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BACKGROUND: Ovarian thecoma-fibroma and solid ovarian cancer have similar clinical and imaging features, and it is difficult for radiologists to differentiate them. Since the treatment and prognosis of them are different, accurate characterization is crucial. PURPOSE: To non-invasively differentiate ovarian thecoma-fibroma and solid ovarian cancer by convolutional neural network based on magnetic resonance imaging (MRI), and to provide the interpretability of the model. MATERIAL AND METHODS: A total of 156 tumors, including 86 ovarian thecoma-fibroma and 70 solid ovarian cancer, were split into the training set, the validation set, and the test set according to the ratio of 8:1:1 by stratified random sampling. In this study, we used four different networks, two different weight modes, two different optimizers, and four different sizes of regions of interest (ROI) to test the model performance. This process was repeated 10 times to calculate the average performance of the test set. The gradient weighted class activation mapping (Grad-CAM) was used to explain how the model makes classification decisions by visual location map. RESULTS: ResNet18, which had pre-trained weight, using Adam and one multiple ROI circumscribed rectangle, achieved best performance. The average accuracy, precision, recall, and AUC were 0.852, 0.828, 0.848, and 0.919 (P < 0.01), respectively. Grad-CAM showed areas associated with classification appeared on the edge or interior of ovarian thecoma-fibroma and the interior of solid ovarian cancer. CONCLUSION: This study shows that convolution neural network based on MRI can be helpful for radiologists in differentiating ovarian thecoma-fibroma and solid ovarian cancer.
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Imagen por Resonancia Magnética , Redes Neurales de la Computación , Neoplasias Ováricas , Neoplasia Tecoma , Humanos , Femenino , Neoplasias Ováricas/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Neoplasia Tecoma/diagnóstico por imagen , Diagnóstico Diferencial , Persona de Mediana Edad , Adulto , Fibroma/diagnóstico por imagen , Anciano , Ovario/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVE: To explore the value of magnetic resonance imaging (MRI) and clinical features in identifying ovarian thecoma-fibroma (OTF) with cystic degeneration and ovary adenofibroma (OAF). METHODS: A total of 40 patients with OTF (OTF group) and 28 patients with OAF (OAF group) were included in this retrospective study. Univariable and multivariable analyses were performed on clinical features and MRI between the two groups, and the receiver operating characteristic (ROC) curve was plotted to estimate the optimal threshold and predictive performance. RESULTS: The OTF group had smaller cyst degeneration degree (P < .001), fewer black sponge sign (20% vs. 53.6%, P = .004), lower minimum apparent diffusion coefficient value (ADCmin) (0.986 (0.152) vs. 1.255 (0.370), P < .001), higher age (57.4 ± 14.2 vs. 44.1 ± 15.9, P = .001) and more postmenopausal women (72.5% vs. 28.6%, P < .001) than OAF. The area under the curve of MRI, clinical features and MRI combined with clinical features was 0.870, 0.841, and 0.954, respectively, and MRI combined with clinical features was significantly higher than the other two (P < .05). CONCLUSION: The cyst degeneration degree, black sponge sign, ADCmin, age and menopause were independent factors in identifying OTF with cystic degeneration and OAF. The combination of MRI and clinical features has a good effect on the identification of the two. ADVANCES IN KNOWLEDGE: This is the first time to distinguish OTF with cystic degeneration from OAF by combining MRI and clinical features. It shows the diagnostic performance of MRI, clinical features, and combination of the two. This will facilitate the discriminability and awareness of these two diseases among radiologists and gynaecologists.
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Adenofibroma , Imagen por Resonancia Magnética , Neoplasias Ováricas , Neoplasia Tecoma , Humanos , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Diagnóstico Diferencial , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/patología , Imagen por Resonancia Magnética/métodos , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/patología , Adulto , Adenofibroma/diagnóstico por imagen , Adenofibroma/patología , Fibroma/diagnóstico por imagen , Anciano , Quistes Ováricos/diagnóstico por imagenAsunto(s)
Tumor de Células de la Granulosa , Neoplasias Ováricas , Neoplasia Tecoma , Femenino , Humanos , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/cirugía , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/cirugía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
RATIONALE: Sex cord-stromal tumors are always found in ovary, but the occurrence of this kind of tumor at extraovarian locations is extremely rare. Up to now, the case concerning fibrothecoma of broad ligament with minor sex cord elements has not been reported, and it is extremely challenging to diagnose before surgery. In this case report, we summarized pathogenesis, clinical features, laboratory finding, imaging studies, pathology, and therapeutic schedule of this tumor, with the aim of raising awareness and attention to this type of disease. PATIENT CONCERNS: A 45-year-old Chinese woman was referred to our department with intermittent lower abdominal pain for about 6 years. On examination, both ultrasonography and computed tomography revealed she had a right adnexal mass. DIAGNOSIS: Based on the results of histology and immunohistochemistry, the final diagnosis was confirmed as fibrothecoma of broad ligament with minor sex cord elements. INTERVENTIONS: This patient underwent laparoscopic unilateral salpingo-oophorectomy with excision of the neoplasm. OUTCOMES: Eleven days post-treatment, the patient complained that the symptoms of abdominal pain was disappeared. There is no evidence of disease recurrence 5 years after laparoscopic surgery according to the consequences of radiologic examination. CONCLUSION: The natural history of this kind of tumor is uncertain. Although main treatment of this neoplasm might be surgical resection and good prognosis can be achieved, we believe that long-time follow-up is extremely important in all patients diagnosed as fibrothecoma of broad ligament with minor sex cord. Laparoscopic unilateral salpingo-oophorectomy with excision of the tumor should be recommended to these patients.
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Ligamento Ancho , Fibroma , Tumores de los Cordones Sexuales y Estroma de las Gónadas , Neoplasia Tecoma , Femenino , Humanos , Persona de Mediana Edad , Dolor Abdominal/etiología , Ligamento Ancho/cirugía , Fibroma/complicaciones , Fibroma/diagnóstico por imagen , Fibroma/patología , Fibroma/cirugía , Tumores de los Cordones Sexuales y Estroma de las Gónadas/complicaciones , Tumores de los Cordones Sexuales y Estroma de las Gónadas/diagnóstico por imagen , Tumores de los Cordones Sexuales y Estroma de las Gónadas/patología , Tumores de los Cordones Sexuales y Estroma de las Gónadas/cirugía , Neoplasia Tecoma/complicaciones , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/patología , Neoplasia Tecoma/cirugía , Laparoscopía , Salpingectomía , Ovariectomía , Ultrasonografía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI)-based characteristics and a texture analysis (TA) for discriminating between ovarian thecoma-fibroma groups (OTFGs) and ovarian granulosa cell tumors (OGCTs). METHODS: This retrospective multicenter study enrolled 52 patients with 32 OGCTs and 21 OTFGs, which were dissected and pathologically diagnosed between January 2008 and December 2019. MRI-based features (MBFs) and texture features (TFs) were evaluated and compared between OTFGs and OGCTs. A least absolute shrinkage and selection operator (LASSO) regression analysis was performed to select features and construct the discriminating model. ROC analyses were conducted on MBFs, TFs, and their combination to discriminate between the two diseases. RESULTS: We selected 3 features with the highest absolute value of the LASSO regression coefficient for each model: the apparent diffusion coefficient (ADC), peripheral cystic area, and contrast enhancement in the venous phase (VCE) for the MRI-based model; the 10th percentile, difference variance, and maximal correlation coefficient for the TA-based model; and ADC, VCE, and the difference variance for the combination model. The areas under the curves of the constructed models were 0.938, 0.817, and 0.941, respectively. The diagnostic performance of the MRI-based and combination models was similar (p = 0.38), but significantly better than that of the TA-based model (p < 0.05). CONCLUSIONS: The conventional MRI-based analysis has potential as a method to differentiate OTFGs from OGCTs. TA did not appear to be of any additional benefit. Further studies are needed on the use of these methods for a preoperative differential diagnosis of these two diseases.
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Fibroma , Tumor de Células de la Granulosa , Neoplasia Tecoma , Femenino , Fibroma/diagnóstico por imagen , Tumor de Células de la Granulosa/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Neoplasias Ováricas , Curva ROC , Estudios Retrospectivos , Neoplasia Tecoma/diagnóstico por imagenRESUMEN
OBJECTIVE: The aim of this study was to investigate the CT imaging characteristics of ovarian fibrothecoma which may aid in the differentiation from early stage epithelial tumours. METHODS: Comparison of 36 patients (41 lesions) with pathologically proven ovarian fibrothecoma tumours and 36 (52 lesions) serous papillary carcinomas (SPCs) lesions. We noted their laterality, size, density, calcifications, Hounsfield units (HUs) and introduced a novel HU comparison technique with the psoas muscle or the uterus. Patients' clinical findings such as ascites, pleural effusion, carbohydrate antigen-125 levels, and lymphadenopathy findings were also included. RESULTS: Average age was 67.8 and 66 across the fibrothecoma and SPC cohort respectively. Fibrothecoma tumours had diameters ranging from 24 to 207 mm (Median: 94 mm). 80.6% of the fibrothecoma cohort had ascites which was comparable to the 72.2% in the SPC cohort. 70.7% of fibrothecoma tumour favour a purely to predominantly solid structural configuration (p < 0.001). The average HU value for the fibrothecoma solid component was 44 ± 11.7 contrasting the SPC HU value of 66.8 ± 15. The psoas:tumour mass ratio demonstrated a median of 0.7, whereas SPCs shows a median of 1.1 (p < 0.001). CONCLUSION: Suspicion of ovarian fibrothecoma should be considered through interrogation of their structural density configuration, low psoas to mass HU ratio and a presence of ascites. ADVANCES IN KNOWLEDGE: CT imaging can be a useful tool in diagnosing fibrothecoma tumours and subsequently reducing oncogynaecological tertiary centre referrals, financial burden and patient operative morbidity and mortality.
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Fibroma , Neoplasias Glandulares y Epiteliales , Neoplasias Ováricas , Neoplasia Tecoma , Ascitis , Antígeno Ca-125 , Femenino , Fibroma/diagnóstico , Fibroma/patología , Tumor de Células de la Granulosa , Humanos , Neoplasias Ováricas/patología , Estudios Retrospectivos , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/patología , Tomografía Computarizada por Rayos XRESUMEN
Synchronous endometrial and ovarian carcinoma is a rare instance and it accounts for 50 to 70% of all synchronous female genital tract tumors. However, it is very rare to find synchronous endometrial carcinoma and ovarian sex cord-stromal tumor (thecoma). The present case is a 75-year-old woman with a complaint of post-menopausal vaginal bleeding. Radiologically, the magnetic resonance imaging (MRI) pelvis revealed altered signal intensity mass in the uterus. Frozen section and routine histopathological examination were done on radical hysterectomy. Microscopically, serous carcinoma involving uterine corpus and left Fallopian tube was identified along with the unusual finding of contralateral ovarian sex cord-stromal tumor (thecoma), which was confirmed on immunohistochemical examination. It is a very rare association and is first reported in the present study after a thorough search of the published literature. Their relationship based on a high level of estrogen produced by the hyperactive ovary is controversial as serous carcinomas are less hormone-dependent.
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Carcinoma , Cistadenocarcinoma Seroso , Neoplasias Ováricas , Tumores de los Cordones Sexuales y Estroma de las Gónadas , Neoplasia Tecoma , Neoplasias Uterinas , Anciano , Carcinoma/patología , Cistadenocarcinoma Seroso/diagnóstico por imagen , Cistadenocarcinoma Seroso/cirugía , Femenino , Humanos , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/cirugía , Tumores de los Cordones Sexuales y Estroma de las Gónadas/diagnóstico , Tumores de los Cordones Sexuales y Estroma de las Gónadas/patología , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/cirugía , Hemorragia Uterina , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologíaRESUMEN
Brenner tumors are rare ovarian neoplasms composed of ovarian transition cells surrounded by dense fibrous tissue. Most of them are small tumors (<2 cm), detected incidentally in asymptomatic women. Its predominantly fibrous content results in relatively low signal on T2 weighted images, establishing differential diagnosis with ovarian fibroma and thecoma. Their imaging features are very similar, the differentiation is based on secondary characteristics, such as signs or symptoms of estrogen excess and the presence of a second ovarian neoplasm, which has been reported in up to 30% of patients with Brenner tumor. Although originally thought to be universally benign, there have been scattered reports in the past decades of borderline and malignant forms of Brenner tumors.
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Tumor de Brenner/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Enfermedades Raras/diagnóstico por imagen , Tumor de Brenner/patología , Cistoadenofibroma/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Fibroma/diagnóstico por imagen , Fibroma/patología , Humanos , Leiomioma/diagnóstico por imagen , Imagen por Resonancia Magnética , Neoplasias Ováricas/patología , Enfermedades Raras/patología , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/patología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
PURPOSE: To survey the occurrence rate of ascites in patients with thecoma-fibroma and its potential correlation with tumor MR imaging characteristics. METHODS: A total of 40 patients with surgically proven thecoma-fibroma were enrolled in this retrospective study. We determined the tumor size, the components (solid or cystic) and their signal intensity features. Second, we identified ascites according to the fat-suppressed sagittal T2-weighted imaging sequence and divided all cases into two groups (with or without ascites). Furthermore, we explored the correlations of ascites with tumor size, tumor solidity, pathological types, patient's postmenopausal status and serum CA-125 levels by using the χ2 test. RESULTS: (1) Among the 40 cases, 15 tumors were fibromas, 15 thecomas, and 10 fibrothecomas. Nine patients (26.47%) had elevated CA-125 levels (>35.0 U/ml). (2) Thirty-one patients had ascites (77.50%), 29 of which had a small amount of ascites. Nine cases had no ascites (22.50%). (3) MRI showed a solid mass in 22 cases (55.0%), cystic mass in five cases (12.5%) and mixed solid-cystic mass in 13 cases (32.5%). The χ2 test revealed that the incidence of ascites was significantly correlated with tumor size, tumor solidity and serum CA-125 levels (P < 0.05), but not with menopause and pathological type (P > 0.05). CONCLUSION: Our data revealed that the incidence of ascites was 77.50% and was mainly correlated with tumor size and elevated CA-125 levels. These findings have potential value for improving the diagnosis and differential diagnosis of thecoma-fibroma.
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Fibroma , Neoplasias Ováricas , Neoplasia Tecoma , Femenino , Fibroma/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Neoplasias Ováricas/diagnóstico por imagen , Estudios Retrospectivos , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/epidemiologíaRESUMEN
Objective To investigate the magnetic resonance imaging(MRI)findings of ovarian thecomas and improve the accuracy of preoperative MRI diagnosis of the disease.Methods A retrospective analysis of 48 patients with ovarian thecoma confirmed by operation and pathology was performed.According to the maximum diameter,the lesions were divided into≥5 cm and <5 cm groups and analyzed in terms of location,size,shape,boundary,cystic necrosis,T1WI/T2WI signals,DWI characteristics,enhancement features,and pelvic effusion.The diagnostic score was evaluated by MRI(the highest score was 6 points).Results All the 48 lesions were single.In the≥5 cm group(n=39),the tumor boundary was clear in 37 cases and unclear in 2 cases;necrosis was found in 35 cases;T1WI showed equal signals in 23 cases and equal low signals in 16 cases;T2WI showed equal signals in 7 cases,equal low signals in 23 cases,and slightly higher signals in 9 cases;DWI showed high signals in 23 cases and mixed high signals in 16 cases;dynamic enhanced scans showed slight enhancement in all cases;33 patients had different degrees of pelvic fluid;score evaluation showed 6 points in 33 cases,5 points in 2 cases,4 points in 2 cases,and 3 points in 2 cases.In the <5 cm group(n=9),all lesions had clear boundaries;cystic necrosis was seen in 3 cases;T1WI showed equal signals in 3 cases and equal low signals in 6 cases;T2WI showed equal signals in 2 cases,equal low signals in 4 cases,and slightly higher signal in 3 cases;DWI showed high signals;the dynamic enhancement of the lesions showed slight enhancement in 8 cases and significant enhancement in one case;a small amount of pelvic fluid was seen in 4 cases;score evaluation revealed 6 points in 3 cases,5 points in 1 case,4 points in 4 cases,and 3 points in 1 case.The incidences of pelvic effusion(χ2=6.680,P=0.010)and cyst necrosis(χ2=14.109,P<0.001)in the≥5 cm group were significantly higher than those in the <5 cm group.The number of patients with cystic lesions with elevated estrogen levels was significantly higher than that of patients without cystic lesions(χ2=5.847,P=0.016;contingency coefficeient=0.330).Conclusions Large ovarian thecomas have high or mixed high signals on DWI;they are often accompanied by pelvic fluid and cystic necrosis,and the cystic necrosis is common and has small involvement.For small ovarian thecomas,DWI often reveals high signals,and cystic necrosis is rare.MRI score evaluation combined with patient's age and other factors is helpful to improve the accuracy of preoperative diagnosis.
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Imagen por Resonancia Magnética , Neoplasias Ováricas , Neoplasia Tecoma , Femenino , Humanos , Neoplasias Ováricas/diagnóstico por imagen , Estudios Retrospectivos , Neoplasia Tecoma/diagnóstico por imagenRESUMEN
To investigate the magnetic resonance imaging (MRI) findings in ovarian thecoma and improve preoperative diagnostic accuracy.Retrospective analysis was performed on 45 patients with surgically and pathologically confirmed ovarian thecoma. Patients were grouped into those with maximum lesion diameter ≥5âcm and <5âcm. Diagnostic scores (up to 6 points) were evaluated on the basis of MRI performance.The ≥5âcm group contained 36 cases (cystic necrosis, 32 cases) with the following findings: T1WI: isointense signal, 22 cases; slightly hypointense signal, 14 cases; T2WI: isointense signal, 6 cases; slightly hypointense signal, 21 cases; slightly hyperintense signal, 9 cases; Diffusion-weighted imaging (DWI): hyperintense signal, 23 cases; mixed hyperintense signal, 13 cases; slight enhancement on dynamic enhanced scans; pelvic fluid accumulation, 31 cases. The diagnostic score evaluations yielded 6 points in 31 cases, 5 points in 1 case, 4 points in 2 cases, and 3 points in 2 cases. The <5âcm group contained 9 cases (cystic necrosis, 3 cases) with the following findings: T1WI: isointense signal, 3 cases; slightly hypointense signal, 6 cases; T2WI: isointense signal, 2 cases; slightly hypointense signal, 4 cases; slightly hyperintense signal, 3 cases; DWI, hyperintense signal; slight enhancement in 8 cases and significant enhancement in 1 case; pelvic fluid accumulation, 4 cases. The diagnostic score evaluations yielded 6 points in 3 cases, 5 points in 1 case, 4 points in 4 cases, and 3 points in 1 case. (iii) Incidence of pelvic fluid accumulation and cystic necrosis differed depending on the size of the lesion (Pâ=â.007, .000).Larger lesions show hyperintense or mixed hyperintense signals on DWI along with pelvic fluid and cystic necrosis; whereas, smaller lesions show a hyperintense signal on DWI, cystic necrosis is rare. MRI characteristics along with the patient age and laboratory findings can improve the accuracy of preoperative diagnosis of these lesions.
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Imagen por Resonancia Magnética/clasificación , Neoplasias Ováricas/diagnóstico por imagen , Neoplasia Tecoma/diagnóstico por imagen , Adulto , Anciano , China , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/normas , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/fisiopatología , Radiología/instrumentación , Radiología/métodos , Radiología/tendencias , Sensibilidad y Especificidad , Neoplasia Tecoma/diagnóstico , Neoplasia Tecoma/fisiopatologíaRESUMEN
Ovarian thecoma is a benign and rare neoplasm that accounts for 0.5% to 1% of all ovarian tumors. A 55-year-old woman with known breast cancer underwent a metastatic workup before surgery. The Tc-MDP whole-body bone scan revealed intense uptake in the left pelvic region. Hybrid SPECT/CT imaging showed that the elevated Tc-MDP activity was in a tumor with calcification in the left adnexa. Dynamic enhanced MRI revealed marked enhancement of the tumor. Resection of the tumor was subsequently performed, and pathologic analysis confirmed the diagnosis of an ovarian thecoma.
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Hallazgos Incidentales , Neoplasias Ováricas/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Medronato de Tecnecio Tc 99m , Neoplasia Tecoma/diagnóstico por imagen , Imagen de Cuerpo Entero , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/secundario , Neoplasia Tecoma/secundarioAsunto(s)
Imagen de Difusión por Resonancia Magnética/métodos , Tumor de Células de la Granulosa/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Neoplasias Ováricas/diagnóstico por imagen , Neoplasia Tecoma/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Imagen Multimodal/métodos , Ovario/diagnóstico por imagen , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: The presence of virilizing signs associated with high serum androgen levels in postmenopausal women is rare. Virilizing ovarian tumors (VOTs) and ovarian stromal hyperthecosis (OH) are the most common etiologies in virilized postmenopausal women. The differential diagnosis between these two conditions is often difficult. OBJECTIVE: To evaluate the contribution of clinical features, hormonal profiles and radiological studies to the differential diagnosis of VOT and OH. DESIGN: A retrospective study. SETTING: A tertiary center. MAIN OUTCOME MEASURES: Clinical data, hormonal status (T, E2, LH and FSH), pelvic images (transvaginal sonography and MRI) and anatomopathology were reviewed. PATIENTS: Thirty-four postmenopausal women with a diagnosis of VOT (13 women) and OH (21 women) were evaluated retrospectively. RESULTS: Clinical signs of hyperandrogenism were more prevalent in the VOT group than the OH group. Although the VOT group showed higher T and E2 levels and lower gonadotropin levels than the OH group, a great overlap occurred among the hormone levels. A pelvic MRI provided an accurate differentiation of these two conditions. CONCLUSION: In this group of patients, the main features contributing to the differential diagnosis of VOT and OH were serum levels of testosterone and gonadotropins and the presence of an ovarian nodule identified on the MRI. Although the association of clinical, hormonal and radiological features contributes to the differential diagnosis of these two conditions, histopathological analysis remains the gold standard for the diagnosis of ovarian hyperandrogenism in postmenopausal women.
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Estradiol/sangre , Hiperandrogenismo/etiología , Neoplasias Ováricas/diagnóstico por imagen , Ovario/diagnóstico por imagen , Lesiones Precancerosas/diagnóstico por imagen , Testosterona/sangre , Regulación hacia Arriba , Anciano , Estudios de Cohortes , Diagnóstico Diferencial , Regulación hacia Abajo , Femenino , Hormona Folículo Estimulante Humana/sangre , Estudios de Seguimiento , Humanos , Hiperandrogenismo/epidemiología , Hiperplasia/sangre , Hiperplasia/diagnóstico por imagen , Hiperplasia/patología , Hiperplasia/fisiopatología , Hormona Luteinizante/sangre , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tamaño de los Órganos , Neoplasias Ováricas/sangre , Neoplasias Ováricas/patología , Neoplasias Ováricas/fisiopatología , Ovario/patología , Posmenopausia , Lesiones Precancerosas/sangre , Lesiones Precancerosas/patología , Lesiones Precancerosas/fisiopatología , Prevalencia , Estudios Retrospectivos , Neoplasia Tecoma/sangre , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/patología , Neoplasia Tecoma/fisiopatología , Carga Tumoral , UltrasonografíaRESUMEN
Positron emission tomography (PET) with fluorodeoxyglucose F18 (18 F-FDG) is useful for detecting malignancies, but benign lesions occasionally have false-positive 18 F-FDG uptake. Here, we report the cases of five postmenopausal women with solid ovarian tumors suspected to be ovarian cancer on magnetic resonance imaging and 18 F-FDG uptake. Mean age of the five patients was 57 years (range, 53-65 years). Average early standardized uptake value (SUV) of 18 F-FDG was 5.76 (range, 2.2-12.0) and delayed SUV was 6.56 (range, 2.4-13.8). In all five patients, frozen section diagnosis at surgery was thecoma, and bilateral salpingo-oophorectomy was performed. On immunohistochemistry, immunoreactive glucose transporter 5 (GLUT5) expression was detected in thecoma tissues. This case shows that thecoma sometimes has positive 18 F-FDG uptake on positron emission tomography-computed tomography (PET-CT), indicating the need for caution regarding false-positive PET-CT in patients with benign solid ovarian tumor.
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Transportador de Glucosa de Tipo 5/metabolismo , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/metabolismo , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/metabolismo , Anciano , Reacciones Falso Positivas , Femenino , Fluorodesoxiglucosa F18 , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias Ováricas/patología , Posmenopausia , Neoplasia Tecoma/patologíaRESUMEN
BACKGROUND: Ovarian thecoma-fibroma groups (OTFG) are uncommon sex cord-stromal neoplasms. The objective of the study was to demonstrate clinical and sonographic features of OTFG and compare with surgical histopathology. METHODS: A total of 61 patients with surgically proven OTFG were enrolled in this retrospective study to demonstrate its clinical and sonographic features and to compare with pathological findings. Gray scale and color Doppler sonography were performed presurgically with either transabdominal or transvaginal approach to image pelvic structures and lesions. The clinical findings and sonographic appearances were compared with the types of the OTFG tumors based on the histopathological diagnosis. RESULTS: The mean patient age was 53.57 (range, 26-86) years. There were 63.93% (39/61) patients in postmenopausal and 63.93% (39/61) patients with no clinical symptoms. Ultrasound findings of OTFG revealed as solid tumors with a typical feature of well-demarcated hypoechoic masses in 70.49% (43/61), among which 74.41% (32/43) tumors were smaller than 5 cm in diameter. There were 17 mixed echogenic masses with calcification, hemorrhage, or cyst, among which 70.59% (12/17) lesions were larger than 5 cm in diameter. Acoustic attenuation of the tumor was presented in 44.26% (27/61) of the cases. Doppler flow signals within the tumors were found in 20 cases (32.79%), in which 80% (16/20) had minimal or moderate flow signals. Ascites was detected in 32.79% (20/61) of the cases, Megi's syndrome was found in 1 case. Final pathology revealed 41 (67.21%) thecoma-fibromas, 15 (24.59%) fibromas, 4 (6.56%) thecomas and 1 (1.64%) fibrosarcoma. There were 58 patients underwent cancer antigen 125 (CA125) test, and 20.69% (12/58) showed an elevated level. The diameter of tumors was found to be significantly correlated with CA125 level (p < 0.01) and the amount of ascites fluid (p < 0.05). CONCLUSIONS: The typical sonographic features of OTFG include adnexal hypoechoic masses with clear border and acoustic attenuation as well as minimal Doppler flow signals. All the aforementioned features could make ultrasound imaging as a assistent tool improve the preoperative diagnostic accuracy.
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Fibroma/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Neoplasia Tecoma/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Adulto , Anciano , Anciano de 80 o más Años , Antígeno Ca-125/metabolismo , Femenino , Fibroma/metabolismo , Fibroma/patología , Fibroma/cirugía , Humanos , Proteínas de la Membrana/metabolismo , Persona de Mediana Edad , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Posmenopausia , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasia Tecoma/metabolismo , Neoplasia Tecoma/patología , Neoplasia Tecoma/cirugíaRESUMEN
In this report, we describe the first case ever reported in the literature, of an inhibin-A (INHA) and inhibin-B (INHB) producing fibrothecoma. A post-menopausal woman was referred to our unit because of follicle stimulating hormone (FSH) level below the reference interval for postmenopausal women. By contrast luteinizing hormone, hCG, and estradiol levels were within normal range. This discrepancy suggested the secretion of FSH inhibitory factors. INHB and INHA levels were markedly elevated for age, 475 pg/mL and 100 pg/mL, respectively. Ultrasonography and MRI showed a pelvic mass of indeterminate nature. Abnormal inhibin secretion is generally observed in granulosa cell tumors. In this case this etiology was unlikely because of low estradiol and AMH levels. Surgical exploration revealed a 10 cm mass of the left ovary proven histologically to be an ovarian fibrothecoma (OFT). After tumor removal, INHB and INHA levels decreased rapidly. Only three cases of OFT with an important secretion of INHB have been reported to date. INHA secretion has never been associated with OFT. There is a need to develop coupled hormone and imaging strategies to diagnose the source of INH secretion in case of FSH/LH discrepancy.
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Fibroma/metabolismo , Hormona Folículo Estimulante/sangre , Inhibinas/sangre , Neoplasias Ováricas/metabolismo , Posmenopausia/sangre , Neoplasia Tecoma/metabolismo , Femenino , Fibroma/diagnóstico por imagen , Fibroma/cirugía , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/cirugía , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/cirugíaRESUMEN
Several studies have noted benign thecomafibroma tumors with positive F18 fluorodeoxyglucose (FDG) accumulation mimicking malignant ovarian tumors following F18 FDG positron emission tomography (PET). The present study analyzed four cases with falsepositive F18 FDG PET/computed tomography (CT) diagnoses of thecomafibroma tumors as malignant tumors due to F18 FDG accumulation, compared with eight cases of FDGpositive ovarian cancers and two cases of FDGnegative fibromas. Hypoxia inducible factor (HIF)1α expression was examined in the six thecomafibroma tumors using reverse transcriptionpolymerase chain reaction (RTPCR). The four F18 FDGpositive cases exhibited higher cellularity, maximum standard uptake and signal intensity on T2weighted imaging, and gadolinium (Gd) enhancement using magnetic resonance imaging than the two FDG-negative fibroma cases. In the F18 FDGpositive thecomafibroma group, Ki67 expression was low and LAT1 expression was not identified, ruling out the diagnosis and potential for malignancy. However, considerable glucose transporter 1, HIF1α, and vascular endothelial growth factor expression was observed. HIF1α expression was elevated in all four falsepositive cases by RTPCR. From these results, it was hypothesized that hypoxia due to elevated cellularity may stimulate HIF1α expression and be associated with F18 FDG accumulation in F18positive thecomafibroma tumors.
Asunto(s)
Fibroma , Glucosa-6-Fosfato/análogos & derivados , Hipoxia , Neoplasias Ováricas , Tomografía de Emisión de Positrones , Neoplasia Tecoma , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Fibroma/diagnóstico por imagen , Fibroma/metabolismo , Glucosa-6-Fosfato/administración & dosificación , Glucosa-6-Fosfato/farmacocinética , Humanos , Hipoxia/diagnóstico por imagen , Hipoxia/metabolismo , Persona de Mediana Edad , Proteínas de Neoplasias/metabolismo , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/metabolismo , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/metabolismoAsunto(s)
Fibroma/patología , Morcelación/efectos adversos , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Neoplasia Tecoma/patología , Anciano , Estudios Transversales , Diagnóstico Diferencial , Endosonografía/métodos , Femenino , Fibroma/diagnóstico por imagen , Fibroma/cirugía , Estudios de Seguimiento , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparotomía/efectos adversos , Laparotomía/métodos , Persona de Mediana Edad , Morcelación/métodos , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Ováricas/diagnóstico por imagen , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/patología , Estudios Retrospectivos , Medición de Riesgo , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/cirugía , Resultado del TratamientoRESUMEN
The aim of this study was to investigate characteristic CT manifestations of the group of ovarian thecoma-fibroma. 24 patients (26 lesions) presenting with the ovarian thecoma-fibroma were analyzed retrospectively, and the diagnosis were confirmed by pathology after surgery. Our findings included: 22 patients were unilateral, while 2 were bilateral; 12 lesions were located in the right side of ovary, while 14 lesions were in the left side. Of the 26 lesions, there were ovarian thecoma (16 lesions), fibrothecoma (6 lesions), and fibroma (4 lesions). The largest diameters of tumor ranged from 37 to 231 mm with the mean value of 100 ± 44.29 mm. 14 patients were accompanied by ascites. All the tumors had well-defined borders. The shape of 22 lesions appeared round or oval, and 4 lesions were irregular. The tumors were solid in 19 lesions, cystic in 2 lesions, and mixed in 5 lesions. Most of the tumors were of heterogeneous density. There were no (20 lesions) or slight enhancement (6 lesions) after injection of the contrast medium. CT values of plain scan, arterial phase and venous among three groups had no significant difference. The enhancement were in the range of 0-5 HU in 10 lesions, and 6-17 HU in 16 lesions. In conclusion, the characteristic CT manifestations of the group of ovarian thecoma-fibroma were: often unilateral solid mass with the shape of oval and well defined border; no enhancement or slight enhancement; accompanied by small amount of ascites.