Ovarian germ cell tumor MRI: Difference between revisions
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{{Ovarian germ cell tumor}} | {{Ovarian germ cell tumor}} | ||
{{CMG}}{{AE}} {{MD}} | {{CMG}}; {{AE}} {{Sahar}} {{MD}} | ||
==Overview== | ==Overview== | ||
[[Abdominal]]/[[pelvic]] [[MRI]] may be helpful in the [[diagnosis]] of [[ovarian]] [[germ cell]] [[tumors]]. Findings on [[MRI]] suggestive of [[ovarian]] [[germ cell]] [[tumors]] include [[Mass|masses]] with a [[cystic]] and [[solid]] component and may contain [[fat]], [[calcification]], [[fat]]-[[fluid]] level, Tuft\[[Hairs]], Palm tree-like protrusion, and [[Dermoid]] nipples-like elements (Rokitansky [[nodules]]). The majority of [[ovarian]] [[germ cell]] [[tumors]] have a [[solid]] and [[cystic]] appearance with areas of [[hemorrhage]] and [[necrosis]]. The predominance of [[cystic]] or [[solid]] component differs for each [[tumor]]. | |||
==Pelvic MRI== | ==Pelvic MRI== | ||
'''Mature teratoma''' | |||
'''Mature | |||
[[Pelvic]] [[MRI]] is sensitive in the [[diagnosis]] of mature [[teratoma]]. Findings on [[MRI]] suggestive of of [[Mature cystic teratoma|mature teratoma]] include:<ref name="pmid11259710">{{cite journal |vauthors=Outwater EK, Siegelman ES, Hunt JL |title=Ovarian teratomas: tumor types and imaging characteristics |journal=Radiographics |volume=21 |issue=2 |pages=475–90 |date=2001 |pmid=11259710 |doi=10.1148/radiographics.21.2.g01mr09475 |url=}}</ref> | |||
*[[Fat]] | |||
**[[Fat]] may be misdiagnosed with [[hemorrhage]] in the [[hemorrhagic]] [[cysts]] and it should be differentiated from that in three following ways: | |||
***Chemical-shift artifact in the frequency-encoding direction | |||
***[[Gradient]]-echo [[imaging]] with an echo time when water and [[fat]] are in the opposite state | |||
***Sequences with frequency-selective [[fat]] [[saturation]] | |||
*[[Calcification]] | |||
*[[Fat]]–[[fluid]] level | |||
*Tuft\[[Hair|Hairs]] | |||
*Palm tree-like protrusion | |||
*[[Dermoid]] [[nipple]]-like elements (Rokitansky [[nodules]]) | |||
'''Mondermal teratoma''' | |||
* [[Struma ovarii]]: | |||
** [[MRI|MR imaging]] findings may be more characteristics for the [[diagnosis]] and include:<ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref> | |||
*** Absence of [[fat]] | |||
*** [[Cystic]] spaces with both high and low signal [[intensity]] on T1 and T2 images | |||
*** Thick, gelatinous colloid of struma may be associated with a low-[[intensity]] signal on both T1 and T2 images. | |||
*** A multilocular mass with variable degree of signal [[intensity]] in T1 and T2 images in the locular spaces. | |||
* [[Carcinoid tumors|Carcinoid tumor]]: | |||
** Absence of [[fat]] | |||
** It should be distinguished from other [[solid]] [[malignancies]]. | |||
'''Immature ovarian teratoma''' | '''Immature ovarian teratoma''' | ||
* | * Foci of [[fat]] interspaced within [[solid]] the [[solid]] [[mass]]<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref> | ||
* | * [[Fat|Fatty]] liquid may be observed in [[cystic]] component | ||
* [[Calcification|Calcifications]] are small, [[Irregular lesion|irregular]], and scattered through the [[tumor]] | |||
''' | '''Dysgerminomas''' | ||
* | * [[Lobular|Lobulated]] [[solid]] [[mass]]<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref> | ||
* Areas of | * Interspaced fibrovascular [[septa]] | ||
** [[Septa]], when edematous, are hyperintense on T2 images | |||
'''Ovarian | * Low signal [[intensity]] compared to [[muscle]] on T1 image | ||
* | * Isointense or slightly hyperintense on T2 image | ||
* It can also mimic the appearance of [[Epithelial ovarian tumors|epithelial ovarian neoplasms]]: | |||
** Multilobular [[mass]] with [[cysts]], [[papillary]] [[Projection areas|projections]] and irregular [[Septation|septations]] | |||
'''Yolk sac tumor''' | |||
* The bright dot sign (enhancing foci in the wall or [[solid]] component) is the common finding, although it is not the pathognomonic finding for the [[yolk sac tumor]].<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref> | |||
* [[Capsular tear]] is another common finding which is not the pathognomonic finding for the [[yolk sac tumor]]. | |||
* Areas of [[hemorrhage]] with high signal [[intensity]] on T1 images can also be observed. | |||
'''Embryonal tumor''' | |||
* The [[tumor]] is large, predominantly [[solid]] and unilateral with areas of [[necrosis]] and [[hemorrhage]].<ref name="SteinWasnik2017">{{cite journal|last1=Stein|first1=Erica B.|last2=Wasnik|first2=Ashish P.|last3=Sciallis|first3=Andrew P.|last4=Kamaya|first4=Aya|last5=Maturen|first5=Katherine E.|title=MR Imaging–Pathologic Correlation in Ovarian Cancer|journal=Magnetic Resonance Imaging Clinics of North America|volume=25|issue=3|year=2017|pages=545–562|issn=10649689|doi=10.1016/j.mric.2017.03.004}}</ref> | |||
* There may be [[cystic]] areas that contains [[Mucus|mucoid]] material. | |||
'''Choriocarcinoma''' | |||
* Highly [[Vascularity|vascularized]] [[solid]] [[mass]]<ref name="SteinWasnik2017">{{cite journal|last1=Stein|first1=Erica B.|last2=Wasnik|first2=Ashish P.|last3=Sciallis|first3=Andrew P.|last4=Kamaya|first4=Aya|last5=Maturen|first5=Katherine E.|title=MR Imaging–Pathologic Correlation in Ovarian Cancer|journal=Magnetic Resonance Imaging Clinics of North America|volume=25|issue=3|year=2017|pages=545–562|issn=10649689|doi=10.1016/j.mric.2017.03.004}}</ref> | |||
* [[Vascular]] component produces signals in T2 images. | |||
'''Mixed germ cell tumors''' | |||
* There is no specific [[imaging]] criteria for these [[tumors]].<ref name="SteinWasnik2017">{{cite journal|last1=Stein|first1=Erica B.|last2=Wasnik|first2=Ashish P.|last3=Sciallis|first3=Andrew P.|last4=Kamaya|first4=Aya|last5=Maturen|first5=Katherine E.|title=MR Imaging–Pathologic Correlation in Ovarian Cancer|journal=Magnetic Resonance Imaging Clinics of North America|volume=25|issue=3|year=2017|pages=545–562|issn=10649689|doi=10.1016/j.mric.2017.03.004}}</ref> | |||
* [[Imaging]] may vary according to the content of the [[tumors]]. | |||
* Finding associated with [[yolk sac tumor]] and [[dysgerminoma]] are more common. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]
Overview
Abdominal/pelvic MRI may be helpful in the diagnosis of ovarian germ cell tumors. Findings on MRI suggestive of ovarian germ cell tumors include masses with a cystic and solid component and may contain fat, calcification, fat-fluid level, Tuft\Hairs, Palm tree-like protrusion, and Dermoid nipples-like elements (Rokitansky nodules). The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. The predominance of cystic or solid component differs for each tumor.
Pelvic MRI
Mature teratoma
Pelvic MRI is sensitive in the diagnosis of mature teratoma. Findings on MRI suggestive of of mature teratoma include:[1]
- Fat
- Fat may be misdiagnosed with hemorrhage in the hemorrhagic cysts and it should be differentiated from that in three following ways:
- Chemical-shift artifact in the frequency-encoding direction
- Gradient-echo imaging with an echo time when water and fat are in the opposite state
- Sequences with frequency-selective fat saturation
- Fat may be misdiagnosed with hemorrhage in the hemorrhagic cysts and it should be differentiated from that in three following ways:
- Calcification
- Fat–fluid level
- Tuft\Hairs
- Palm tree-like protrusion
- Dermoid nipple-like elements (Rokitansky nodules)
Mondermal teratoma
- Struma ovarii:
- MR imaging findings may be more characteristics for the diagnosis and include:[2]
- Absence of fat
- Cystic spaces with both high and low signal intensity on T1 and T2 images
- Thick, gelatinous colloid of struma may be associated with a low-intensity signal on both T1 and T2 images.
- A multilocular mass with variable degree of signal intensity in T1 and T2 images in the locular spaces.
- MR imaging findings may be more characteristics for the diagnosis and include:[2]
- Carcinoid tumor:
- Absence of fat
- It should be distinguished from other solid malignancies.
Immature ovarian teratoma
- Foci of fat interspaced within solid the solid mass[3]
- Fatty liquid may be observed in cystic component
- Calcifications are small, irregular, and scattered through the tumor
Dysgerminomas
- Lobulated solid mass[3]
- Interspaced fibrovascular septa
- Septa, when edematous, are hyperintense on T2 images
- Low signal intensity compared to muscle on T1 image
- Isointense or slightly hyperintense on T2 image
- It can also mimic the appearance of epithelial ovarian neoplasms:
- Multilobular mass with cysts, papillary projections and irregular septations
Yolk sac tumor
- The bright dot sign (enhancing foci in the wall or solid component) is the common finding, although it is not the pathognomonic finding for the yolk sac tumor.[3]
- Capsular tear is another common finding which is not the pathognomonic finding for the yolk sac tumor.
- Areas of hemorrhage with high signal intensity on T1 images can also be observed.
Embryonal tumor
- The tumor is large, predominantly solid and unilateral with areas of necrosis and hemorrhage.[4]
- There may be cystic areas that contains mucoid material.
Choriocarcinoma
- Highly vascularized solid mass[4]
- Vascular component produces signals in T2 images.
Mixed germ cell tumors
- There is no specific imaging criteria for these tumors.[4]
- Imaging may vary according to the content of the tumors.
- Finding associated with yolk sac tumor and dysgerminoma are more common.
References
- ↑ Outwater EK, Siegelman ES, Hunt JL (2001). "Ovarian teratomas: tumor types and imaging characteristics". Radiographics. 21 (2): 475–90. doi:10.1148/radiographics.21.2.g01mr09475. PMID 11259710.
- ↑ Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). "Ovarian Teratomas: Tumor Types and Imaging Characteristics". RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
- ↑ 3.0 3.1 3.2 Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). "Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features". RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.
- ↑ 4.0 4.1 4.2 Stein, Erica B.; Wasnik, Ashish P.; Sciallis, Andrew P.; Kamaya, Aya; Maturen, Katherine E. (2017). "MR Imaging–Pathologic Correlation in Ovarian Cancer". Magnetic Resonance Imaging Clinics of North America. 25 (3): 545–562. doi:10.1016/j.mric.2017.03.004. ISSN 1064-9689.