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Endometriotic cyst. a, b Endometriotic cyst of the left ovary in a woman in her 40 s. It has a smooth wall and the inside of the cyst shows hypointense on coronal T2WI (a). The inside intensity of the cyst is higher than that of fat on T1WI (b). c Endometriotic cyst of
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There are many types of ovarian tumors, and these different types often form cystic masses with a similar appearance, which can make their differentiation difficult. However, with the exclusion of rare ovarian tumors, the number of ovarian tumors encountered in daily practice is somewhat fixed. It goes without saying that magnetic resonance imaging...
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... age have endometriosis in the pelvis [2]. The most common organ to show endometriosis is the ovary (17-65%), followed by uterine ligaments (3-69%) such as the uterosacral ligament and broad ligament, fallopian tubes (10-44%), and peritoneum (6.4-15.2%) [2]. On MRI, endometriotic cysts are observed as a unilocular or multilocular cystic mass (Fig. 2). The intensity of endometriotic cysts show equal to or higher than that of fat on T1WI. Endometriotic cysts show as hypointense to hyperintense on T2WI (Fig. 2) [15]. Occasionally, 'shading' on T2WI is seen as a finding of endometriotic cysts [14]. If the endometriotic lesion is in contact with the uterus, adenomyotic lesions that ...
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... the uterosacral ligament and broad ligament, fallopian tubes (10-44%), and peritoneum (6.4-15.2%) [2]. On MRI, endometriotic cysts are observed as a unilocular or multilocular cystic mass (Fig. 2). The intensity of endometriotic cysts show equal to or higher than that of fat on T1WI. Endometriotic cysts show as hypointense to hyperintense on T2WI (Fig. 2) [15]. Occasionally, 'shading' on T2WI is seen as a finding of endometriotic cysts [14]. If the endometriotic lesion is in contact with the uterus, adenomyotic lesions that infiltrate the myometrium of the uterus from the contact site may be present (Fig. 2). It should be noted that some tumors such as endometrioid carcinoma, clear ...
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... than that of fat on T1WI. Endometriotic cysts show as hypointense to hyperintense on T2WI (Fig. 2) [15]. Occasionally, 'shading' on T2WI is seen as a finding of endometriotic cysts [14]. If the endometriotic lesion is in contact with the uterus, adenomyotic lesions that infiltrate the myometrium of the uterus from the contact site may be present (Fig. 2). It should be noted that some tumors such as endometrioid carcinoma, clear cell carcinoma, and seromucinous borderline tumor originate from endometriotic lesions [2]. In these tumors, solid components with a contrast-enhancement effect are found on MRI [16], although there is no solid component in most cases of endometriotic ...
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... is an admixture of Mullerian cell types (including endometrioid, ciliated, mucinous, and hobnail types) in varying proportions [1,6]. The morphologic and behavioral features are shared with serous borderline tumor [6]. MRI findings reflect these pathological characteristics, and it appears as an endometriotic cyst with papillary mural nodules (Fig. 12) [39]. The mural nodules show as dendritic hypointensity with surrounding markedly hyperintense areas on T2WI (Fig. 12) [39,40]. This reflects the papillary architecture and internal branching pattern, a finding that is useful for differentiating it from endometrioid carcinoma and clear cell carcinoma, which also originate from ...
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... proportions [1,6]. The morphologic and behavioral features are shared with serous borderline tumor [6]. MRI findings reflect these pathological characteristics, and it appears as an endometriotic cyst with papillary mural nodules (Fig. 12) [39]. The mural nodules show as dendritic hypointensity with surrounding markedly hyperintense areas on T2WI (Fig. 12) [39,40]. This reflects the papillary architecture and internal branching pattern, a finding that is useful for differentiating it from endometrioid carcinoma and clear cell carcinoma, which also originate from endometriosis [40]. Although serous borderline tumor may show similar findings to seromucinous borderline tumor, the clues to ...
Citations
... This similarity complicates counseling for patients regarding treatment and follow-up, especially for young women seeking to preserve fertility. Magnetic resonance imaging serves as a second-line tool; however, it may encounter challenges in distinguishing between typical endometriosis and malignant potential [10,11]. ...
Endometriosis is a benign condition affecting women of reproductive age. A potential association with ovarian cancer has been documented. Atypical endometriosis (AE) is characterized by deviations from the typical microscopic appearance of endometriosis, including cytologic and architectural atypia. AE has been recognized as a potential precursor to endometriosis-associated ovarian cancers (EAOC), particularly endometrioid and clear cell subtypes. AE presents challenges in diagnosis due to its diverse clinical and pathological features, often requiring careful histological evaluation for accurate identification. Architectural AE, defined by localized proliferation of crowded glands with atypical epithelium resembling endometrial neoplasia, and cytologic AE, characterized by nuclear atypia within the epithelial lining of endometriotic cysts, are key subtypes. Immunohistochemical and molecular studies have revealed aberrant expression of markers such as Ki67, COX-2, BAF250a, p53, estrogen receptor, progesterone receptor, and IMP-3. Long-term follow-up studies suggest relatively low recurrence and malignant transformation rates among patients with AE, but uncertainties persist regarding its exact malignancy potential and optimal management strategies. Integration of artificial intelligence and shared molecular aberrations between AE and EAOC may enhance diagnostic accuracy. Continuous interdisciplinary collaboration and ongoing research efforts are crucial for a deeper understanding of the relationship between endometriosis and carcinogenesis, ultimately improving patient care and surveillance.
... CCC is visualized as a unilocular cystic lesion with polypoid mural nodules more frequently than EC [9]. EC represents as multilocular cystic lesions with large broad-based mural nodules entrapped within the locules [1,10,11]. The imaging feature "polypoid growth pattern of the mural nodule" has demonstrated an accuracy of 73.4% for discriminating CCC from EC [10]. ...
... The following MRI-based features of the solid component were interpreted and evaluated referring to SI of the myometrium: (1) growth pattern including polypoid, focal, or eccentric or large broad-based, multifocal, or concentric [9][10][11] (Fig. 3); (2) continuity of the mural nodules (defined as a tumor involving more than one-third of the wall; (3) margin of the solid component (smooth or irregular); (4) SI on T2WIs (hypo-intensity or iso-to hyper-intensity; (5) SI on unenhanced T1WIs (hypo-intensity or iso-to hyperintensity); (6) SI on contrast-enhanced T1WIs during arterial, portal venous, and equilibrium phases (hypo-intensity or iso-to hyper-intensity); and (7) SI on DWI (hypo-to isointensity or hyper-intensity). ...
Purpose
To retrospectively evaluate the diagnostic potential of magnetic resonance imaging (MRI)-based features and radiomics analysis (RA)-based features for discriminating ovarian clear cell carcinoma (CCC) from endometrioid carcinoma (EC).
Materials and methods
Thirty-five patients with 40 ECs and 42 patients with 43 CCCs who underwent pretherapeutic MRI examinations between 2011 and 2022 were enrolled. MRI-based features of the two groups were compared. RA-based features were extracted from the whole tumor volume on T2-weighted images (T2WI), contrast-enhanced T1-weighted images (cT1WI), and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator (LASSO) regression with tenfold cross-validation method was performed to select features. Logistic regression analysis was conducted to construct the discriminating models. Receiver operating characteristic curve (ROC) analyses were performed to predict CCC.
Results
Four features with the highest absolute value of the LASSO algorithm were selected for the MRI-based, RA-based, and combined models: the ADC value, absence of thickening of the uterine endometrium, absence of peritoneal dissemination, and growth pattern of the solid component for the MRI-based model; Gray-Level Run Length Matrix (GLRLM) Long Run Low Gray-Level Emphasis (LRLGLE) on T2WI, spherical disproportion and Gray-Level Size Zone Matrix (GLSZM), Large Zone High Gray-Level Emphasis (LZHGE) on cT1WI, and GLSZM Normalized Gray-Level Nonuniformity (NGLN) on ADC map for the RA-based model; and the ADC value, spherical disproportion and GLSZM_LZHGE on cT1WI, and GLSZM_NGLN on ADC map for the combined model. Area under the ROC curves of those models were 0.895, 0.910, and 0.956. The diagnostic performance of the combined model was significantly superior ( p = 0.02) to that of the MRI-based model. No significant differences were observed between the combined and RA-based models.
Conclusion
Conventional MRI-based analysis can effectively distinguish CCC from EC. The combination of RA-based features with MRI-based features may assist in differentiating between the two diseases.
... Và trong nhóm u giáp biên và ác tính chủ yếu thành phần u dạng hỗn hợp (cả thành phần đặc và dạng nang) lần lượt là 44,44% và 83,33%; phần tổ chức ngấm thuốc đều (33,33% và 58,33%) và xâm nhiễm phúc mạc và tạng khác (22,22% và 41,67%). Theo Ayumi Ohya và cộng sự, trên MRI tổn thương dạng dạng chủ yếu là các khối u buồng trứng lành tính như u nang huyết thanh, u nang chức năng, u nang biểu mô bề mặt, và lạc nội mạc tử cung, và tổn thương nang có thành phần rắn có nhiều khả năng là ác tính, nhưng một số có thể được chẩn đoán là lành tính [7]. 4.4. ...
Mục tiêu: Mô tả đặc điểm cận lâm sàng u biểu mô buồng trứng được phẫu thuật. Đối tượng và phương pháp nghiên cứu: Phương pháp mô tả hồi cứu các bệnh nhân u biểu mô buồng trứng được phẫu thuật trong năm 2022. Kết quả: Tuổi trung bình của nhóm bệnh nhân u lành tính là 37,0 ±15,8 thấp hơn so tuổi trung bình của nhóm bệnh nhân u ác tính là 48,8 ± 10,3. Đặc điểm trên siêu âm của u biểu mô buồng trứng nói chung là trống âm, giảm âm (78,64%) và có vách (31,72%); sự xuất hiện của phần tổ chức (hỗn hợp âm) tăng mức độ ác tính của khối u. Trên MRI/ CLVT u biểu mô buồng trứng có thành phần chủ yếu dạng dịch đồng nhất chiếm 49,33%, thành phần hỗn hợp và tổ chức ngấm thuốc chủ yếu trong u biểu mô ác tính chiếm 83,33% và 58,33%. Giá trị trung bình của CA125 và HE4 của nhóm lành tính nhỏ hơn nhóm ác tính có ý nghĩa thống kê. Mô bệnh học chiếm nhiều nhất của u biểu mô buồng trứng nói chung và u biểu mô ác tính nói riêng là u biểu mô thanh dịch. Kết luận: Khi có u buồng trứng, với bệnh nhân tuổi cao thì nguy cơ ác tính cũng cao hơn. Tính chất khối u hỗn hợp âm (phần đặc và phần dịch) trên siêu âm và thành phần hỗn hợp và tổ chức ngấm thuốc trên MRI/CLVT gợi ý nhiều đến u ác tính. Giá trị trung bình của CA125 và HE4 tăng theo mức độ ác tính của khối u. U biểu mô thanh dịch chủ yếu yếu trong u biểu mô buồng trứng nói chung và chiếm tỷ lệ ác tính cao nhất.
... Therefore, gynaecologists must perform a differential diagnosis between Bo/Ma-OTs and Be-OTs as accurately as possible before surgery. To ensure accurate classification of many types of ovarian tumours (OTs) at the same time, magnetic resonance imaging (MRI), considered one of the most reliable tools [6][7][8][9], is usually performed after the OT is detected by transvaginal ultrasound (TVUS) in an outpatient examination. At the study hospital, which is a moderate-scale regional institution, differential diagnosis is performed on the basis of MRI results. ...
... When the possibility of a Bo/Ma-OT is detected, laparoscopic salpingo-oophorectomy may be selected to prevent the spread of tumour cells. Similar to previous studies [6][7][8][9], this differentiation between Be-OTs and Bo/Ma-OTs is performed based on MRI interpretation at the study hospital. Over 8 years, data from > 1000 OT cases were accumulated and analysed to evaluate the algorithm for selecting the type of surgery. ...
Objective
For selecting minimally invasive surgery (i.e. laparoscopic ovarian cystectomy) for treating ovarian tumours (OTs) in premenopausal patients, the pre-operative differentiation of benign ovarian tumours (Be-OTs) based on magnetic resonance imaging (MRI) interpretation is important. This paper describes the authors’ 8-year experience of approximately 1000 OT cases, and provides information about a diagnostic algorithm to help other hospitals.
Study design
The medical records of 901 patients aged < 50 years with OTs from 1 January 2015–31 March 31 2023 were reviewed. First, the accuracy of pre-operative differentiation between Be-OTs and borderline/malignant ovarian tumours (Bo/Ma-OTs) was compared in each type of OT. Second, to identify the factors influencing differentiation between Be-OTs and Bo/Ma-OTs in 164 serous/mucinous ovarian tumours (SM-OTs), a multi-variate logistic regression analysis was performed to assess the effect of 13 factors, including MRI findings, OT size and tumour markers.
Results
In the comparison of diagnostic accuracy of pre-operative MRI for each OT type, accuracy was found to be notably high for ovarian endometrial cyst (OEC) (n = 409), ovarian mature cystic teratoma (OMCT) (n = 308), ovarian endometrioid adenocarcinoma (OEA) (n = 6) and ovarian clear cell adenocarcinoma (OCCA) (n = 14). On the other hand, discrepancies between MRI and pathological findings often occurred in SM-OTs, including ovarian serous cystadenoma (n = 86), ovarian mucinous adenocarcinoma (n = 61), ovarian serous adenocarcinoma (n = 12) and ovarian mucinous adenocarcinoma (n = 5). In the multi-variate logistic regression analysis of the latter 164 patients, in addition to MRI findings, OT size and carbohydrate antigen 125 also had an effect to some extent. The combination of MRI interpretation and OT size may enhance differentiation of Be-OTs and Bo/Ma-OTs.
Conclusions
Among four types of OTs (OEC, OMCT, OEA and OCCA), MRI interpretation was able to differentiate between Be-OTs and Bo/Ma-OTs almost perfectly. Additionally, to mitigate the difficulty in differentiating SM-OTs, OT size may be useful in combination with MRI findings, although further accumulation and analysis of OT cases is needed.
... MRI is the imaging modality with the highest tissue resolution. It is the method of choice in the differentiation of primary ovarian tumors as well as in the diagnosis of metastatic lesions [24][25][26][27]. ...
Simple Summary
Epithelial ovarian cancer (EOC) has always been considered one of the most challenging problems for gynecologic oncologists. This is not only due to difficulties in treatment, but also in the diagnosis and differentiation of this malignant tumor. MR imaging techniques, combined with diffusion-weighted imaging (DWI) or dynamic contrast enhancement (DCE), make it possible not only to identify the exact location of lesions, but also to identify the types of EOC. In our study, we described the characteristics of a rare ovarian malignancy, mucinous ovarian cancer (MOC), on MRI. We compared the DWI and DCE values for MOC and more or less aggressive histological types of EOC, such as high-grade serous carcinoma (HGSC) (type I and type II) as well as the low-grade serous carcinoma (LGSC) (both type I).
Abstract
(1) Background. The purpose of this study is to evaluate the diagnostic accuracy of a quantitative analysis of diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI of mucinous ovarian cancer (MOC). It also aims to differentiate between low grade serous carcinoma (LGSC), high-grade serous carcinoma (HGSC) and MOC in primary tumors. (2) Materials and Methods. Sixty-six patients with histologically confirmed primary epithelial ovarian cancer (EOC) were included in the study. Patients were divided into three groups: MOC, LGSC and HGSC. In the preoperative DWI and DCE MRI, selected parameters were measured: apparent diffusion coefficients (ADC), time to peak (TTP), and perfusion maximum enhancement (Perf. Max. En.). ROI comprised a small circle placed in the solid part of the primary tumor. The Shapiro–Wilk test was used to test whether the variable had a normal distribution. The Kruskal–Wallis ANOVA test was used to determine the p-value needed to compare the median values of interval variables. (3) Results. The highest median ADC values were found in MOC, followed by LGSC, and the lowest in HGSC. All differences were statistically significant (p < 0.000001). This was also confirmed by the ROC curve analysis for MOC and HGSC, showing that ADC had excellent diagnostic accuracy in differentiating between MOC and HGSC (p < 0.001). In the type I EOCs, i.e., MOC and LGSC, ADC has less differential value (p = 0.032), and TTP can be considered the most valuable parameter for diagnostic accuracy (p < 0.001). (4) Conclusions. DWI and DCE appear to be very good diagnostic tools in differentiating between serous carcinomas (LGSC, HGSC) and MOC. Significant differences in median ADC values between MOC and LGSC compared with those between MOC and HGSC indicate the usefulness of DWI in differentiating between less and more aggressive types of EOC, not only among the most common serous carcinomas. ROC curve analysis showed that ADC had excellent diagnostic accuracy in differentiating between MOC and HGSC. In contrast, TTP showed the greatest value for differentiating between LGSC and MOC.
This is a rare case of struma ovarii combined with sarcomatoid carcinoma. Whether it's struma ovarii or ovarian sarcomatoid carcinoma, the incidence of both is extremely low and rarely reported, so there are no clear guidelines for either disease and to our knowledge this may be the first case of combined occurrence of both. Therefore, this report describes its clinical manifestations, diagnosis and treatment, analyzes the pathogenesis, and summarizes the previous literature in the hope that it can be helpful to other tumor-related medical personnel and provide material support for the formation of guidelines in this disease.
This is a rare case of struma ovarii combined with sarcomatoid carcinoma. Whether it's struma ovarii or ovarian sarcomatoid carcinoma, the incidence of both is extremely low and rarely reported, so there are no clear guidelines for either disease and to our knowledge this may be the first case of combined occurrence of both. Therefore, this report describes its clinical manifestations, diagnosis and treatment, analyzes the pathogenesis, and summarizes the previous literature in the hope that it can be helpful to other tumor-related medical personnel and provide material support for the formation of guidelines in this disease.
