Presentation
Progressive abdominal distension.
Patient Data
A large pelvi-abdominal multilocular complex cystic and solid heterogeneously enhancing soft tissue mass lesion measuring about 14.8 x 7.8 x 12.5 cm along its maximum axial and craniocaudal dimensions respectively. It is seen displacing the bowel loops upward and to the right. Faint internal linear calcifications are noted.
Moderate amount of pelvi-abdominal ascites.
An enhanced MRI pelvis was requested.
A large pelviabdominal multilocular complex soft and cystic mass lesion measuring about 14.8 x 7.8 x 12.5 cm along its maximum axial and CC dimensions respectively. The soft tissue component is seen eliciting low to intermediate T1, heterogeneous predominantly high T2 signal with restricted diffusion in the DWI. It shows heterogeneous enhancement in the post-contrast series. Innumerable variable-sized cystic structures are seen eliciting low T1 and bright T2 signal. The largest of them measures about 7.3 x 5.4 cm in diameter.
The uterus is average in size and of normal myometrial signal. The endometrium is seen thickened measuring about 18 mm in thickness, yet it appears hyperintense. Preserved junctional zone. Normal MR appearance of the cervix and the vagina.
Preserved follicular activity of the right ovary showing a dominant follicle measuring about 2.75 x 2 cm in diameter. Inconspicuous left ovary.
Prominent bilateral external iliac and inguinal lymph nodes.
Moderate amount of free pelviabdominal collection.
Case Discussion
Ovarian neoplasms can be divided into:
- epithelial tumors: serous, mucinous, endometrioid, clear cell, Brenner and undifferentiated
- germ cell tumors: teratoma (mature or immature), dysgerminoma, endodermal sinus tumor, embryonal cell carcinoma and choriocarcinoma
- sex cord-stromal tumors: granulosa-stromal cell tumors (granulosa cell tumor, fibrothecoma and sclerosing stromal tumor), Sertoli-stromal tumors (Sertoli-Leydig cell tumor) and steroid cell tumors
- other tumors: metastatic tumors
Epithelial tumors are the most common and represent about 60% of all ovarian tumors. Dysgerminoma (type of germ cell tumors) is found mainly in young females. It is considered as the ovarian counterpart of seminoma of the testis. It is not associated with endocrine hormone secretion unless syncytiotrophoblastic giant cells are present which secrete HCG (5% of cases). Calcification can be present. Imaging findings are characterized by the presence of multi-lobulated solid masses with prominent fibrovascular septa.