Ovarian germ cell tumor ultrasound: Difference between revisions
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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 ovarian germ cell tumors on ultrasound alone. Both solid and cystic lesions with calcification may be present. Dysgerminoma often appears as a hypoechoic mass while other ovarian germ cell tumors often have variable echogenicity. Ovarian teratoma may be further characterized by the presence of sebaceous and hair components arising from the Rokitansky protuberance. | It is difficult to distinguish [[ovarian]] [[germ cell]] [[tumors]] on [[ultrasound]] alone. Both [[solid]] and [[cystic]] [[lesions]] with [[calcification]] may be present. Dysgerminoma often appears as a [[Echogenicity|hypoechoic]] [[mass]] while other [[ovarian]] [[germ cell]] [[tumors]] often have variable [[echogenicity]]. Ovarian teratoma may be further characterized by the presence of [[sebaceous]] and [[hair]] components arising from the Rokitansky protuberance. | ||
==Ultrasound== | ==Ultrasound== | ||
'''Ovarian mature teratoma''' | '''Ovarian mature teratoma''' | ||
*[[Ultrasound]] is the most frequently used modality for the diagnosis.<ref name="SabaGuerriero2009">{{cite journal|last1=Saba|first1=Luca|last2=Guerriero|first2=Stefano|last3=Sulcis|first3=Rosa|last4=Virgilio|first4=Bruna|last5=Melis|first5=GianBenedetto|last6=Mallarini|first6=Giorgio|title=Mature and immature ovarian teratomas: CT, US and MR imaging characteristics|journal=European Journal of Radiology|volume=72|issue=3|year=2009|pages=454–463|issn=0720048X|doi=10.1016/j.ejrad.2008.07.044}}</ref> | *[[Ultrasound]] is the most frequently used [[modality]] for the [[diagnosis]].<ref name="SabaGuerriero2009">{{cite journal|last1=Saba|first1=Luca|last2=Guerriero|first2=Stefano|last3=Sulcis|first3=Rosa|last4=Virgilio|first4=Bruna|last5=Melis|first5=GianBenedetto|last6=Mallarini|first6=Giorgio|title=Mature and immature ovarian teratomas: CT, US and MR imaging characteristics|journal=European Journal of Radiology|volume=72|issue=3|year=2009|pages=454–463|issn=0720048X|doi=10.1016/j.ejrad.2008.07.044}}</ref> | ||
*On [[Ultrasound]] imaging, it may have variable appearances, however, the three most common appearances from the most common to least common include:<ref name="SabaGuerriero2009">{{cite journal|last1=Saba|first1=Luca|last2=Guerriero|first2=Stefano|last3=Sulcis|first3=Rosa|last4=Virgilio|first4=Bruna|last5=Melis|first5=GianBenedetto|last6=Mallarini|first6=Giorgio|title=Mature and immature ovarian teratomas: CT, US and MR imaging characteristics|journal=European Journal of Radiology|volume=72|issue=3|year=2009|pages=454–463|issn=0720048X|doi=10.1016/j.ejrad.2008.07.044}}</ref><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> | *On [[Ultrasound]] imaging, it may have [[Variable-order Markov model|variable]] appearances, however, the three most common appearances from the most common to least common include:<ref name="SabaGuerriero2009">{{cite journal|last1=Saba|first1=Luca|last2=Guerriero|first2=Stefano|last3=Sulcis|first3=Rosa|last4=Virgilio|first4=Bruna|last5=Melis|first5=GianBenedetto|last6=Mallarini|first6=Giorgio|title=Mature and immature ovarian teratomas: CT, US and MR imaging characteristics|journal=European Journal of Radiology|volume=72|issue=3|year=2009|pages=454–463|issn=0720048X|doi=10.1016/j.ejrad.2008.07.044}}</ref><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> | ||
**Cystic lesion with a projecting tubercle (Rokitansky nodule) into the cyst lumen that is densely echogenic | **[[Cystic]] [[lesion]] with a projecting [[Tubercle (anatomy)|tubercle]] (Rokitansky [[nodule]]) into the [[cyst]] [[lumen]] that is [[Dens|densely]] [[echogenic]] | ||
**A mass with partial or diffuse echogenicity due to [[sebaceous]] material and [[ hair]] within the cyst cavity | **A mass with partial or diffuse echogenicity due to [[sebaceous]] material and [[ hair]] within the [[cyst]] [[cavity]] | ||
**A cyst cavity with multiple thin, echogenic bands owing to hair materials | **A [[cyst]] [[cavity]] with multiple thin, [[echogenic]] [[bands]] owing to [[hair]] materials | ||
'''Immature ovarian teratoma''' | '''Immature ovarian teratoma''' | ||
* Ultrasound imaging is not helpful for the diagnosis of immature teratoma.<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> | * [[Ultrasound imaging]] is not helpful for the [[diagnosis]] of immature teratoma.<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> | ||
* The US finding are usually nonspecific and include: | * The [[Ultrasound|US]] finding are usually nonspecific and include: | ||
** | ** [[Heterogeneous]] appearance with partially [[solid]] [[lesion]] | ||
** Foci of calcification | ** Foci of [[calcification]] | ||
'''Monodermal teratoma''' | '''Monodermal teratoma''' | ||
* Struma ovarii: | * Struma ovarii: | ||
** Nonspecific finding on the ultrasound imaging.<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> | ** Nonspecific finding on the [[ultrasound imaging]].<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> | ||
** A | ** A [[heterogeneous]] [[mass]] which is predominantly [[solid]] | ||
** A complex mass with multiple solid | ** A complex [[mass]] with multiple [[solid]] and [[cystic]] areas | ||
'''Dysgerminoma''' | '''Dysgerminoma''' | ||
* They are purely solid (with rare exceptions)<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> | * They are purely [[solid]] (with rare exceptions)<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> | ||
* Lobulated components with | * [[Lobular|Lobulated]] components with [[heterogeneous]] [[echogenicity]] and with well-defined borders. | ||
On color and power Doppler ultrasound: | On color and power [[Doppler ultrasound]]: | ||
* These tumors are highly vascularized. | * These [[Tumor|tumors]] are highly [[Vascular|vascularized]]. | ||
''' | '''Yolk sac tumor''' | ||
* | * [[Heterogeneous]] [[echogenicity]] in the [[solid]] portion<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> | ||
* | * [[Septa|Septas]] dividing the [[cystic]] portion | ||
'''Embryonal carcinoma''' | |||
* There is no specific [[imaging]] criteria for embryonal carcinoma. | |||
==References== | ==References== | ||
Latest revision as of 13:56, 22 April 2019
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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
It is difficult to distinguish ovarian germ cell tumors on ultrasound alone. Both solid and cystic lesions with calcification may be present. Dysgerminoma often appears as a hypoechoic mass while other ovarian germ cell tumors often have variable echogenicity. Ovarian teratoma may be further characterized by the presence of sebaceous and hair components arising from the Rokitansky protuberance.
Ultrasound
Ovarian mature teratoma
- Ultrasound is the most frequently used modality for the diagnosis.[1]
- On Ultrasound imaging, it may have variable appearances, however, the three most common appearances from the most common to least common include:[1][2]
Immature ovarian teratoma
- Ultrasound imaging is not helpful for the diagnosis of immature teratoma.[3]
- The US finding are usually nonspecific and include:
- Heterogeneous appearance with partially solid lesion
- Foci of calcification
Monodermal teratoma
- Struma ovarii:
- Nonspecific finding on the ultrasound imaging.[3]
- A heterogeneous mass which is predominantly solid
- A complex mass with multiple solid and cystic areas
Dysgerminoma
- They are purely solid (with rare exceptions)[4]
- Lobulated components with heterogeneous echogenicity and with well-defined borders.
On color and power Doppler ultrasound:
- These tumors are highly vascularized.
Yolk sac tumor
- Heterogeneous echogenicity in the solid portion[4]
- Septas dividing the cystic portion
Embryonal carcinoma
- There is no specific imaging criteria for embryonal carcinoma.
References
- ↑ 1.0 1.1 Saba, Luca; Guerriero, Stefano; Sulcis, Rosa; Virgilio, Bruna; Melis, GianBenedetto; Mallarini, Giorgio (2009). "Mature and immature ovarian teratomas: CT, US and MR imaging characteristics". European Journal of Radiology. 72 (3): 454–463. doi:10.1016/j.ejrad.2008.07.044. ISSN 0720-048X.
- ↑ 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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 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.