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{{Ovarian germ cell tumor}}
{{Ovarian germ cell tumor}}


{{CMG}}{{AE}} {{MD}}
{{CMG}}; {{AE}} {{Sahar}} {{MD}}
==Overview==
==Overview==
It is difficult to distinguish subtypes of ovarian germ cell tumor on [[MRI]] alone. The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of [[hemorrhage]] and [[necrosis]]. On MRI, ovarian germ cell tumors may be characterized by T2: the septae are often hypointense or isointense T1 C+ (Gd): the septae often show marked enhancement ([[dysgerminoma]]), the presence of a prominent solid component containing calcifications and small foci of [[fat]] (mature [[teratoma]]), areas of hemorrhage can also be seen (yolk sac tumor).<ref name= xab> Ovarian dysgerminoma. http://radiopaedia.org/articles/ovarian-dysgerminoma. URL Accessed on November 11, 2015</ref><ref name= abc> Mature (cystic) ovarian teratoma. http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma. URL Accessed on November 11, 2015</ref><ref name= xxx> Ovarian yolk sac tumour. http://radiopaedia.org/articles/ovarian-yolk-sac-tumour. URL Accessed on November 11, 2015</ref>
[[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==
'''Dysgerminomas '''<ref name= xab> Ovarian dysgerminoma. http://radiopaedia.org/articles/ovarian-dysgerminoma. URL Accessed on November 11, 2015</ref>
'''Mature teratoma'''
* Tumors are often seen divided into lobules by [[septa]]
* Reported signal characteristics include:
** T2: the septae are often hypointense
** isointense  T1 C+ (Gd): the septae often show marked enhancement
 
'''Mature (cystic) ovarian teratoma'''<ref name= abc> Mature (cystic) ovarian teratoma. http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma. URL Accessed on November 11, 2015</ref>
* MR evaluation usually tends to be reserved for difficult cases, but is exquisitely sensitive to fat components
* Both [[fat]] suppression techniques and chemical shift artefact can be used to confirm the presence of fat
* Enhancement is also able to identify solid invasive components, and as such can be used to accurately locally stage malignant variants
 
'''Immature ovarian teratoma'''<ref name= yyy> Immature ovarian teratoma. http://radiopaedia.org/articles/immature-ovarian-teratoma. URL Accessed on November 11, 2015</ref>
* The presence of a prominent solid component containing calcifications and small foci of fat is suggestive. [[Cystic]] components may contain serous, mucinous, or fatty [[sebaceous]] material
* Hemorrhage may be present
 
'''Ovarian yolk sac tumor''' <ref name= xxx> Ovarian yolk sac tumour. http://radiopaedia.org/articles/ovarian-yolk-sac-tumour. URL Accessed on November 11, 2015</ref>
* They can be associated with prominent signal voids on [[MRI]]
* Areas of hemorrhage can also be seen


[[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'''
* 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>
* 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 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]

Mondermal teratoma

Immature ovarian teratoma

Dysgerminomas

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

Choriocarcinoma

Mixed germ cell tumors

References

  1. ↑ 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.
  2. ↑ 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. ↑ 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. ↑ 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.

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