OBG Radiology Case - Ovarian Tumors

Question 1

What are the common ovarian masses?

Answer 1

1. Ovarian cyst
2. Germ cell tumors including dermoid cyst and teratoma
3. Other ovarian cancers

Question 2

What are the useful imaging modalities in evaluating an ovarian mass?

Answer 2

1. Pelvic U/S
2. MRI
3. Pelvic CT

Question 3

What is the primary way to evaluate pelvic masses?

Answer 3

Ultrasound (TV is most accurate, but TA can be complementary); Doppler is a useful adjunct

Question 4

What is the utility of MRI in evaluating an ovarian mass?

Answer 4

Solid vs. cystic; determine organ of origin

Question 5

MRI can distinguish benign from malignant ovarian masses with ___% accuracy.

Answer 5

91

Question 6

What is the utility of CT in evaluating an ovarian mass?

Answer 6

Useful to evaluate the extent of metastatic disease in known/suspected ovarian cancer; not indicated for the primary evaluation of adnexal masses

Question 7

What is the appropriateness criteria for clinically suspected adnexal masses?

Answer 7

TV and TA U/S with Doppler is the test of choice. MRI is useful for further characterizeation of adnexal masses, while CT is rarely indicated for primary evaluation

Question 8

What are the imaging findings of ovarian cysts on U/S?

Answer 8

Simple cysts are characterized by anechoic fluid filling the cyst cavity + thin walls

If recently ruptured, one will see fluid in the pelvis. If there are echoes within the cyst it may be from hemorrhage.

Question 9

What are the radiologic findings of a malignant ovarian mass?

Answer 9

Any solid component on U/S is a possible feature of malignancy, especially a complex cystic and solid mass. A thick wall can be sign, but some benign cysts also have a thick wall. Solid components are more likely to have centrally located detectable flow on color Doppler.

Question 10

What are ovarian teratomas?

Answer 10

Germ cell tumors comprised of multiple cell types derived from 1 or more of 3 germ layers. They are almost always benign and occur frequently during reproductive years.

Question 11

What are dermoid cysts?

Answer 11

Mature cystic teratoma composed of developmentally mature skin with hair follicles and sweat glands, sometimes clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Because it contains mature tissue, it is almost always benign.

Question 12

What are the imaging findings in dermoid cysts and ovarian teratomas?

Answer 12

• Predominantly cystic mass that may be unilocular or multilocular
• May contain calcifications with acoustic shadows, hyperechoic lines (dermoid mesh), fat-fluid level, echogenic solid nodule (dermoid plug), “tip-of-the-iceberg” sign

Question 13

What do hyperechoic lines (dermoid mesh) on imaging of a dermoid cyst represent?

Answer 13

Hair floating in fluid

Question 14

What is a dermoid plug?

Answer 14

Echogenic solid nodule which may contain calcific, dental, adipose, hair, and/or sebaceous components

Question 15

What is the “tip-of-the-iceberg” sign?

Answer 15

Prominent acoustic shadows produced by highly echogenic hair and sebum

Question 16

What is seen on CT and MRI of dermoid cysts/ovarian teratomas?

Answer 16

Calcifications with foci of fat

Question 17

What is the clinical presentation of an ovarian mass?

Answer 17

• Pressure symptoms, including urinary frequency, pelvic discomfort, and constipation
• Abdominal swelling with fatigue and abdominal pain (most common symptoms)
• Irregular vaginal bleedi
• Virilization with Sertoli-Leydig cell tumors, which may secrete androgens (Nb - granulosa cells secrete estrogens)