Ovarian Serous Surface Papillary Borderline Tumor: Sea Anemone Sign

Abstract

HomeRadioGraphicsVol. 41, No. 7 PreviousNext Cases from the Cooky JarFree AccessOvarian Serous Surface Papillary Borderline Tumor: Sea Anemone SignC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargAuthor AffiliationsFrom the Department of Radiology, University of Alabama at Birmingham School of Medicine, 619 19th Street S, JT N338, Birmingham, AL 35249 (C.A.W.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (V.L.T.); and Department of Radiology, Seth GS Medical College and KEM Hospital, Parel Mumbai, Maharashtra, India (T.R.G.).Address correspondence to C.A.W. (e-mail: [email protected]).C. Austin Wheeler Ciléin KearnsValery L. TurnerTushar R. GargPublished Online:Nov 1 2021https://doi.org/10.1148/rg.2021210201MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In On the pathway from benign cystadenoma to malignant cystadenocarcinoma, borderline tumors represent a crucial entity within the spectrum of ovarian epithelial carcinogenesis. Of this class, serous borderline neoplasms represent the common subclass (65%) (1).One distinct sub-subclass is named serous surface papillary borderline tumor (SSPBT) for its unique (although not wholly exclusive) imaging features (2) (Figs 1–3). Macroscopically, its surface stroma frequently branches into exophytic papillary stalks; hence the name. When these cystic lesions form frondlike excrescences, they mimic the likeness of a sea anemone at MRI (1,2). Histopathologic analysis even recapitulates this architectural pattern with micropapillary tumor cell proliferation.Figure 1. Classically described sea anemone appearance of a borderline serous surface papillary tumor in a 52-year-old woman. (A) Axial postcontrast T1-weighted MR image of the pelvis demonstrates heterogeneous soft-tissue enhancement with multiple enhancing fronds (arrow). (B, C) Axial (B) and sagittal (C) T2-weighted MR images of the pelvis demonstrate a complex T2-hyperintense adnexal tumor with multiple papillary excrescences (arrow).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. (A, B) Gray-scale (A) and color Doppler (B) transvaginal US images in a 52-year-old woman (same patient as in Fig 1) show that this mass has internal echogenic content with a branching appearance (arrow in A) and internal vascularity (arrowhead in B). (C) Low-power photomicrograph (hematoxylin-eosin stain) used for histologic correlation shows that epithelial ovarian tumor cells grow as papillary structures (P) in a hierarchical fashion (large, medium, and small papillae). Tumor cells composing papillae are of serous type with eosinophilic cytoplasm and mild to moderate nuclear atypia. No mitotic activity is seen in this case. (Fig 2C courtesy of Longwen Chen, MD, PhD.)Figure 2.Download as PowerPointOpen in Image Viewer Figure 3. Medical illustration shows the sea anemone sign, which features papillary fingerlike projections with internal branching. Associated findings may include coarse calcifications, ascites, para-aortic lymphadenopathy, and spread to the peritoneum. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2021.)Figure 3.Download as PowerPointOpen in Image Viewer Preoperative detection at diagnostic imaging can be informative because less aggressive borderline tumors tend to carry a more favorable prognosis, potentially altering management. Early identification and treatment are vital, as these tumors commonly manifest in younger women of childbearing age who may benefit from fertility-sparing surgery (1).All authors have disclosed no relevant relationships.