Sexcord/ stromal ovarian tumors MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  ; Maneesha Nandimandalam, M.B.B.S.[2]

Overview

MRI may be helpful in the diagnosis of sexcord/ stromal ovarian tumors. Findings on MRI suggestive of sexcord/ stromal ovarian tumors depends on the tumor subtypes. Granulosa cell tumors show heterogeneous signal intensity on both T1WI and T2WI and high signal intensity on DWI images. Fibroma, Fibrothecoma, and Thecoma appear as hypointense masses on T1-weighted MRI with very low signal intensity on T2-weighted imaging. Sclerosing stromal tumor of ovary show hyperintense cystic components or a heterogeneous solid mass of intermediate to high signal intensity on T2-weighted MRI.

MRI

Granulosa cell tumors:

A 54 -year-old woman with primary adult type OGCT (Ic). The mass shows as the purely cystic lesion with mostly high signal on T1WI (a) and T2WI (b). Note, the hemorrhagic contents locates on the left side of the tumor, representing the relatively high signal on T1WI and low signal on T2WI (arrowhead) and high signal on DWI (c). After injection of contrast medium, the cystic wall shows minor enhancement (d),Zhang H, Zhang H, Gu S, Zhang Y, Liu X, Zhang G. MR findings of primary ovarian granulosa cell tumor with focus on the differentiation with other ovarian sex cord-stromal tumors. J Ovarian Res. 2018;11(1):46. Published 2018 Jun 5. doi:10.1186/s13048-018-0416-x,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989475/

Fibroma, Fibrothecoma, and Thecoma:

A 47-year-old women with a fibroma on the right ovary(arrows). Axial T1-weighted image (a) shows an oval mass of low signal intensity. Axial T2-weighted with fat suppression image (b) and coronal T2-weighted image (c) shows the mass was homogenous low signal intensity. T1-weighted contrast enhanced images (d) shows the mass was slightly enhanced. The mass shows low signal intensity on DW imaging (e) and has a significant low ADC value of 0.132 × 10− 3 mm2/s (f),Zhao SH, Li HM, Qiang JW, Wang DB, Fan H. The value of MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary: emphasis on diffusion-weighted MR imaging. J Ovarian Res. 2018;11(1):73. Published 2018 Aug 30. doi:10.1186/s13048-018-0444-6,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116557/

Sclerosing Stromal Tumor of Ovary:

  • They show hyperintense cystic components or a heterogeneous solid mass of intermediate to high signal intensity on T2-weighted MRI
  • There is clear-cut contrast enhancement with internal small cleft and cysts
  • The tumors show early peripheral enhancement with centripetal progression on dynamic contrast-enhanced imaging
  • Characteristic early enhancement reflects the cellular areas with their prominent vascular networks, whereas an area of prolonged enhancement in the inner portion of the mass represents the collagenous hypocellular area
A 30-year-old young women with a sclerosing stromal tumor on the left ovary (arrows) combined with a mature teratoma on the right ovary(arrow heads). Axial T1-weighted image (a) shows a mass of low signal intensity. T2-weighted with fat suppression image (b) shows the mass has heterogenous high signal intensity. The mass shows moderate signal intensity on DW imaging (c) and has a significant high ADC value of 2.291 × 10− 3 mm2/s (d). T1-weighted contrast enhanced images (e) showed the mass was enhanced significantly. The photomicrograph (H&E, × 40) (f) shows the pseudolobulation of the cellular areas separated by hypocellular areas of loose edematous connective tissue,Zhao SH, Li HM, Qiang JW, Wang DB, Fan H. The value of MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary: emphasis on diffusion-weighted MR imaging. J Ovarian Res. 2018;11(1):73. Published 2018 Aug 30. doi:10.1186/s13048-018-0444-6,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116557/

References

  1. Jung SE, Rha SE, Lee JM, Park SY, Oh SN, Cho KS, Lee EJ, Byun JY, Hahn ST (July 2005). "CT and MRI findings of sex cord-stromal tumor of the ovary". AJR Am J Roentgenol. 185 (1): 207–15. doi:10.2214/ajr.185.1.01850207. PMID 15972425.
  2. Zhang H, Zhang H, Gu S, Zhang Y, Liu X, Zhang G (June 2018). "MR findings of primary ovarian granulosa cell tumor with focus on the differentiation with other ovarian sex cord-stromal tumors". J Ovarian Res. 11 (1): 46. doi:10.1186/s13048-018-0416-x. PMC 5989475. PMID 29871662.
  3. Zhao SH, Li HM, Qiang JW, Wang DB, Fan H (August 2018). "The value of MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary: emphasis on diffusion-weighted MR imaging". J Ovarian Res. 11 (1): 73. doi:10.1186/s13048-018-0444-6. PMC 6116557. PMID 30165895.
  4. Matsutani H, Nakai G, Yamada T, Yamamoto K, Ohmichi M, Narumi Y (December 2018). "Diversity of imaging features of ovarian sclerosing stromal tumors on MRI and PET-CT: a case report and literature review". J Ovarian Res. 11 (1): 101. doi:10.1186/s13048-018-0473-1. PMC 6302382. PMID 30572921.
  5. Stein EB, Wasnik AP, Sciallis AP, Kamaya A, Maturen KE (August 2017). "MR Imaging-Pathologic Correlation in Ovarian Cancer". Magn Reson Imaging Clin N Am. 25 (3): 545–562. doi:10.1016/j.mric.2017.03.004. PMID 28668159.
  6. Zhang P, Cui Y, Li W, Ren G, Chu C, Wu X (November 2012). "Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T". World J Surg Oncol. 10: 237. doi:10.1186/1477-7819-10-237. PMC 3514117. PMID 23137333.
  7. Mohaghegh P, Rockall AG (October 2012). "Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques". Radiographics. 32 (6): 1751–73. doi:10.1148/rg.326125520. PMID 23065168.
  8. Forstner R, Meissnitzer M, Cunha TM (2016). "Update on Imaging of Ovarian Cancer". Curr Radiol Rep. 4: 31. doi:10.1007/s40134-016-0157-9. PMC 4826654. PMID 27110476.
  9. Imaoka I, Wada A, Kaji Y, Hayashi T, Hayashi M, Matsuo M, Sugimura K (2006). "Developing an MR imaging strategy for diagnosis of ovarian masses". Radiographics. 26 (5): 1431–48. doi:10.1148/rg.265045206. PMID 16973774.
  10. Kitajima K, Kaji Y, Sugimura K (2008). "Usual and unusual MRI findings of ovarian fibroma: correlation with pathologic findings". Magn Reson Med Sci. 7 (1): 43–8. PMID 18460848.
  11. Chung BM, Park SB, Lee JB, Park HJ, Kim YS, Oh YJ (June 2015). "Magnetic resonance imaging features of ovarian fibroma, fibrothecoma, and thecoma". Abdom Imaging. 40 (5): 1263–72. doi:10.1007/s00261-014-0257-z. PMID 25273949.

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