Abstract
PurposeTo probe the magnetic resonance imaging (MRI) features of ovarian clear cell carcinoma (OCCC).MethodsThis study retrospectively collected MRI data for 21 pathology-confirmed OCCCs from 19 female patients. The MRI findings were analyzed to determine the tumor size, shape/edge, shape and number of protrusions within the cyst, cystic or necrotic components, signal intensity (SI) and enhancement features.ResultsThe age of the 19 patients ranged from 28 to 63 years (mean age: 53 years). Unilateral tumors were found in 17 patients (17/19, 89%); the average size of all tumors was 10.8 cm. The tumors on MRI were classified into two categories: (a) “cystic adnexal mass with solid protrusions” in 12 (57%) and (b) “solid adnexal mass with cystic areas or necrosis” in 9 (43%). For group a, high to very high SI was observed for most tumors (10/12, 83%) on T1-weighted images (T1WIs), and very high SI was observed on T2-weighted images (T2WIs) for all 12 tumors. Most solid protrusions were irregular and few in number and exhibited heterogeneous intermediate SI on T1WIs and T2WIs and prolonged enhanced SI in the contrast study. All 9 OCCCs in group b were predominantly solid masses with unequally sized necrotic or cystic areas in which some cysts were located at the periphery of the tumor (4/9, 44%). The solid components in all 9 tumors showed iso- or slightly high SI on T1WIs, heterogeneous iso-high SI on T2WIs and heterogeneous prolonged enhancement. According to FIGO classification, 14 tumors (14/19, 74%) were stages I-II, and 5 (5/19, 26%) were stages III-IV.ConclusionsOn MRI, OCCCs present as large unilateral multilocular or unilocular cystic masses with irregular intermediate SI solid protrusions or predominantly solid masses with cysts or necrosis at an early FIGO stage.
Highlights
Ovarian cancer, one of the most lethal cancers in women, is second only to endometrial carcinoma as the most common gynecological malignancy
The tumors on magnetic resonance imaging (MRI) were classified into two categories: (a) “cystic adnexal mass with solid protrusions” in 12 (57%) and (b) “solid adnexal mass with cystic areas or necrosis” in 9 (43%)
High to very high signal intensity (SI) was observed for most tumors (10/12, 83%) on T1weighted images (T1WIs), and very high SI was observed on T2-weighted images (T2WIs) for all 12 tumors
Summary
One of the most lethal cancers in women, is second only to endometrial carcinoma as the most common gynecological malignancy. 90% of ovarian cancers are epithelial in origin, and subtypes of these tumors include serous, mucinous, endometrioid, clear cell, and undifferentiated tumors[1, 2]. Ovarian clear cell adenocarcinoma (OCCC) is a subgroup of primary epithelial ovarian carcinoma (EOC). In 1973, the World Health Organization (WHO) recognized OCCCs as a distinct histological type of epithelial ovarian neoplasm and defined OCCCs as tumors with clear cells growing in solid, tubular or glandular patterns and with hobnail cells lining the cysts and tubules[3]. The WHO updated the definition of OCCC in 2003 to describe a neoplasm composed of clear cells growing in a solid, tubular or papillary pattern with hobnail cells lining the tubules and cysts[4]. The characterization of an ovarian mass is of the utmost importance in the preoperative evaluation of an ovarian neoplasm because it enables the surgeon to anticipate an ovarian carcinoma or predict the type of ovarian carcinoma prior to surgery so that adequate procedures can be planned[7]
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