Solid Ovarian Lesions Research Articles

T2-weighted imaging hypointensity in an ovarian lesion: is it a benign finding?

ABSTRACTObjective To evaluate whether the presence of a hypointense signal at T2-weighted imaging in a solid ovarian lesion on magnetic resonance imaging is a predictor of stability and benignity.Methods This is a single center study, prospectively read with retrospective acquired data. The database was searched for patients who underwent magnetic resonance imaging between January 2008 and October 2019 and whose reports mentioned solid ovarian lesions with low signal on T2-weighted imaging. A total of 47 nodules were included. A radiologist who was blinded to the clinical indication for magnetic resonance imaging and original reports evaluated the cases. Objective and subjective criteria of ovarian lesions in magnetic resonance imaging were evaluated.Results Thirty-five nodules were considered benign/stable and 12 were considered non-stable. The analysis showed that the non-stable lesions showed statistically more hyperintensity at T1-weighted imaging compared to the stable lesions.Conclusion T2-weighted imaging hypointensity can be considered a predictor of stability in solid ovarian lesions when associated with iso/hypointensity in T1-weighted imaging.

Diagnosis And Treatment of Benign Ovarian Tumors

The most common disorders of the ovaries are benign ovarian tumors which occur with an 80% incidence in women compared to malignancies. The incidence of benign ovarian tumors with cystic type in Indonesia in 2015 occurred as many as 23,400 people with a death rate of 13,800 people. In connection with this incident, there are several risk factors associated and the symptoms that occur are usually common such as gastrointestinal symptoms, urinary frequency, and constituent symptoms so that a proper diagnosis is needed by doing anamnesis, physical examination and supporting examinations. Supporting examinations can be done by ultrasound, MRI, X-rays and blood tests with tumor markers CA-125 where in malignant ovarian tumors, the tumor marker CA-125 increases, which is >35 IU/ml. Management of benign ovarian tumors is generally done through observation and also surgery depending on the degree of severity. The surgery that is usually performed is either partial surgery or radical surgery. Surgery is indicated if there are several indications such as cystic ovarian structures measuring more than 5 cm that have been observed for 6 - 8 weeks without regression, solid ovarian lesions, ovarian lesions with papillary vegetation on the cyst wall, and other indications as well.

Ovarian fibromatosis: “The black garland sign”

The main objective in the imaging differential diagnosis of an ovarian mass is to establish whether it is cystic or solid; solid lesions are less common. Ovarian fibromatosis is a benign disease of the ovary that is rarely included in the differential diagnosis of solid ovarian lesions. Characteristic features of masses that have a fibrous component are low signal in T1-weighted MRI sequences and especially in T2-weighted MRI sequences. The presence of peripheral fibrotic tissue around the residual ovarian tissue is specific to ovarian fibromatosis; on MRI, this results in marked hypointensity on T2-weighted images that has been dubbed the “black garland sign”. This sign, together with slight peripheral enhancement after the administration of contrast material and the preservation of the ovarian architecture, facilitates the diagnosis, making it possible to avoid unnecessary surgical interventions.

Fibromatosis ovárica: “signo de la guirnalda negra”

The main objective in the imaging differential diagnosis of an ovarian mass is to establish whether it is cystic or solid; solid lesions are less common. Ovarian fibromatosis is a benign disease of the ovary that is rarely included in the differential diagnosis of solid ovarian lesions. Characteristic features of masses that have a fibrous component are low signal in T1-weighted MRI sequences and especially in T2-weighted MRI sequences. The presence of peripheral fibrotic tissue around the residual ovarian tissue is specific to ovarian fibromatosis; on MRI, this results in marked hypointensity on T2-weighted images that has been dubbed the “black garland sign”. This sign, together with slight peripheral enhancement after the administration of contrast material and the preservation of the ovarian architecture, facilitates the diagnosis, making it possible to avoid unnecessary surgical interventions.

The Added Value of Dynamic Contrast Enhanced MRI Semiquantitative Parameter in Discrimination of Ovarian Lesions

AbstractBackground: Ovarian tumors are one of the most common women cancers. The high vascularity of malignant ovarian tumors can be assessed by the dynamic contrast enhanced MRI allowing preoperative characterization of ovarian lesions which help for planning the proper surgical management.Aim of Study: To evaluate the role of semiquantitative parameters of the dynamic contrast enhanced MRI in differ-entiation of ovarian lesions.Material and Methods: 25 patients with complex or solid ovarian lesions underwent dynamic contrast enhanced MRI (DCE MRI). The semiquantitative parameters including max-imum relative enhancement percentage (MRE%) and time to peak (Tmax) as well as the type of time intensity curve (TIC) were analyzed and compared to the histopathological results.Results: The MRE% was higher for malignant ovarian tumors than for benign (p<0.001) and for borderline lesions (p 0.002). The Tmax was earlier in malignant ovarian tumors than in benign (p<0.001) and in borderline ovarian masses (p 0.019). TIC Type III was specific for invasive malignant tumors. The DCE MRI maximal accuracy was 88.2.Conclusion: The semiquantitative parameters of DCE MRI had increased the accuracy and sensitivity of MRI for discrimination between malignant, borderline and benign ovarian lesions.

Malignancy risk of sonographically benign appearing purely solid adnexal masses in asymptomatic postmenopausal women.

To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women. Retrospective observational cohort study comprising 99 women (mean age, 58.2 years, ranging from 50 to 77 years) diagnosed as having a purely solid ovarian lesion at transvaginal ultrasound between April 2001 and October 2015. Inclusion criteria were as follows: asymptomatic postmenopausal women with a well-defined purely solid ovarian lesion with International Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and histologic data (in case of surgery) were retrieved for analysis. Patients who were managed conservatively were assessed by transvaginal sonography every 6 months for a minimum of a year. In case of bilateral lesions we used the largest one for analysis. Five women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9 cm (range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic shadowing was present in 59.6% of cases. International Ovarian Tumor Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases, respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL). Forty-two women underwent surgery after diagnosis (histologic diagnoses were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid (n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1), primary invasive cancer (n = 2). One case of invasive cancer CA-125 was 403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were stage 1. Fifty-seven women were managed with serial follow-up. With a median follow-up time of 36 months (range, 12-142 months) all these lesions had no change and women remain asymptomatic. Considering all 99 cases the risk of malignancy is 2% (95% CI, 0.1-7.5). The risk of malignancy of benign appearing purely solid adnexal masses in asymptomatic postmenopausal women is low. Conservative management of these lesions might be an option.

Massive Ovarian Edema Masquerading as Ovarian Neoplasm: Report of Two Cases

Background: In the pediatric and adolescent age group, solid ovarian lesions are considered highly suspicious for malignancy. Massive ovarian edema (MOE) is an extremely rare lesion, which clinically mimics a neoplasia and is benign in nature. This uncommon condition usually leads to overtreatment in children and adolescents if not clinically diagnosed. Cases: The occurrence of MOE in two young female patients who presented with fullness in the lower abdomen, one of them investigated for primary infertility, is presented. Clinical and radiological diagnosis of ovarian malignancy was made, and they underwent an oopherectomy. Conclusions: MOE is not a well-known condition, and therefore more extensive treatment than is necessary is often undertaken, as was the case in our patients. Conservative management is advised, with the preservation of fertility by retaining the ovary and biopsy with frozen section when clinically indicated. (J GYNECOL SURG 28:431)

OP24.05: Sonographic follow‐up of solid ovarian lesion &lt; 5 cm in post‐menopausal women: preliminary results

endometrial-myometrial junction, presence of the ‘‘bright edge’’ sign at the edges of the lesions, and preservation of normal endometrial lining adjacent to the lesion. Patient clinical history and histological assessment of tumor grading were assessed. Results: 79 cases were analyzed, 26 were benign and 53 cases malignant. Antero-posterior lesion diameter was 8.89 ± 5.58, 14.8 ± 6.99, and 20 ± 10.57 millimeters for the benign, low grade and high grade malignancy lesions respectively, which was statistically significant (P < 0.05). High echogenicity, cystic formation within lesions, presence of ‘‘bright edge’’ and preservation of normal endometrium adjacent to the endometrial lesion were significantly more common in the benign group as compare to malignant lesions (P < 0.05). Complex echogenicity and loss of endometrial-myometrial junction were significantly more common in the malignant lesions group (P < 0.05). These parameters could not distinguish between low and high grade endometrial malignancy. Conclusions: Malignant endometrial lesions are associated with larger antero-posterior diameters. Sonographic parameters such as high echogenicity, cystic formation, presence of ‘‘bright edge’’ and preservation of normal endometrium might be used to distinguish between benign and malignant lesions. These parameters should be assessed, while considering a surgical intervention for endometrial lesions.

Giant primary ovarian fibrosarcoma: Case report and review of pitfalls

Primary ovarian fibrosarcomas are very uncommon neoplasms; less than one hundred cases have been reported. Diagnosis can be difficult to establish and other similar appearing mesenchymal lesions must be ruled out. A 23 year old nulliparous woman presented with a huge right ovarian tumor (25 × 17 × 12 cm). Ultrasonography guided aspiration was performed and a strong possibility of fibrosarcoma was suggested based on cytomorphological findings. No epithelial element was noted. She underwent surgical excision which confirmed the diagnosis of primary ovarian fibrosarcoma (the largest till date to our knowledge). Immunohistochemical analyses showed vimentin and CD 34 positivity. We speculate that ovarian fibrosarcoma at the preoperative examination might be considered in the differential diagnosis whenever a unilateral, heterogeneous, largely round solid ovarian lesion is detected.

Sonographic features of primary ovarian fibrosarcoma: a report of two cases

Two cases of primary cellular fibroblastic tumor of the ovary are described, which presented a challenging clinical and histopathological differential diagnosis of primary ovarian fibrosarcoma and mitotically active cellular fibroma. On sonographic evaluation they both appeared as solid lesions with irregular margins, and on histological analysis both showed a count of 5-7 mitotic figures per 10 high-power fields. Histopathological examination of the first case was characterized by the presence of hemorrhage, necrosis and severe nuclear atypia, with a metastatic peritoneal lesion, and the eventual diagnosis was primary ovarian fibrosarcoma. The second case, however, was diagnosed as a 'mitotically active cellular fibroma' owing to the lack of substantial severe cellular atypia, hemorrhage or necrosis. We speculate that ovarian fibrosarcoma at the preoperative examination might be considered in the differential diagnosis whenever a unilateral, heterogeneous, largely round solid ovarian lesion is detected.

Rare ovarian lesion in an adolescent girl

Large solid ovarian lesions are considered malignant in nature in pediatric and adolescent age group. We present an adolescent girl who had large solid ovarian lesion, with negative tumor markers. She underwent laparotomy and right oopherectomy. Histopathology revealed that the lesion was massive ovarian edema. This is an extremely rare lesion of ovary and is benign in nature. Very few case reports are available in English literature. Hence we suggest that massive ovarian edema should be considred as one of the differential diagnosis in all the patients having large solid ovarian lesions with ngative tumor marker assay. Ovarian preservation with the help of frozen section analysis should always be considred in these patients.