Ovarian germ cell tumor MRI

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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

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, an MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

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).[1][2][3]

Pelvic MRI

Mature teratoma Pelvic MRI is sensitive in the diagnosis of mature teratoma. Findings on MRI suggestive of/diagnostic of mature teratoma include:[4]

  • 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\Hairs
  • Palm tree-like protrusion
  • Dermoid nipples (Rokitansky nodules)

Mondermal teratoma

  • Struma ovarii:
    • MR imaging findings may be more characteristics for the diagnosis and include:[5]
      • 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 tumor:
    • Absence of fat
    • It should be distinguished from other solid malignancies.

Immature ovarian teratoma

  • Foci of fat interspaced within solid the solid mass[6]
  • Fatty liquid may be observed in cystic component
  • Calcifications are small, irregular, and scattered through the tumor

Dysgerminomas

  • Lobulated solid mass[6]
  • 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 epithelaial ovarain 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.[6]
  • 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.[7]
  • There may be cystic areas that contains mucoid material.

Choriocarcinoma

  • Highly vascularized solid mass[7]
  • Vascular component produces signals in T2 images.

Mixed germ cell tumors

  • There is no specific imaging criteria for these tumors.[7]
  • Imaging may vary according to the content of the tumors.
  • Finding associated with yolk sca tumor and dysgerminoma are more common.

References

  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. 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.
  5. 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.
  6. 6.0 6.1 6.2 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.
  7. 7.0 7.1 7.2 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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