Ovarian germ cell tumor ultrasound

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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]

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.[1][2][3][4]

Ultrasound

Dysgerminomas[1]

  • They may be seen as a septated ovarian mass with varying echotexture
  • Color Doppler interrogation may show prominent flow signal within the fibrovascular septa

Ovarian mature teratoma

  • Ultrasound is the most frequently used modality for the diagnosis.[5]
  • On Ultrasound imaging, it may have variable appearances, however, the three most common appearances from the most common to least common include:[5][6]
    • Cystic lesion with a projecting tubercle (Rokitansky nodule) into the cyst lumen that is densely echogenic
    • 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


  • Color Doppler: no internal vascularity
  • Internal vascularity requires further workup to exclude a malignant lesion

Immature ovarian teratoma

  • Ultrasound imaging is not helpful for the diagnosis of immature teratoma.[7]
  • The US finding are usually nonspecific and include:
    • Heterogenous appearance with partially solid lesion
    • Foci of calcification

Monodermal teratoma

  • Struma ovarii:
    • Nonspecific finding on the ultrasound imaging.[7]
    • A heterogenous mass which is predominantly solid
    • A complex mass with multiple solid nad cystic areas

Ovarian yolk sac tumor

  • Heterogenous echogenicity in the solid portion[8]
  • septas dividing the cystic posrtion

References

  1. 1.0 1.1 Ovarian dysgerminoma. http://radiopaedia.org/articles/ovarian-dysgerminoma. URL Accessed on November 11, 2015
  2. Mature (cystic) ovarian teratoma. http://radiopaedia.org/articles/mature-cystic-ovarian-teratoma. URL Accessed on November 11, 2015
  3. Ovarian yolk sac tumour. http://radiopaedia.org/articles/ovarian-yolk-sac-tumour. URL Accessed on November 11, 2015
  4. Immature ovarian teratoma. http://radiopaedia.org/articles/immature-ovarian-teratoma. URL Accessed on November 11, 2015
  5. 5.0 5.1 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.
  6. 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.
  7. 7.0 7.1 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.
  8. 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.

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