Cystic ovarian tumor

When no or only small amounts of fat are present (8%), dermoids are not distinguishable from benign cystic ovarian tumors or ovarian cancer (Fig. 9.28) [75]. 

Fig. 10.28. Juvenile type of granulosa cell tumor. CT in a 17-year-old girl who presented with primary amenorrhea. A large, well-defined cystic ovarian tumor with multiple irregular septations and solid areas is demonstrated in the midpelvis. Small amounts of ascites (asterisk) without evidence of peritoneal seeding at surgery...

Ovarian cancer patients with progressed disease often present with ascites/ peritoneal fluid. In some women, ovarian cysts are detected containing cystic fluid. The concentrations of suPAR in these body fluids were compared with those in serum made from peripheral blood and blood aspirated from the surface veins on the tumor in 77 patients admitted for surgery of ovarian tumors [21]. In this study, elevated levels of suPAR were measured in serum from peripheral blood and tumor blood in the patients with more advanced disease. However, the concentrations of suPAR in the body fluids were quite different, in serum the measured concentrations were between 46 and 98 pmol/liter, in ascites/peritoneal fluid concentrations were between 293 and 586 pmol/liter, and in cystic fluids the concentrations were even higher, that is 651-8468 pmol/liter. The concentrations of suPAR in cystic fluids clearly separated benign and malignant cysts with predictive values above 90%. The levels of suPAR in cystic fluids could therefore be used in the early diagnosis of ovarian cancer patients. The suPAR in the cystic fluids was present both in intact and cleaved forms and at least some of the suPAR(I-III) was not occupied by uPA [21]. In another study, tumor tissue, serum, ascites, and urine from ovarian cancer patients were analyzed for their content of the different uPAR forms. Whereas all of tumor lysates, ascites, and urine contained uPAR(I-III) and uPAR(II-III), domain I was only present in urine samples. In serum, only intact suPAR was detected [82], The antibodies used for identification were mAb R3 (domain I) and mAb R2 (domain III). 

Nichols GE, Mills SE, Ulbrij t TM, et al. Spindle cell mural nodules in cystic ovarian mucinous tumors A clinicopathologic and immunohistochemical study of five cases. Am J Surg Pathol. 1991 15 1055-1062. 

Fig. 9.12. Granulosa cell tumor. A 52-year-old female with a history of hysterectomy and unilateral oophorectomy for granulosa cell tumors several years before. A solid and cystic pelvic tumor with irregular margins displacing bowel loops is seen at the acetabular level. From imaging, it cannot be differentiated from an ovarian cancer...

Cystadenofibromas account for 1.7% of ovarian tumors. They are benign serous ovarian tumors that display as cystic tumors with variable amounts of fibrous stroma. They can also be purely cystic with small foci of stroma detected microscopically. The margin tends to be well defined and smooth. Endocrine activity is not found. 

Carcinoid tumors are frequently associated with a mature cystic teratoma or a mucinous ovarian tumor. Unlike most cystic teratomas, they are predominantly found in postmenopausal women. The course is usually benign rarely will metastases be found. Carcinoid syndrome is uncommon. 

Brenner tumors present rare ovarian tumors that occur at a mean age of 50 years. Brenner tumors constitute l%-3% of ovarian tumors. They are mostly henign, with less than 2% demonstrating borderline or malignant transformation. They are typically small, solid, unilateral ovarian tumors, with 60% of these tumors found under 2 cm in size. Extensive calcification may he observed. The vast majority is discovered incidentally in pathologic specimen of the adnexa. Brenner tumors rarely produce estrogen, and then they may be associated with endometrial thickening [87]. If cystic components are found in Brenner tumors, they may be associated with cystadenomas [88]. Up to 20% of Brenner tumors are associated with mucinous cystadenomas or other epithelial neoplasm (Fig. 9.34). 

Fig. 10.3. Papillary projections in ovarian cancer. On a parasagittal T2-weighted image, a cystic ovarian lesion with sep-tations and multiple papillary projections is demonstrated. Some small isolated papillary projections are located at the base of the lesion arrow). At the top, a 1.5-cm papillary projection protrudes into the fluid-filled cavity. At the posterior aspect of the tumor, septal wall thickening and coalescence of papillary projections forming hroad-based formations (long arrow) is demonstrated. Papillary projections typically display low signal intensity on T2-weighted image. B, bladder...

Fig. 10.4. Calcifications in ovarian cancer. Multiple plaquelike calcifications are demonstrated within a mixed solid and cystic bilateral ovarian tumor. They also cloak the peritoneal surface of the uterus (U). These small calcifications present psammoma bodies and are found in approximately 10% of serous ovarian adenocarcinomas in CT.B, bladder...

Fig. 10.12. Pelvic sidewall invasion. Transaxial CT at the level of the iliac bifurcation. A mixed solid and cystic adnexal tumor, which was nondifferen-tiated ovarian cancer at histopathology, is located in the pelvis. The left pelvic sidewall, including iliac vessels and psoas muscle, are clearly separated by fat. The right pelvic sidewall (arrow) is in direct contact with the solid tumor component. Furthermore, external and internal iliac arteries are displaced, the latter is encased by tumor (arrowhead)...

Confident distinction between primary and metastatic ovarian cancers is not possible because of overlapping findings in imaging. Bilateral, sharply delineated, purely solid or predominantly solid tumors with necrosis strongly favor the diagnosis of a metastatic ovarian tumor, most likely Krukenberg tumors [68]. Contrast uptake aids in the differentiation of solid ovarian metastases from stromal tumors. Stromal tumors typically display a mild and delayed contrast uptake [69]. If metastases are cystic... 

Extreme clinical examples of androgen excess include central precocious puberty, the adrenogenital syndromes, and androgen-secreting adrenal, ovarian, or testicular tumors. Less severe problems include idiopathic hirsutism, premenstrual syndrome, and severe cystic acne. 

Vang R, Gown AM, Zhao C, et al. Ovarian mucinous tumors associated with mature cystic teratomas Morphologic and immunohistochemical analysis identifies a subset of potential teratomatous origin that shares features of lower gastrointestinal tract mucinous tumors more commonly encountered as secondary tumors in the ovary. Am J Surg Pathol. 2007 31 854-869. 

The imaging features are nonspecific and may be similar to malignant tumors or borderline tumors. Variable amoimts of fibrous stroma in ovarian cystadenofibromas produces imaging features that vary from purely cystic to a complex cystic tumor with one ore more solid components (Fig. 9.27). In one series of 32 ovarian cystadenofibromas, 50% displayed as multiloculated masses identical to cystadenomas. The other half were complex cystic tumors with one or more solid components and smooth thickened septa [70]. 

Teratomas are the most common ovarian neoplasm in women under 45 years of age, and account for up to 70% of tumors in females less than 19 years of age [67]. Ovarian teratomas derive from germ cells and are classified into three main categories, among vdiich the mature cystic teratomas account for 99%. Less common types of mature teratomas are the monodermal teratomas, which include the struma ovarii and carcinoid tumors. It is typical for monodermal teratomas not to be cystic but contain... 

Fig. 9.31. Collision tumor of the ovary. CT at the level of the mid pelvis in a 65-year-old woman with sonographically suspected ovarian cancer. A cystic right adnexal mass is demonstrated showing multiple thin septa-tions and a 3-cm lesion with fat density and mural calcifications (asterisk). Pathologically, a collision tumor composed of a benign mucinous cystadenoma and a benign dermoid was diagnosed...

Sclerosing stromal cell tumors tend to be well encapsulated multiloculated cystic or heterogenous ovarian lesions (Fig. 9.35). On T1 and T2-weighted images, a... 

Fig. 10.11. Rectal wall invasion. Trans-axial T2-weighted image. A cystic and solid left ovarian cancer arrow) compresses bladder (B) and rectum (R).The latter shows broad contact with the solid tumor component located in the cul-de-sac. B, bladder...

Endometrioid carcinomas represent 8% of all ovarian carcinomas. They occur with synchronous endometrial carcinomas or endometrial hyperplasia in up to 33% of cases [39]. Furthermore, an association with breast cancer has been reported [2]. Rarely, endometrioid carcinoma may arise from endometriosis [40]. Bilateral ovarian involvement is encountered in 30%-50% of cases. Macroscopically, these tumors are solid and cystic, the cysts may contain mucinous or greenish fluid. Rarely, solid tumors with extensive hemorrhage or necrosis may be found [2]. 

Metastatic cancers different from Krukenberg tumors may have a variable appearance resembling other malignant ovarian lesions with cystic and mixed cystic and solid patterns [64,67]. 

Colon cancer metastases commonly present as unilateral or bilateral, multiloculated, predominantly cystic tumors (Fig. 10.31) [63]. Presence of nodules or multi-nodularity at the ovarian surface may also be a sign of metastatic ovarian involvement Ascites may be present The presence of another tumor outside the ovaries should warrant the diagnosis of metastases to the ovaries if the pattern of spread is atypical for ovarian cancer. In particular, the presence of pulmonary and hepatic metastases in absence of extensive peritoneal... 

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