Ovarian germ cell tumor ultrasound: Difference between revisions

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Latest revision as of 13:56, 22 April 2019

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]
- 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

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.

Template:WikiDoc Sources

[SabaGuerriero2009-1] 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.

[pmid11259710-2] 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.

[OutwaterSiegelman2001-3] 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.

[ShaabanRezvani2014-4] 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.

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[2]

[3]

[4]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Ovarian germ cell tumor}}
+{{CMG}}{{AE}} {{Sahar}} {{MD}}
+==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 [[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==
+'''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>
+*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 (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 [[cyst]] [[cavity]] with multiple thin, [[echogenic]] [[bands]] owing to [[hair]] materials
+'''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>
+* The [[Ultrasound|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]].<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 [[heterogeneous]] [[mass]] which is predominantly [[solid]]
+** A complex [[mass]] with multiple [[solid]] and [[cystic]] areas
+'''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>
+* [[Lobular|Lobulated]] components with [[heterogeneous]] [[echogenicity]] and with well-defined borders.
+On color and power [[Doppler ultrasound]]:
+* 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.
-{{CMG}}{{AE}} {{MD}}
-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.
-MRI
-Tumours are often seen divided into lobules by septa.
-Reported signal characteristics include:
-T2: the septae are often hypointense or isointense 3
-T1 C+ (Gd): the septae often show marked enhancement 3
-Conventional radiography
-Mature (cystic) ovarian teratomaMay show calcific and tooth components with the pelvis.
-Pelvic ultrasound
-Ultrasound is the preferred imaging modality. Typically an ovarian dermoid is seen as a cystic adnexal mass with some mural components.  Most lesions are unilocular.
-The spectrum of sonographic features includes:
-diffusely or partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity
-echogenic interface at the edge of mass that obscures deep structures: the tip of the iceberg sign
-mural hyperechoic Rokitansky nodule: dermoid plug
-echogenic, shadowing calcific or dental (tooth) components
-presence of fluid-fluid levels 5
-multiple thin, echogenic bands caused by hair in the cyst cavity: the dot-dash pattern
-colour Doppler: no internal vascularity
-internal vascularity requires further workup to exclude a malignant lesion
-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.
-Pelvic MRI
-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
-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.
 ==References==
 {{reflist|2}}

Ovarian germ cell tumor ultrasound: Difference between revisions

Latest revision as of 13:56, 22 April 2019

Overview

Ultrasound

References

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