Ovarian germ cell tumor CT
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2] Ultrasound dysgerminomas May be seen as a septated ovarian mass with varying echotexture. Colour Doppler interrogation may show prominent flow signal within the fibrovascular septa 2.
CT
Calcification may be present in a speckled pattern. Characteristic imaging findings include multilobulated solid masses with prominent fibrovascular septa. Post contrast imaging can often show enhancement of the septae.
Mature (cystic) ovarian teratomaMay show calcific and tooth components with the pelvis.
CT
CT has high sensitivity in the diagnosis of cystic teratomas 6 though it is not routinely recommended for this purpose owing to its ionising radiation.
Typically CT images demonstrate fat (areas with very low Hounsfield values), fat-fluid level, calcification (sometimes dentiform), Rokitansky protuberance, and tufts of hair. The presence of most of the above tissues is diagnostic of ovarian cystic teratomas in 98% of cases 5. Whenever the size exceeds 10 cm or soft tissue plugs and cauliflower appearance with irregular borders are seen, malignant transformation should be suspected 5.
When ruptured, the characteristic hypoattenuating fatty fluid can be found as antidependent pockets, typically below the right hemidiaphragm, a pathognomonic finding 2. The escaped cyst content also leads to a chemical peritonitis and the mesentery may be stranded and the peritoneum thickened, which may mimicperitoneal carcinomatosis 2.
Immature ovarian teratoma
The imaging appearance is typically of a large, heterogeneous mass with a prominent solid component. However, the spectrum of appearances ranges from a predominatly cystic to a predominantly solid mass. Immature teratomas tend to be larger than mature cystic teratomas at initial presentation.
Extension through the tumour capsule may be present.
Immature teratoma may metastasise to peritoneum, liver or lung. Metastasis to brain has also been reported 7.
Pelvic ultrasound
Ultrasound appearance can be as a heterogeneous adnexal mass although is non-specific. Calcifications may be present.
CT and MRI
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. Haemorrhage may be present.
Ovarian yolk sac tumour
General
The tumour typically manifests as a large, complex pelvic mass that extends into the abdomen and contains both solid and cystic components. The cystic areas are composed of epithelial lined cysts produced by the tumour or of co-existing mature teratomas. Bilaterality is rare.
Pelvic ultrasound
Tends to have both echogenic and hypoechoic components 4.
Pelvic MRI
They can be associated with prominent signal voids on MRI 2. Areas of haemorrhage can also be seen.
Ovarian choriocarcinoma On imaging, choriocarcinomas appear as vascular solid tumours with cystic, haemorrhagic, and necrotic areas.