Pearls and Potential Pitfalls for Correct Diagnosis of Ovarian Cystadenofibroma in MRI: A Pictorial Essay

MRI combined with clinical features to differentiate ovarian thecoma-fibroma with cystic degeneration from ovary adenofibroma

OBJECTIVE

To explore the value of magnetic resonance imaging (MRI) and clinical features in identifying ovarian thecoma-fibroma (OTF) with cystic degeneration and ovary adenofibroma (OAF).

METHODS

A total of 40 patients with OTF (OTF group) and 28 patients with OAF (OAF group) were included in this retrospective study. Univariable and multivariable analyses were performed on clinical features and MRI between the two groups, and the receiver operating characteristic (ROC) curve was plotted to estimate the optimal threshold and predictive performance.

RESULTS

The OTF group had smaller cyst degeneration degree (P < .001), fewer black sponge sign (20% vs. 53.6%, P = .004), lower minimum apparent diffusion coefficient value (ADCmin) (0.986 (0.152) vs. 1.255 (0.370), P < .001), higher age (57.4 ± 14.2 vs. 44.1 ± 15.9, P = .001) and more postmenopausal women (72.5% vs. 28.6%, P < .001) than OAF. The area under the curve of MRI, clinical features and MRI combined with clinical features was 0.870, 0.841, and 0.954, respectively, and MRI combined with clinical features was significantly higher than the other two (P < .05).

CONCLUSION

The cyst degeneration degree, black sponge sign, ADCmin, age and menopause were independent factors in identifying OTF with cystic degeneration and OAF. The combination of MRI and clinical features has a good effect on the identification of the two.

ADVANCES IN KNOWLEDGE

This is the first time to distinguish OTF with cystic degeneration from OAF by combining MRI and clinical features. It shows the diagnostic performance of MRI, clinical features, and combination of the two. This will facilitate the discriminability and awareness of these two diseases among radiologists and gynaecologists.

Ovarian Cystadenofibroma: An Innocent Tumor Causing Early Postoperative Small Bowel Obstruction and Perforation Peritonitis

Ovarian serous cystadenofibroma (CAF) is a relatively uncommon variant of benign epithelial tumors of the ovary. It is frequently misdiagnosed as malignant ovarian mass, on both ultrasound (USG) and computed tomography (CT). Although most cases are easily treatable by surgery, some cases can present with life-threatening complications increasing patient morbidity and mortality. The present case report briefs about a 69-year-old female, P4 L4, who presented to the gynecology outpatient department with a complaint of pain in the lower abdomen for 2-3 months. USG and CT were suggestive of a suspicious-looking ovarian mass favoring malignancy. A staging laparotomy with pelvic and para-aortic lymphadenectomy with omental biopsy was done. Although the tumor was benign, extensive surgery, due to the suspicion of malignancy led to the patient developing early postoperative small bowel obstruction, mandating a re-exploration. CAF is a specific type of ovarian tumor that exhibits a combination of benign characteristics. This tumor presents as a partly cystic (containing fluid-filled sacs) and partly solid (composed of fibrous tissue) growth within the ovary, displaying a diverse architectural pattern. Mostly the diagnosis is incidental, on USG done for some other indication. CAF of the ovary needs a very high index of suspicion for diagnosis as these are frequently misdiagnosed as malignant ovarian masses. Although an innocent tumor, extensive surgery done for CAF, under suspicion for malignancy, can sometimes lead to serious complications.

Pictorial essay: MRI evaluation of endometriosis-associated neoplasms

Endometriosis is a frequent pathology mostly affecting women of young age. When typical aspects are present, the diagnosis can easily be made at imaging, especially at MRI. Transformation of benign endometriosis to endometriosis-associated neoplasms is rare. The physiopathology is complex and remains controversial. Endometrioid carcinoma and clear cell carcinoma are the main histological subtypes. Our goal was to review the main imaging characteristics that should point to an ovarian or extra-ovarian endometriosis-related tumor, especially at MRI, as it may be relevant prior to surgical management.Key points• Transformation of benign endometriosis to endometriosis-associated neoplasms is rare.• MRI is useful when displaying endometriosis lesions associated to an ovarian tumor.• Subtraction imaging should be used in the evaluation of complex endometriomas.

Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI

Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life.

MRI Appearance of a Giant Ovarian Sero-mucinous Cystadenofibroma Mimicking Ascites. A Case Report and Brief Literature Review

Introduction: Giant ovarian cystadenofibromas are rare, mostly benign tumors. In the early stages, they are asymptomatic; however, as they grow in size, they begin to produce symptoms, most often due to the compressive effects they exert on surrounding structures. In the early stages, they are frequently diagnosed by ultrasonography, but complicated cases or cystadenofibromas that reach giant dimensions are ideally evaluated by magnetic resonance imaging (MRI) to establish a therapeutic surgical decision that is as safe as possible for the patient.

Case report: We present the case of a 49-year-old perimenopausal patient without vaginal bleeding or other gynecological symptoms who presented to the hospital with abdominal pain and abdominal distension with increasing intensity. Ultrasound examination revealed the presence of a high volume of fluid in the abdomen, and MRI and histopathological examination confirmed the diagnosis of a giant left ovarian type III seromucinous cystadenofibroma. The patient was treated surgically, with favorable postoperative evolution.

Conclusion: Giant cystadenofibromas are rare clinical entities that must always be considered in the differential diagnosis of an abdominopelvic pathology in middle-aged female patients and should ideally be investigated by MRI to accurately define their origin, characteristics, and local invasion.

MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges

Borderline epithelial ovarian tumors are a distinct pathologic entity characterized by increased epithelial proliferation and nuclear atypia, but without frank stromal invasion. Borderline tumor (BT) is now considered to represent an intermediate phase in the stepwise progression from benign to malignant ovarian epithelial tumor. Since BTs commonly manifest at early stages in women of reproductive age and are associated with a good prognosis, making the correct diagnosis is important in determining whether a patient is a candidate for fertility-sparing surgery. There are six histologic BT subtypes (serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner), and each has different MRI features, reflecting their unique histologic architectures. Radiologists should be aware of the MRI features that can suggest BTs. These features include a hyperintense papillary architecture with hypointense internal branching, which can be observed with serous and seromucinous BTs on T2-weighted images; aggregates of microcysts that have hypointensity on T2-weighted images and reticular enhancement on contrast-enhanced T2-weighted images, which can be seen with mucinous BTs; and moderately high signal intensity on diffusion-weighted images along with relatively high apparent diffusion coefficient values, which can be observed regardless of the histologic subtype. Nevertheless, because the imaging features of BTs overlap with those of many benign lesions (eg, cystadenoma and cystadenofibroma, decidualized endometriosis, and polypoid endometriosis) and malignant tumors (ovarian cancers and metastases), histologic confirmation is required for the final diagnosis. Special emphasis is placed on the MRI features of BTs, pathologic correlation, and the challenges related to diagnosis. ^©RSNA, 2022.