CASE OF THE (PREVIOUS) WEEK

CASE HISTORY
• 22YR FEMALE WITH H/O MENSTRUAL IRREGULARITY
FOR 6 MONTHS WAS REFERRED FOR LOWER
ABDOMEN USG.
• MARITAL STATUS-MARRIED FOR 2 YRS;NO ISSUES.
• ON PALPATION A PELVIC MASS WAS MADE OUT.
• P/V-NORMAL
• URINE PREGNANCY TEST RESULT-NEGATIVE
FIRST EXCLUDE A (PEDUNCULATED) LEIOMYOMA,
BY VISUALIZING A NORMAL OVARY ON THAT SIDE
D/D OF PELVIC MASS
Reproductive Age Group

Differential Diagnosis
 USG PRESENTATION
• B/L OVARIAN TUMOR
 D/D OF B/L OVARIAN TUMORS

• SEROUS CYSTADENOMA &

CYSTADENOCARCINOMA
• KRUKENBERG’S TUMOR
• DERMOID CYST
• MUCINOUS CYSTADENOMA
• FUNCTIONAL CYSTS
FEW IMPORTANT CLINICAL POINTS
• FUNCTIONAL CYSTS NEVER GROW
>7CM,UNILOCULAR WITH CLEAR FLUID &
TRANSIENT IN NATURE.

• IF ANY CYSTS PERSISTS FOR LONGER THAN 2

MONTHS,POSSIBILITY OF A NEOPLASTIC CYST
MUST BE KEPT IN MIND AND SHOULD BE
EVALUATED.
 Transvaginal sonographic approach

BY PLACING PRESSURE ON THE TRANSVAGINAL PROBE

AND ON THE PATIENT'S ABDOMEN WITH THE FREE
HAND YOU CAN ELICIT PELVIC TENDERNESS AND
HELPS THE EXAMINER ASSESS THE MOBILITY AND
COMPRESSIBILITY OF AN OVARIAN MASS, AS WELL
AS THE CONSISTENCY OF ITS INTERNAL STRUCTURES.
 Question 2

Is the mass solid?

Solid ovarian masses are generally the smallest subset of

ovarian tumors; approximately 10% are malignant.
 Question 3

Is it a simple or complex cyst?

The risk that a simple, thin-walled cyst is malignant

increases with patient age and the size of the cyst.
Although the risk of malignancy rises as loculated cysts
become more complex, the Mucinous cystadenomas
contain multiple septations and fluid with fine debris
secondary to their thick mucinous content.
 Question 5
Are there echo-dense foci?
benign cystic teratomas usually produces echogenic foci
with acoustic shadowing, but some malignant tumors
may have components that cast an acoustic shadow.

72% of cystic teratomas are avascular.

If the solid components of an apparent benign cystic

teratoma have vascular flow, a struma ovarii
consisting largely of thyroid tissue should be
considered.
 Question 6
Is there echogenicity of interior fluid?

• a serous cyst generally contains clear fluid,

• a mucinous cysts contain fine debris.
• An endometrioma tends to contain homogeneous
debris .
• a hemorrhagic cyst may have a ground-glass
appearance .
• echogenic foci with acoustic shadowing are
characteristic of a benign cystic teratoma
Question 7

Ascites?
 Question 8

How does the mass change over time?

a follow-up ultrasound examination in 6 to 8

weeks may provide additional information
about a mass's etiology.
Repeat sonography is recommended in cases
without obvious stigmata of malignancy or a
size that would mandate surgery.
 Ovarian Doppler.
Because of the many types of ovarian masses,
sonographic morphology is usually not
pathognomic and—when used alone—results
in a high false-positive rate in the diagnosis
of malignancy. The role of color and pulse
Doppler is to reduce these false-positives.
 Ovarian Doppler.
Findings suggestive
of malignancy.

Malignant tumors characteristically contain

dilated, saccular, and randomly dispersed
vessels. Centrally located flow, flow along
septations, and flow within papillary
excrescences also suggest malignancy.
 Ovarian Doppler.
Findings suggesting
a benign mass

Peripheral flow is more consistent with a

benign neoplasm. Hemorrhage in a mass is
highly suggestive of a benign mass or cyst.
• T1 WEIGHTED M.R.IMAGING OF THE LOWER
ABDOMEN WAS DONE.
CASE DISCUSSION
OVARIAN TUMORS
 Frequency of Ovarian Neoplasm
(WHO Classification)

Class Frequency (%)

Epithelial stromal (Common epithelial) tumors 65
Germ cell tumors 20-25
Sex cord-stromal tumors 6
Lipid (lipoid) cell tumors <0.01
Gonadoblastoma <0.01

Soft-tissue tumors (not specific to the ovary)

Unclassified tumors
Secondary (metastatic) tumors
Tumor-like conditions (not true neoplasm)