, and MRI in imaging ovarian neoplasms. The main focus is on the radiologic and pathologic features of the multiple ovarian neoplasm subtypes. An algorithmic approach to the diagnosis of ovarian neoplasms is presented. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Erin C Taylor
- From the Department of Radiology and Biomedical Imaging (E.C.T., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Lina Irshaid
- From the Department of Radiology and Biomedical Imaging (E.C.T., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Radiology and Biomedical Imaging (E.C.T., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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AlGhamdi M, AlMutairi B, AlOsaimi A, Felemban A, AlYahya M. Mature cystic ovarian teratoma without intracystic fat: Case report with the "fat within the wall" sign. Radiol Case Rep 2020; 15:367-370. [PMID: 32055261 PMCID: PMC7005499 DOI: 10.1016/j.radcr.2020.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/01/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022] Open
Abstract
Mature cystic teratoma is the most common ovarian neoplasm among young females. Diagnosed through radiological imaging as it exhibits typical radiological features; typically, fat. However, complete cystic teratoma without visible fat is a very rare and challenging diagnosis. It is difficult to distinguish it from malignant neoplasm, due to the presence of enhancing components, for example, Rokitansky nodule and the presence of diffusion restriction from keratinized products. We present a case of an incidental mature cystic teratoma without visible intracystic fat, where the correct diagnosis based on imaging was failed. Mature cystic teratoma was then confirmed upon histologic examination.
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Affiliation(s)
- Maram AlGhamdi
- Department of Medical Imaging, Prince Sultan Military Medical City, P. Box. 7897, Riyadh, Saudi Arabia
- Corresponding author.
| | - Badr AlMutairi
- Department of Diagnostic Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz AlOsaimi
- Department of Diagnostic Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Afaf Felemban
- Department of Obstetrics and Gynaecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mauth AlYahya
- Department of Histopathology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Chung AD. Extrahepatic Fat-Containing Lesions of the Abdomen and Pelvis: An Organ-Based Approach to Differential Diagnoses. Can Assoc Radiol J 2020; 71:19-29. [PMID: 32063003 DOI: 10.1177/0846537119887871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The presence of intralesional fat provides an invaluable tool for narrowing the differential diagnosis for both benign and malignant neoplasms of the abdomen and pelvis. The ability to characterize intralesional fat is further expanded by the ability of magnetic resonance imaging to detect small quantities (intravoxel) of fat. While the presence of intralesional fat can help to provide a relatively narrow set of diagnostic possibilities, depending on the type of fat (macroscopic vs intravoxel) that is present and the organ of origin, radiologists must be aware of uncommon mimickers of pathology, both benign and malignant.
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Affiliation(s)
- Andrew D Chung
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging features of unusual lesions and complications associated with ovarian mature cystic teratoma. Clin Imaging 2019; 57:115-123. [DOI: 10.1016/j.clinimag.2019.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022]
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Son JK, Ali S, Al Khori N, Lee EY. MR Imaging Evaluation of Pediatric Genital Disorders:. Magn Reson Imaging Clin N Am 2019; 27:301-321. [DOI: 10.1016/j.mric.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lam CZ, Chavhan GB. Magnetic resonance imaging of pediatric adnexal masses and mimics. Pediatr Radiol 2018; 48:1291-1306. [PMID: 30078037 DOI: 10.1007/s00247-018-4073-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/07/2017] [Accepted: 01/03/2018] [Indexed: 01/09/2023]
Abstract
Evaluation of adnexal masses in children and adolescents relies on imaging for appropriate diagnosis and management. Pelvic MRI is indicated and adds value for all adnexal masses when surgery is considered or when ultrasound findings are indeterminate. Specifically, features on MR imaging can help distinguish between benign and malignant lesions, which not only influences the decision between surgery and conservative treatment, but also the type of surgery to be performed, including potential use of fertility-sparing approaches with minimally invasive techniques. Larger size, younger age, presentation with precocious puberty or virilization, restricted diffusion in a solid mass, and rapid and strong enhancement of solid components are all features concerning for malignancy. In addition, distinctive MR imaging features of adnexal masses, combined with clinical and laboratory biomarkers, might suggest a specific histological diagnosis.
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Affiliation(s)
- Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
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Bernot JM, Haeusler KA, Lisanti CJ, Brady RO, Ritchie BL. Mature Cystic Teratoma: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2017; 37:1401-1407. [PMID: 28898187 DOI: 10.1148/rg.2017170003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).
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Affiliation(s)
- Jeremy M Bernot
- From the Departments of Radiology (J.M.B., C.J.L., B.L.R.) and Pathology (K.A.H., R.O.B.), San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219; and F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (B.L.R.)
| | - Kelly A Haeusler
- From the Departments of Radiology (J.M.B., C.J.L., B.L.R.) and Pathology (K.A.H., R.O.B.), San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219; and F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (B.L.R.)
| | - Christopher J Lisanti
- From the Departments of Radiology (J.M.B., C.J.L., B.L.R.) and Pathology (K.A.H., R.O.B.), San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219; and F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (B.L.R.)
| | - Robert O Brady
- From the Departments of Radiology (J.M.B., C.J.L., B.L.R.) and Pathology (K.A.H., R.O.B.), San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219; and F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (B.L.R.)
| | - Brittany L Ritchie
- From the Departments of Radiology (J.M.B., C.J.L., B.L.R.) and Pathology (K.A.H., R.O.B.), San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78219; and F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (B.L.R.)
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A series of malignant ovarian cancers arising from within a mature cystic teratoma: a single institution experience. Int J Gynecol Cancer 2016; 25:792-7. [PMID: 25790042 DOI: 10.1097/igc.0000000000000431] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mature cystic teratoma (MCT) is the most common germ cell tumor. It accounts for 10% to 20% of all ovarian masses. The likelihood of malignancy arising from within an MCT is low, and prognosis is poor. METHODS A single-institution retrospective chart review was completed of all cases of MCT from 2004 to 2012. Multiple variables were examined including procedure performed, residual disease after surgery, surgical stage, histologic type, site of primary disease, date of recurrence, whether or not adjuvant chemotherapy was given, and whether or not there was death secondary to disease. RESULTS During the study period, 1.2% of MCTs exhibited malignant transformation. The average age at presentation was 53.7 years. Mean follow-up time was 23 months. The most common presenting symptoms were bloating and abdominal pain. The average tumor size was 18 cm. Of note, 33% of cases were at least surgical stage IIIC at the time of presentation, whereas the remainder were stage IC or lower. Four (44.4%) of the 9 cases were identified as mucinous adenocarcinoma in addition to 1 case each of malignant melanoma, squamous cell carcinoma, and poorly differentiated adenocarcinoma. Only 1 patient experienced recurrence. One patient had a known MCT that was being managed expectantly and exhibited malignant transformation to a mucinous adenocarcinoma. CONCLUSIONS A large ovarian mass that is suspected to be a mature teratoma should be managed more aggressively in older patients. Our data suggest that although malignancy arising from mature teratomas is rare, it is more likely when patients are older than 40 years, the mass is greater than 18 cm, and there is any suspicion for a mucinous tumor. Like most ovarian tumors, these tumors most often present at later stages and, thus, can be difficult to treat. It is unclear what role chemotherapy or radiation plays in the management of these tumors.
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Shetty MK. Adnexal Masses: Role of Supplemental Imaging With Magnetic Resonance Imaging. Semin Ultrasound CT MR 2015; 36:369-84. [DOI: 10.1053/j.sult.2015.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Shaaban AM, Rezvani M, Elsayes KM, Baskin H, Mourad A, Foster BR, Jarboe EA, Menias CO. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features. Radiographics 2015; 34:777-801. [PMID: 24819795 DOI: 10.1148/rg.343130067] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ovarian malignant germ cell tumors (OMGCTs) are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad. OMGCTs are rare, accounting for about 2.6% of all ovarian malignancies, and typically manifest in adolescence, usually with abdominal pain, a palpable mass, and elevated serum tumor marker levels, which may serve as an adjunct in the initial diagnosis, monitoring during therapy, and posttreatment surveillance. Dysgerminoma, the most common malignant germ cell tumor, usually manifests as a solid mass. Immature teratomas manifest as a solid mass with scattered foci of fat and calcifications. Yolk sac tumors usually manifest as a mixed solid and cystic mass. Capsular rupture or the bright dot sign, a result of increased vascularity and the formation of small vascular aneurysms, may be present. Embryonal carcinomas and polyembryomas rarely manifest in a pure form and are more commonly part of a mixed germ cell tumor. Some OMGCTs have characteristic features that allow a diagnosis to be confidently made, whereas others have nonspecific features, which make them difficult to diagnose. However, imaging features, the patient's age at presentation, and tumor markers may help establish a reasonable differential diagnosis. Malignant ovarian germ cell tumors spread in the same manner as epithelial ovarian neoplasms but are more likely to involve regional lymph nodes. Preoperative imaging may depict local extension, peritoneal disease, and distant metastases. Suspicious areas may be sampled during surgery. Because OMGCTs are almost always unilateral and are chemosensitive, fertility-sparing surgery is the standard of care.
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Affiliation(s)
- Akram M Shaaban
- From the Department of Diagnostic Radiology (A.M.S., M.R.) and Department of Radiology, Primary Children's Medical Center (H.B.), University of Utah, 30 N 1900 E, Room 1A71, Salt Lake City, UT 84132; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Diagnostic Radiology, VA Pittsburgh Healthcare System, Pittsburgh, Pa (A.M.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah (E.A.J.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
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Heo SH, Kim JW, Shin SS, Jeong SI, Lim HS, Choi YD, Lee KH, Kang WD, Jeong YY, Kang HK. Review of Ovarian Tumors in Children and Adolescents: Radiologic-Pathologic Correlation. Radiographics 2014; 34:2039-55. [DOI: 10.1148/rg.347130144] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine; Dongjak-gu Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine; Dongjak-gu Korea
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Poncelet E, Delpierre C, Kerdraon O, Lucot JP, Collinet P, Bazot M. Value of dynamic contrast-enhanced MRI for tissue characterization of ovarian teratomas: correlation with histopathology. Clin Radiol 2013; 68:909-16. [PMID: 23726654 DOI: 10.1016/j.crad.2013.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/24/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
AIM To analyse the value of double contrast-enhanced (DCE) magnetic resonance imaging (MRI) in addition to conventional MRI to characterize ovarian teratomas subtypes with histological correlation. MATERIALS AND METHODS From January 2005 to December 2008, 38 women undergoing MRI and subsequent resection of ovarian teratomas were identified [40 mature cystic teratomas (MCT), two struma ovarii, three immature teratomas]. MRI images were analysed blindly by two radiologists according to morphological and vascular abnormalities. An experienced histopathologist reviewed all slides to determine the presence and histological composition of Rokitansky protuberances. RESULTS Thirty-one MCT (77%) had at least one small, regular Rokitansky protuberance presenting at an acute angle with the cyst wall. Ten out of 31 MCT did not display any enhancement on contrast-enhanced MRI related to sebaceous glands, adipose lobules, keratin, and pilosebaceous adnexa at histology. Three different time-intensity curve (TIC), types 1, 2, and 3, were related to presence of smooth muscular cells and fibrous, neuroglial, or thyroid tissue, respectively, found at histology of MCT. Type 3 TIC was also present in one struma ovarii and two immature teratomas. CONCLUSION TIC types are related to the specific content of the solid tissue of ovarian teratomas but cannot be used to differentiate benign and malignant ovarian teratomas.
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Affiliation(s)
- E Poncelet
- Departments of Radiology, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille and Université de Lille Nord de France, Lille, France
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HORI M, KIM T, ONISHI H, NAKAMOTO A, TSUBOYAMA T, TATSUMI M, TOMIYAMA N. Ovarian Masses: MR Imaging with T1-weighted 3-dimensional Gradient-echo IDEAL Water-fat Separation Sequence at 3T. Magn Reson Med Sci 2012; 11:117-27. [DOI: 10.2463/mrms.11.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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A calcific pelvic mass in a woman with chronic spinal pain: a case of mature cystic teratoma. J Chiropr Med 2011; 10:327-32. [DOI: 10.1016/j.jcm.2011.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/16/2011] [Accepted: 06/21/2011] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVE Squamous cell carcinoma (SCC) is the most common type of malignant transformation in mature cystic teratoma (MCT) of the ovary. The SCC is difficult to preoperatively diagnose. We conducted a retrospective study to seek the possible risk/prognostic factors and treatments for SCC arising from MCT of the ovary. METHODS Using an institutional database, we identified 3 women treated for SCC arising from an MCT of the ovary at the Kaohsiung Veteran General Hospital. A retrospective chart review was conducted, with information obtained from radiographs, operative reports, pathology reports, and radiation oncology records. RESULTS A total of 1551 cases of MCT were diagnosed at Kaohsiung Veteran General Hospital from 1990 to 2009, of which, malignant teratoma SCC type was noted in 3 cases (0.19%). The median age of the subjects was 39 years. Abdominal fullness was the most common symptom (3/3 cases). The mean diameter of the ovarian tumor was 17.3 cm, ranging from 16 to 18 cm. All 3 patients received simple right salpingo-oophorectomy or debulking surgery. Two of the patients reached stage IIIC and died. CONCLUSIONS : With our review as basis, we recommend being cautious of the following risk factors: patient age, tumor size, ultrasound characteristics, sonar tumor vessel wave form, computed tomography, and levels of SCC and CA125 tumor markers. We suggest that patients have regular ovarian ultrasound examination. Based on our literature review, stage IA patients who undergo standardized operational procedures do well without adjuvant treatment, but such patients must be confirmed accurately with complete surgical staging to be in stage IA before undergoing conservative management. The optimal approach to the management of patients with advanced stage and recurrent disease is unclear. Surgical cytoreduction with proper staging, adjuvant therapy with platinum-based or paclitaxel-based chemotherapy, and concurrent whole pelvic radiation have been recommended as possible methods of treatment.
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Titulaer MJ, Soffietti R, Dalmau J, Gilhus NE, Giometto B, Graus F, Grisold W, Honnorat J, Sillevis Smitt PAE, Tanasescu R, Vedeler CA, Voltz R, Verschuuren JJGM. Screening for tumours in paraneoplastic syndromes: report of an EFNS task force. Eur J Neurol 2010; 18:19-e3. [PMID: 20880069 DOI: 10.1111/j.1468-1331.2010.03220.x] [Citation(s) in RCA: 319] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND paraneoplastic neurological syndromes (PNS) almost invariably predate detection of the malignancy. Screening for tumours is important in PNS as the tumour directly affects prognosis and treatment and should be performed as soon as possible. OBJECTIVES an overview of the screening of tumours related to classical PNS is given. Small cell lung cancer, thymoma, breast cancer, ovarian carcinoma and teratoma and testicular tumours are described in relation to paraneoplastic limbic encephalitis, subacute sensory neuronopathy, subacute autonomic neuropathy, paraneoplastic cerebellar degeneration, paraneoplastic opsoclonus-myoclonus, Lambert-Eaton myasthenic syndrome (LEMS), myasthenia gravis and paraneoplastic peripheral nerve hyperexcitability. METHODS many studies with class IV evidence were available; one study reached level III evidence. No evidence-based recommendations grade A-C were possible, but good practice points were agreed by consensus. RECOMMENDATIONS the nature of antibody, and to a lesser extent the clinical syndrome, determines the risk and type of an underlying malignancy. For screening of the thoracic region, a CT-thorax is recommended, which if negative is followed by fluorodeoxyglucose-positron emission tomography (FDG-PET). Breast cancer is screened for by mammography, followed by MRI. For the pelvic region, ultrasound (US) is the investigation of first choice followed by CT. Dermatomyositis patients should have CT-thorax/abdomen, US of the pelvic region and mammography in women, US of testes in men under 50 years and colonoscopy in men and women over 50. If primary screening is negative, repeat screening after 3-6 months and screen every 6 months up till 4 years. In LEMS, screening for 2 years is sufficient. In syndromes where only a subgroup of patients have a malignancy, tumour markers have additional value to predict a probable malignancy.
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Affiliation(s)
- M J Titulaer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.
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Bazot M, Lafont C, Roussel A, Jarboui L, Nassar-Slaba J, Thomassin-Naggara I. Caractérisation tissulaire IRM du pelvis féminin. ACTA ACUST UNITED AC 2010; 91:453-64. [DOI: 10.1016/s0221-0363(10)70060-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Intracellular Lipid in Ovarian Thecomas Detected by Dual-Echo Chemical Shift Magnetic Resonance Imaging. J Comput Assist Tomogr 2010; 34:223-5. [DOI: 10.1097/rct.0b013e3181c22053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Damarey B, Farine M, Vinatier D, Collinet P, Lucot J, Kerdraon O, Poncelet E. Tératomes ovariens matures et immatures : caractéristiques en échographie, TDM et IRM. ACTA ACUST UNITED AC 2010; 91:27-36. [DOI: 10.1016/s0221-0363(10)70003-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Mody VV, Nounou MI, Bikram M. Novel nanomedicine-based MRI contrast agents for gynecological malignancies. Adv Drug Deliv Rev 2009; 61:795-807. [PMID: 19427886 DOI: 10.1016/j.addr.2009.04.020] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 04/28/2009] [Indexed: 11/16/2022]
Abstract
Gynecological cancers result in significant morbidity and mortality in women despite advances in treatment and diagnosis. This is due to detection of the disease in the late stages following metastatic spread in which treatment options become limited and may not result in positive outcomes. In addition, traditional contrast agents are not very effective in detecting primary metastatic tumors and cells due to a lack of specificity and sensitivity of the diagnostic tools, which limits their effectiveness. Recently, the field of nanomedicine-based contrast agents offers a great opportunity to develop highly sophisticated devices that can overcome many traditional hurdles of contrast agents including solubility, cell-specific targeting, toxicities, and immunological responses. These nanomedicine-based contrast agents including liposomes, micelles, dendrimers, multifunctional magnetic polymeric nanohybrids, fullerenes, and nanotubes represent improvements over their traditional counterparts, which can significantly advance the field of molecular imaging.
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Affiliation(s)
- Vicky V Mody
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Texas Medical Center Campus, 1441 Moursund Street, Houston, Texas 77030, USA
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26
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Asch E, Levine D, Pedrosa I, Hecht JL, Kruskal J. Patterns of misinterpretation of adnexal masses on CT and MR in an academic radiology department. Acad Radiol 2009; 16:969-80. [PMID: 19380241 DOI: 10.1016/j.acra.2009.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 02/21/2009] [Accepted: 02/23/2009] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess potential quality assurance (QA) issues in the diagnosis and characterization of adnexal masses on pelvic computed tomographic (CT) and magnetic resonance (MR) imaging studies. MATERIALS AND METHODS Images from 128 women who had oophorectomies during a 16-month period with CT and/or MR studies within 5 years of surgery (145 CT scans from 103 women and 49 MR studies from 42 women, with 17 having both MR and CT studies) were reviewed by three radiologists who assigned QA scores of 0 (no QA issue), 1 (minor issue with minimal impact on clinical care), or 2 (major issue with potential impact on clinical care). The difficulty of diagnosis was assigned a score of 0 (very difficult diagnosis to make), 1 (difficult but possible to make the diagnosis), or 2 (diagnosis should be made). The incidence of adnexal QA issues was calculated using total CT and MR pelvic examinations performed on women during the interval. RESULTS Twenty-nine QA issues were identified in 28 women in 17 of 145 CT studies (11.7%) and 12 of 49 MR examinations (24.5%) in women having adnexal surgery (17 of 11,194 [0.15%] of female pelvic CT studies and 12 of 603 [2.0%] of female pelvic MR studies performed in the time interval). Issues included missed lesions, lesions misidentified as leiomyomas, fat described in the lesion but not seen histologically, postmenopausal status of patient not considered, ultrasound correlation not recommended, and confusion of right and left sides. CONCLUSION Errors in CT and MR studies regarding the diagnosis and characterization of adnexal masses in a highly enriched population of women undergoing adnexal surgery are common. Knowledge of the types of QA issues found in CT and MR studies of adnexal masses should aid in decreasing future errors.
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Saba L, Guerriero S, Sulcis R, Virgilio B, Melis G, Mallarini G. Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol 2008; 72:454-63. [PMID: 18804932 DOI: 10.1016/j.ejrad.2008.07.044] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/27/2008] [Accepted: 07/31/2008] [Indexed: 11/25/2022]
Abstract
Ovarian teratomas (OTs) are the most common germ cell neoplasm. They include mature cystic teratomas, monodermal teratomas (neural tumors, struma ovarii, carcinoid tumors) and immature teratomas. Teratomas are the most common benign ovarian neoplasms in women less than 45 years old. OTs are usually characterized by ultrasound (US) and magnetic resonance (MR) whereas they are usually an incidental finding on CT. The purpose of this paper is to review the most common types of teratomas and to describe CT, US and MR imaging features of the various types of mature and immature OTs.
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Affiliation(s)
- Luca Saba
- Department of Science of the Images, Policlinico Universitario (Cagliari), Italy.
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28
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Park SB, Kim JK, Kim KR, Cho KS. Imaging findings of complications and unusual manifestations of ovarian teratomas. Radiographics 2008; 28:969-983. [PMID: 18635624 DOI: 10.1148/rg.284075069] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Ovarian teratomas can be associated with various complications and demonstrate a wide spectrum of clinical and imaging features. The complications include torsion (16% of ovarian teratomas), rupture (1%-4%), malignant transformation (1%-2%), infection (1%), and autoimmune hemolytic anemia (<1%). These complications require different therapeutic strategies; therefore, timely and accurate diagnosis of these complications is important for optimal patient treatment. In cases of complicated ovarian teratomas, the clinical manifestations provide only limited information and often overlap with those of other diseases. Furthermore, ovarian teratomas may have unusual clinical and imaging manifestations, thereby leading to misdiagnosis. These unusual manifestations include immature teratomas, monodermal teratomas (struma ovarii), combination tumors and collision tumors containing teratomas, and mature cystic teratomas without demonstrable fat or with pure fatty components. To provide adequate treatment and prevent misdiagnosis, it is necessary to be familiar with the imaging findings of both the complications and the unusual manifestations of ovarian teratomas.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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29
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Abstract
Ultrasound is the screening method of choice for evaluation of pelvic anatomy and abnormalities of the female pelvis. It allows for detailed assessment of the uterus, endometrium, and ovaries. However, there are times when the sonographic diagnosis is nonspecific. This review article details the use of magnetic resonance imaging for assessment of uterine duplication anomalies, adnexal and uterine masses, and for aiding in the assessment of pregnant patients with nonspecific sonographic findings in the pelvis.
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Affiliation(s)
- Deborah Levine
- Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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30
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Tamai K, Koyama T, Saga T, Kido A, Kataoka M, Umeoka S, Fujii S, Togashi K. MR features of physiologic and benign conditions of the ovary. Eur Radiol 2006; 16:2700-11. [PMID: 16736136 DOI: 10.1007/s00330-006-0302-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 04/08/2006] [Accepted: 04/18/2006] [Indexed: 11/28/2022]
Abstract
In reproductive women, various physiologic conditions can cause morphologic changes of the ovary, resembling pathologic conditions. Benign ovarian diseases can also simulate malignancies. Magnetic resonance imaging (MRI) can play an important role in establishing accurate diagnosis. Functional cysts should not be confused with cystic neoplasms. Corpus luteum cysts typically have a thick wall and are occasionally hemorrhagic. Multicystic lesions that may mimic cystic neoplasms include hyperreactio luteinalis, ovarian hyperstimulation syndrome, and polycystic ovary syndrome. Recognition of clinical settings can help establish diagnosis. In endometrial cysts, MRI usually provides specific diagnosis; however, decidual change during pregnancy should not be confused with secondary neoplasm. Peritoneal inclusion cysts can be distinguished from cystic neoplasms by recognition of their characteristic configurations. Ovarian torsion and massive ovarian edema may mimic solid malignant tumors. Recognition of normal follicles and anatomic structures is useful in diagnosing these conditions. In pelvic inflammatory diseases, transfascial spread of the lesion should not be confused with invasive malignant tumors. Radiologic identification of abscess formation can be a diagnostic clue. Many benign tumors, including teratoma, Brenner tumor, and sex-cord stromal tumor, frequently show characteristic MRI features. Knowledge of MRI features of these conditions is essential in establishing accurate diagnosis and determining appropriate treatment.
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Affiliation(s)
- Ken Tamai
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Kyoto, Japan.
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31
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Pereira JM, Sirlin CB, Pinto PS, Casola G. CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis, differential diagnosis, and pitfalls. Radiographics 2006; 25:69-85. [PMID: 15653588 DOI: 10.1148/rg.251045074] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The differential diagnosis of extrahepatic abdominopelvic masses is wide. Demonstration of fat within a lesion at noninvasive imaging is an important clue for narrowing the differential diagnosis. Macroscopic fat is readily identified with both computed tomography (CT) and magnetic resonance (MR) imaging. Demonstration of microscopic fat is more difficult and may require special techniques. Identification of fat with CT is based on x-ray resorption and therefore on the attenuation (typically less than -20 HU). Several MR imaging techniques have been developed for fat suppression. Two of the most widely available are spectroscopic fat saturation and chemical shift (in-phase/opposed-phase) imaging. Entities with predominantly macroscopic fat include myelolipoma, angiomyolipoma, teratoma, liposarcoma, lipoma, epiploic appendagitis, omental infarction, and mesenteric panniculitis. Lesions with predominantly microscopic fat include adrenal adenoma and some teratomas. Other fat-containing entities involve the mesentery and bowel wall; these include fibrofatty mesenteric proliferation and submucosal fat deposition.
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Affiliation(s)
- Jose M Pereira
- Department of Radiology, Porto Medical School, Hospital S. João, Porto, Portugal
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32
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Sherer DM, Zinn H, Gavrilescu T, Abdelmalek E, Hellmann M, Sokolovski M, Abulafia O. Transvaginal sonographic diagnosis of a large retroperitoneal pelvic epidermoid cyst (monodermal teratoma). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:265-8. [PMID: 16439792 DOI: 10.7863/jum.2006.25.2.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, 11203-2098 USA.
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Rha SE, Byun JY, Jung SE, Kim HL, Oh SN, Kim H, Lee H, Kim BK, Lee JM. Atypical CT and MRI manifestations of mature ovarian cystic teratomas. AJR Am J Roentgenol 2004; 183:743-50. [PMID: 15333365 DOI: 10.2214/ajr.183.3.1830743] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sung Eun Rha
- Department of Radiology, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505, Banpo-Dong, Seocho-Ku, Seoul 137-040, South Korea
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Abstract
Magnetic resonance imaging (MRI) plays an important role in localizing and characterizing pelvic masses, particularly adnexal masses. The multiplanar capability of MRI helps to locate an abnormality outside the ovary and facilitate the exclusion of malignancy. Its superior soft-tissue contrast features help to diagnose specific benign masses, including teratoma, endometrioma, and ovarian fibroma. In addition, cystic ovarian neoplastic lesions can be further characterized as benign versus malignant, particularly after gadolinium administration. An approach to adnexal evaluation using MRI is discussed based on these features.
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35
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Abstract
MR imaging enables a physician to make an accurate diagnosis of various benign adnexal masses and helps to obviate unnecessary surgery.
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Affiliation(s)
- Kaori Togashi
- Department of Diagnostic and Interventional Imageology, Graduate School of Medicine, Kyoto University 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto 606-01, Japan.
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36
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Abstract
MR imaging has become a valuable modality in the evaluation of the female pelvis. In many cases, it follows the performance of HSG or US. These cases include infertility and pelvic pain. In some cases, it should serve as the test of choice. This is true in the local staging of cervical cancer and the evaluation of pain or disability in the pregnant patient. Finally, in the evaluation of advanced gynecologic cancers, it is usually a secondary choice with CT preferred.
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Affiliation(s)
- Julia R Fielding
- Department of Radiology, University of North Carolina Chapel Hill, Campus Box 7510, University of North Carolina Hospital, 101 Manning Drive, Chapel Hill, NC 27599, USA.
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37
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Abstract
MR imaging is well suited to evaluation of the pelvis. Ultrasonography remains the study of choice for the initial evaluation of a suspected gynecologic mass. MR imaging and computed tomography remain problem-solving tools that can help to characterize masses and stage gynecologic malignancies. MR imaging has the advantage of higher soft tissue contrast compared with computed tomography. This article reviews the MR findings of congenital anomalies and masses of the adnexa and uterus in adolescent girls.
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Affiliation(s)
- Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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38
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Abstract
Magnetic resonance imaging (MRI) of the pelvis can characterize a wide variety of ovarian lesions. We discuss MRI strategies for identification and characterization of ovarian neoplasms and correlate MRI findings with lesion gross pathological and histopathological structure.
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Affiliation(s)
- E S Pretorius
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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39
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Abstract
Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas (eg, struma ovarii, carcinoid tumors, neural tumors). Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification. At computed tomography (CT), fat attenuation within a cyst is diagnostic. At magnetic resonance (MR) imaging, the sebaceous component is specifically identified with fat-saturation techniques. The US appearances of immature teratoma are nonspecific, although the tumors are typically heterogeneous, partially solid lesions, usually with scattered calcifications. At CT and MR imaging, immature teratomas characteristically have a large, irregular solid component containing coarse calcifications. Small foci of fat help identify these tumors. The US features of struma ovarii are also nonspecific, but a heterogeneous, predominantly solid mass may be seen. On T1- and T2-weighted images, the cystic spaces demonstrate both high and low signal intensity. Familiarity with the US, CT, and MR imaging features of ovarian teratomas can aid in differentiation and diagnosis.
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Affiliation(s)
- E K Outwater
- Department of Radiology, University of Arizona, 1501 N. Campbell Ave., Rm. 1361, Tucson, AZ 85724-5067, USA.
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40
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Bazot M, Boudghéne F, Billiéres P, Antoine J, Uzan S, Bigot J. Value of fat-suppression gradient-echo MR imaging in the diagnosis of ovarian cystic teratomas. Clin Imaging 2000; 24:146-53. [PMID: 11150681 DOI: 10.1016/s0899-7071(00)00189-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Gradient-echo MR imaging (MRI) was evaluated for the diagnosis of ovarian mature cystic teratomas (MCTs). The FLASH technique was applied to T1-weighted images with and without fat suppression in 18 surgical operated patients with 19 MCTs, and findings were compared to those of conventional spin-echo (SE) T1-weighted-SE. Seventeen out of 19 MCTs were correctly diagnosed using FLASH and SE T1-weighted MR images with and without fat saturation. This study suggests that gradient-echo MRI can replace conventional SE T1-weighted MRI for the diagnosis of ovarian MCTs.
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Affiliation(s)
- M Bazot
- Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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41
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Abstract
Pelvic imaging techniques such as computed tomography and ultrasonography provide a limited capability for tissue characterization. Fat, fluid, and calcification, for example, can be identified on the basis of parameters such as x-ray attenuation, echogenicity, and sound attenuation. Because of the many tissue parameters, such as T1, T2, magnetic susceptibility, and chemical shift, that contribute to signal intensity, magnetic resonance (MR) imaging may afford an ability to identify a wider array of specific tissues. The purpose of this article is to review the ability of MR imaging to help identify various types of soft tissue and to provide an approach to interpretation of MR images of the female pelvis through tissue characterization. Lipid, fluid, hemorrhage, smooth muscle, fibrosis, solid malignant tissue, and hydrated soft tissue (including edema, mucin, and myxomatous tissue) have typical MR imaging properties, and their presence in a mass can often be established on MR images. Consideration of the tissue composition of various pathologic processes in the pelvis can result in more systematic approaches to image interpretation and thus narrow the differential diagnosis.
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Affiliation(s)
- E S Siegelman
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
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42
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Siegel MJ. PELVIC TUMORS IN CHILDHOOD. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Kido T, Yamashita Y, Sumi S, Baba Y, Takahashi M, Ootsuka Y, Ueda S. Chemical shift GRE MRI of renal angiomyolipoma. J Comput Assist Tomogr 1997; 21:268-70. [PMID: 9071298 DOI: 10.1097/00004728-199703000-00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The renal angiomyolipoma is a fairly common benign renal tumor composed of various proportions of smooth muscle, blood vessels, and fat. Because fat is present in virtually every case, the CT findings in angiomyolipomas are so distinctive that a histologic diagnosis may be suggested. In angiomyomas composed mainly of vascular tissue and muscle or in those in which recent hemorrhage has occurred, the majority of tumors may have soft tissue CT density values without apparent fatty component (1,2). In such cases, preoperative diagnosis is extremely difficult. In this case report, we detected a small amount of fatty tissue with a chemical shift GRE MRI technique, although CT failed to detect the fatty tissue.
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Affiliation(s)
- T Kido
- Department of Radiology, Kumamoto University School of Medicine, Japan
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