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{{Ovarian germ cell tumor}}
{{Ovarian germ cell tumor}}
 
{{CMG}}; {{AE}} {{MD}} {{Sahar}}
{{CMG}}{{AE}} {{MD}}
==Overview==
 
It is difficult to distinguish [[ovarian]] [[germ cell]] [[tumors]] on [[CT]] alone, however, [[pelvic]]/[[abdominal]] CT scan may be helpful in the diagnosis. Sensitive findings on [[CT scan]] for the [[diagnosis]] of [[Mature cystic teratoma|mature teratoma]] include [[Fat]] attenuation, presence or absence of [[calcification]] in the [[cyst]] wall, palm-tree like protrusion, and [[fat]]-[[fluid]] levels. Presence of cauliflower appearance with irregular borders may warrant the necessity to search for [[malignant transformation]] of these [[tumors]]. [[CT scan]] findings characteristics of immature [[teratoma]] include A large, irregular [[solid]] [[mass]], presence of coarse [[calcification]], small foci of [[fat]], and [[Hemorrhage]]. CT findings associated with other [[ovarian]] [[germ cell]] [[tumors]] are not specific, but may be helpful.
Dysgerminomas
==CT==
 
===Mature teratoma===
CT
[[CT scan]] is a sensitive method to [[diagnose]] [[Mature cystic teratoma|mature teratoma]]. Findings on [[Computed tomography|CT scan]] suggestive of/diagnostic of [[Mature cystic teratoma|mature teratoma]] include:<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>
 
*[[Fat]] attenuation
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.
*Presence or absence of [[calcification]] in the [[cyst]] wall
 
*Gravity dependent layering<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>
Mature (cystic) ovarian teratoma
*Palm-tree like protrusion
* CT has high sensitivity in the diagnosis of cystic teratomas though it is not routinely recommended for this purpose owing to its ionising radiation
*[[Fat]]-[[fluid]] levels
* Typically CT images demonstrate fat (areas with very low Hounsfield values), fat-fluid level, calcification (sometimes dentiform), Rokitansky protuberance, and tufts of hair
* Whenever cauliflower appearance with irregular borders are observed, [[malignant transformation]] should be suspected.<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>
* The presence of most of the above tissues is diagnostic of ovarian cystic teratomas in 98% of cases
===Immature teratoma===
* Whenever the size exceeds 10 cm or soft tissue plugs and cauliflower appearance with irregular borders are seen, malignant transformation should be suspected
[[CT scan]] findings of immature [[teratoma]] are characteristics and include:<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>
* When ruptured, the characteristic hypoattenuating fatty fluid can be found as antidependent pockets, typically below the right hemidiaphragm, a pathognomonic finding 
* A large, irregular [[solid]] [[mass]]
* The escaped cyst content also leads to a chemical peritonitis and the mesentery may be stranded and the peritoneum thickened, which may mimicperitoneal carcinomatosis
* Presence of coarse [[calcification]]
 
* Small foci of [[fat]]
 
* [[Hemorrhage]] may also be present.
 
===Dysgerminoma===
Immature ovarian teratoma
[[CT scan]] findings of [[dysgerminoma]] include:
 
* [[Lobular|Lobulated]] pattern 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>
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.
* Areas of [[septa]] which are enhnacing
Extension through the tumour capsule may be present.
* Areas of [[hemorrhage]] and [[necrosis]] which appear [[cystic]]
Immature teratoma may metastasise to peritoneum, liver or lung. Metastasis to brain has also been reported 7.
* Speckled pattern of [[calcification]]
 
===Yolk sac tumor===
 
[[CT scan]] findings of [[yolk sac tumor]] include:
Immature teratoma
* The bright dot [[Sign name|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]].<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>
CT and MRI
* [[Capsule|Capsular]] tear is another common finding which is not the pathognomonic finding for the [[yolk sac tumor]].
 
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.
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 13:57, 22 April 2019

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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] Sahar Memar Montazerin, M.D.[3]

Overview

It is difficult to distinguish ovarian germ cell tumors on CT alone, however, pelvic/abdominal CT scan may be helpful in the diagnosis. Sensitive findings on CT scan for the diagnosis of mature teratoma include Fat attenuation, presence or absence of calcification in the cyst wall, palm-tree like protrusion, and fat-fluid levels. Presence of cauliflower appearance with irregular borders may warrant the necessity to search for malignant transformation of these tumors. CT scan findings characteristics of immature teratoma include A large, irregular solid mass, presence of coarse calcification, small foci of fat, and Hemorrhage. CT findings associated with other ovarian germ cell tumors are not specific, but may be helpful.

CT

Mature teratoma

CT scan is a sensitive method to diagnose mature teratoma. Findings on CT scan suggestive of/diagnostic of mature teratoma include:[1]

Immature teratoma

CT scan findings of immature teratoma are characteristics and include:[3]

Dysgerminoma

CT scan findings of dysgerminoma include:

Yolk sac tumor

CT scan findings of yolk sac tumor include:

  • 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.[4]
  • Capsular tear is another common finding which is not the pathognomonic finding for the yolk sac tumor.

References

  1. ↑ 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.
  2. ↑ 2.0 2.1 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.
  3. ↑ 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. ↑ 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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