Radiologic Findings of Malignant Tumors Arising from Ovarian Endometriosis

Abstract

Purpose : To determine the radiologic characteristics of malignant tumors arising from ovarian endometriosis.Materials and Methods : The radiologic findings of eleven patients with pelvic masses histologically confirmed as malignant ovarian tumors arising from endometriosis were retrospectively reviewed. All patients underwent MR, and six underwent ultrasonography. The findings were evaluated with regard to tumor size and shape, locularity, thickness and enhancement of the wall and septa, the presence of papillary nodule or solid portion, signal intensity of the locule, the presence of mass in contralateral ovary, ascites, local invasion, distant metastases, and the Pathologic diagnosis included clear cell carcinoma in six cases, endometrioid carcinom in three, and mucinous cystadenocarcinoma of borderline malignancy and endometrial stromal sarcoma in one case each.Results : Tumor size ranged from 8 to 20 (mean, 12.7) cm. The tumors were mixed in four cases, entirely cystic in three, predominantly cystic in three, and predominantly solid in one. Six cases were unilocular and five were multilocular. The wall and septa varied in thickness and regularity and were well enhanced in all but one case. In all cases papillary nodules or solid portions with similar enhancement to uterine myometrium were seen. On T1WI, the signal intensity of fluid was seen to be high in eight cases, low or intermediate in two, andof differing intensity in one. Ten cases showed high signal intensity on T2WI, whereas in one case in which high signal intensity was seen on T1WI, there was low signal intensity(shading). In threee cases the contralateral ovary contained an endometrioma. Other features included ascites in seven cases and peritoneal seeding in one.Conclusion :Malignant ovarian tumors arising from endometriosis showed radiologic features of malignancy: they were larger than 10cm, there was enhancement of the wall and septa, and a papillary nodule or solid portion was present. However, the presence of hyperintense fluid, as seen on T1WI, as well as shading, differing signal intensity, a non-enhanced wall and septa, and endometriosis on the contralateral ovary suggests that a malignant tumor may arise from an underlying endometrioma.