5. Ovarian Cancer

Question 1

Think Cancer if

Answer 1

Complex cystic adnexal masses + thick (> 3mm) septations + papillary projections (nodule with flow)

Solid + necrosis

with Ascites, invasive spread, Lymphadenopathy

Question 2

Multiple thin or thick septations =

Answer 2

Call the surgeon

Question 3

Nodule with flow =

Answer 3

Call the surgeon

Question 4

Solid nodule without flow =

Answer 4

MR - make sure it’s not dermoid
If dermoid = call surgeon

Question 5

Answer 5

Serous ovarian Neoplasm / Cystadenocarcinoma / Cystadenoma

Large + unilocular + few septations

Question 6

most common type of ovarian malignancy

Answer 6

Serous ovarian

Question 7

What finding is suggestive of malignancy

Answer 7

Papillary projection

Question 8

Answer 8

Mucinous Ovarian Cystadenocarcinoma

Multiloculated
Papillary projection less common
+ low level echoes (Mucin)

Question 9

Can get Pseudomyxoma peritonei with scalloping along solid organs

Answer 9

Mucinous ovarian Cystadenocarinoma

Question 10

Ovarian mass + Enometrial thickening =

Answer 10

1. Endometrioid CA = ovarian + endometrial CA (ovarian = mets)
2. Granulosa-Theca Cell Tumor = estrogen producing leading to endometrial hyperplasia

Question 11

This is the second most common ovarian cancer

Answer 11

Endometrioid ovarian Ca

1st - serous
3rd - mucinous

Question 12

What to know about endometrioid ovarian Cancer

Answer 12

• 25% of women will have concomitant endometrial cancer, with the endometrial cancer as the primary (ovary is met).
• Endometriomas can turn into endometrioid cancer \
• 15% are bilateral

Question 13

It’s useful to have a differential for a B.F.M. (Big Fucking Mass) in an adult and a child

For adults think about 3 main things:

Answer 13

1. Ovarian masses - Mucinous and Serous
2. Desmoids - remember Gardner Syndrome
3. Sarcomas

Question 14

Benign ovarian tumor similar to a fibroid + middle aged women

Answer 14

Fibroma/Fibrothecoma

Question 15

Answer 15

Fibroma/Fibrothecoma

Dark T1/T2 with a band of T2 dark signal around the tumor on all planes

Question 16

Answer 16

Fibromatosis

“black garland sign”

Dark T1 and T2

Question 17

Dark T1/T2 Fibrous ovarian tumor =

Answer 17

Fibroma/Fibrothecoma

Question 18

Dark T1/T2 Fibrous ovarian tumor + Calcifications =

Answer 18

Brenner Tumor

Question 19

Dark T1/T2 Fibrous ovarian tumor + Omental fibrosis + sclerosis peritonitis

Answer 19

Fibromatosis

Question 20

Meig’s Syndrome triad

Answer 20

1. Ascites
2. Pleural effusion
3. BEnign ovarian tumor (most commonly fibroma - black garland)

Question 21

Answer 21

Struma Ovarii

Very low T2 signal in the “cystic” areas

multilocular, predominantly cystic mass with an INTENSELY enhancing solid component.

Question 22

“Contains THYROID TISSUE”

+ hyperthyroid/thyroid storm

Answer 22

Struma Ovarii

Question 23

% of mets in the ovary

Answer 23

10%

The primary is most commonly from colon, gastric, breast, lung, and contralateral ovary. The most common look is bilateral solid tumors.