Characterization of Ovarian Granulosa Cell Tumors using Magnetic Resonance Imaging

PURPOSE

To identify the MRI features that aid in the characterization of ovarian granulosa cell tumors.

MATERIALS AND METHODS

11 MR pelvis of an adult woman with pathology-proven ovarian granulosa cell tumors with surgical pathology.We evaluated the patient's age, Ca-125, size, laterality, and with MRI features such as indirect signs (i.e., thickened endometrium > 0.9 cm), morphology (cystic, solid-cystic, or solid), subacute hemorrhage, T2 signal (low or intermediate-to-high), restricted diffusion (B values: 0, 50, 1000 sec/mm3/ADC), and dynamic enhancement (intense or similar to myometrium). Also, the presence of ascites, peritoneal implants, or adenopathy.

RESULTS

The final cohort included 11 women with a surgical-pathological diagnosis of granulosa cell tumors. The median age was 52.4 years (range, 17-80). The Ca-125 level was with a median within normal limits. The median size was 9.4 cm. Most cases were unilateral (81.8%) and more frequent on the left (54.5%).

MRI ANALYSIS

36.4% had endometrial thickening. Ovarian granulosa cell tumors were polymorphous: cystic (54.6%), mixed solid-cystic (9.1%), and solid (36.3%). Most GC had intermediate to high signal on T2 (90.9%), restricted diffusion (81.8%), intense enhancement (81.8%), and 36.4% had intraparenchymal bleeding. 9.1% had associated implants/adenopathy/ascites at diagnosis.

CONCLUSION

The MRI features characteristic of ovarian granulosa cell tumors were the polymorphous morphology, an intense enhancement to the myometrium, restricted diffusion, and the presence of intraparenchymal hemorrhage.

[Magnetic resonance imaging accuracy and utility for testicular cancer diagnosis]

PURPOSE

The purpose of our study is to analyze the imaging findings described in MRI and the histopathologic type of testicular lesions to determine which findings are the best predictors of malignancy.

MATERIALS AND METHODS

Forty six (46) patients with testicular lesions were initially studied with ultrasound (US) and with testicular MRI (tMRI) on a 1.5-T magnet. MRIs were reviewed by a radiologist with 8 years of experience and imaging findings such as the size of the lesion, the signal intensity in T1, T2 weighted sequences, and the enhancement after endovenous contrast administration, were correlated with the histopathologic diagnosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.

RESULTS

The enhancement after administration of contrast was the finding of better performance with a sensitivity, specificity, PPV and NPV of 90 (71-97), 47 (24-71), 74 (56-87) and 73 (40-92), respectively. Meanwhile, the results for hypointense/heterogeneous lesions in T2 weighted sequences and with enhancement with intravenous contrast were 87 (49-84), 47 (44-89), 74 (55-86) y 67 (35-89), respectively.

CONCLUSION

The finding of a testicular lesion of low signal intensity and heterogeneous in T2 weighted sequences, with IV contrast enhancement represents a valuable predictor of malignancy. The latter being the most sensitive as a predictor of malignancy.

[Cerebral embolism as an atypical presentation of May Thurner syndrome]

May-Thurner syndrome is an anatomic abnormality that predisposes patients to increase risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery and lumbar spine. This may lead to deep venous thrombosis and paradoxical embolism that could provoke cerebral ischemia in patients with a cardiac shunt from right-to-left. Embolic cerebral ischemic event is reported in a 30-year-old man after sexual intercourse. Further studies revea led suggestive findings of May-Thurner syndrome coupled with a patent foramen ovale and a factor V Leiden thrombophilia. He was placed on anticoagulation therapy and has not had any recurrent events.

Self limiting sternal tumors of childhood: two case reports

Sternal tumours are rare in children. The differential diagnoses include a wide spectrum of benign (from bone cyst to osteoblastoma, osteochondroma and fibrous displasia) and malignant tumours (Ewing's sarcoma, chondrosarcoma rhabdomyosarcoma), inflammatory lesions and infectious processes. The SELSTOC (Self Limiting Sternal Tumours of Childhood) are entities of non-specific origin, they are self-limiting and characterised by a rapidly growing tumour that disappears spontaneously with no history of trauma or active infection. The onset of a rapidly growing mass with no preceding trauma is worrying to parents who then consult the health professionals. Soft tissue ultrasound enables us to characterise these lesions and define their nature in relation to the adjacent tissues. Chest x-ray and MRI can also help to characterise these lesions. In this paper we present two case reports of children referred to our department for characterisation of sternal tumours.