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Pelvic ultrasonography remains the preferred imaging method to evaluate most adnexal cysts given its ability to characterize such cysts with high resolution and accuracy. Most cystic adnexal masses have characteristic findings that can guide counseling and management decisions. For instance, mature cystic teratomas have hyperechoic lines/dots and acoustic shadowing; hydrosalpinx are tubular or s shaped and show a “waist sign.”
In parts 1 through 3 of this 4-part series on adnexal pathology, we presented images detailing common benign adnexal cysts, including:
- simple and hemorrhagic cysts (Part 1:Telltale sonographic features of simple and hemorrhagic cysts)
- mature cystic teratomas (dermoid cysts) and endometriomas (Part 2: Imaging the endometrioma and mature cystic teratoma)
- hydrosalpinx and pelvic inclusion cysts (Part 3: “Cogwheel” and other signs of hydrosalpinx and pelvic inclusion cysts)
In this conclusion to the series, we detail imaging for ovarian neoplasias (including cystadenoma and cystadenocarcinoma).
OVARIAN NEOPLASIA
A woman’s lifetime risk of undergoing surgery for suspected ovarian malignancy is 5% to 10% in the United States, and only about 13% to 21% of those undergoing surgery will actually be diagnosed with ovarian cancer.1 Therefore, the goal of diagnostic evaluation is to exclude malignancy.
Diagnostic evaluation includes:
- imaging
- lab work
- history
- physical findings.
The preferred imaging modality for a pelvic mass in asymptomatic premenopausal and postmenopausal women is transvaginal ultrasonography according to the American College of Obstetricians and Gynecologists (ACOG) practice bulletin, which was reaffirmed in 2013.1 “No alternative imaging modality has demonstrated sufficient superiority to transvaginal ultrasonography to justify its routine use.”1
Transvaginal ultrasonography with color Doppler interrogation has demonstrated a sensitivity of 0.86% and a specificity of 0.91% for discriminating between malignant and benign ovarian masses.
Sonographic features that are worrisome for malignancy include:
- Multiple thin septations (if indeterminate, the mass may possibly be benign)
- Thick (> 3 mm), irregular septations
- Focal areas of wall thickening (> 3 mm)
- Mural nodules or papillary projections
- Levine and colleagues note that a cyst with a mural nodule with internal blood flow on color Doppler has the highest likelihood of being malignant2
- Moderate or large amount of ascitic fluid in pelvis (in conjunction with ovarian mass showing the above characteristics)
Various morphology indices have been developed that combine these criteria with ovarian mass volume to determine the preoperative predictive value for malignancy.
In the images that follow, we present 14 cases that demonstrate cystadenoma, low malignant potential tumors, and ovarian neoplasia.
CASE 1. Right ovarian mucinous cystadenoma in 68-year-old woman with uterine prolapse and history of ovarian cyst
CASE 2. Borderline serous cystadenoma in 56-year-old woman with right lower quadrant pain, nausea, and loss of appetite
CASE 3. Mucinous cystadenoma in 38-year-old woman undergoing sonography for spontaneous abortion
CASE 4. Mucinous cystadenoma in 54-year-old woman undergoing follow-up ultrasound for persistent ovarian cyst
CASE 7. Mature cystic teratoma in 31-year-old woman with progressively heavier bleeding and pelvic pain
CASE 11. Sex-cord stromal tumor in 61-year-old woman with postmenopausal bleeding
CASE 12. Juvenile granulosa cell tumor in 19-year-old patient with secondary amenorrhea
CASE 14. Mucinous borderline tumor in 55-year-old woman with pelvic discomfort
Dr. Ozcan is Assistant Professor and Associate Program Director, Obstetrics and Gynecology Residency, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville. Dr. Kaunitz serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this article.
Dr. Ozcan is Assistant Professor and Associate Program Director, Obstetrics and Gynecology Residency, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville. Dr. Kaunitz serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this article.
Dr. Ozcan is Assistant Professor and Associate Program Director, Obstetrics and Gynecology Residency, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville. Dr. Kaunitz serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this article.
Pelvic ultrasonography remains the preferred imaging method to evaluate most adnexal cysts given its ability to characterize such cysts with high resolution and accuracy. Most cystic adnexal masses have characteristic findings that can guide counseling and management decisions. For instance, mature cystic teratomas have hyperechoic lines/dots and acoustic shadowing; hydrosalpinx are tubular or s shaped and show a “waist sign.”
In parts 1 through 3 of this 4-part series on adnexal pathology, we presented images detailing common benign adnexal cysts, including:
- simple and hemorrhagic cysts (Part 1:Telltale sonographic features of simple and hemorrhagic cysts)
- mature cystic teratomas (dermoid cysts) and endometriomas (Part 2: Imaging the endometrioma and mature cystic teratoma)
- hydrosalpinx and pelvic inclusion cysts (Part 3: “Cogwheel” and other signs of hydrosalpinx and pelvic inclusion cysts)
In this conclusion to the series, we detail imaging for ovarian neoplasias (including cystadenoma and cystadenocarcinoma).
OVARIAN NEOPLASIA
A woman’s lifetime risk of undergoing surgery for suspected ovarian malignancy is 5% to 10% in the United States, and only about 13% to 21% of those undergoing surgery will actually be diagnosed with ovarian cancer.1 Therefore, the goal of diagnostic evaluation is to exclude malignancy.
Diagnostic evaluation includes:
- imaging
- lab work
- history
- physical findings.
The preferred imaging modality for a pelvic mass in asymptomatic premenopausal and postmenopausal women is transvaginal ultrasonography according to the American College of Obstetricians and Gynecologists (ACOG) practice bulletin, which was reaffirmed in 2013.1 “No alternative imaging modality has demonstrated sufficient superiority to transvaginal ultrasonography to justify its routine use.”1
Transvaginal ultrasonography with color Doppler interrogation has demonstrated a sensitivity of 0.86% and a specificity of 0.91% for discriminating between malignant and benign ovarian masses.
Sonographic features that are worrisome for malignancy include:
- Multiple thin septations (if indeterminate, the mass may possibly be benign)
- Thick (> 3 mm), irregular septations
- Focal areas of wall thickening (> 3 mm)
- Mural nodules or papillary projections
- Levine and colleagues note that a cyst with a mural nodule with internal blood flow on color Doppler has the highest likelihood of being malignant2
- Moderate or large amount of ascitic fluid in pelvis (in conjunction with ovarian mass showing the above characteristics)
Various morphology indices have been developed that combine these criteria with ovarian mass volume to determine the preoperative predictive value for malignancy.
In the images that follow, we present 14 cases that demonstrate cystadenoma, low malignant potential tumors, and ovarian neoplasia.
CASE 1. Right ovarian mucinous cystadenoma in 68-year-old woman with uterine prolapse and history of ovarian cyst
CASE 2. Borderline serous cystadenoma in 56-year-old woman with right lower quadrant pain, nausea, and loss of appetite
CASE 3. Mucinous cystadenoma in 38-year-old woman undergoing sonography for spontaneous abortion
CASE 4. Mucinous cystadenoma in 54-year-old woman undergoing follow-up ultrasound for persistent ovarian cyst
CASE 7. Mature cystic teratoma in 31-year-old woman with progressively heavier bleeding and pelvic pain
CASE 11. Sex-cord stromal tumor in 61-year-old woman with postmenopausal bleeding
CASE 12. Juvenile granulosa cell tumor in 19-year-old patient with secondary amenorrhea
CASE 14. Mucinous borderline tumor in 55-year-old woman with pelvic discomfort
Pelvic ultrasonography remains the preferred imaging method to evaluate most adnexal cysts given its ability to characterize such cysts with high resolution and accuracy. Most cystic adnexal masses have characteristic findings that can guide counseling and management decisions. For instance, mature cystic teratomas have hyperechoic lines/dots and acoustic shadowing; hydrosalpinx are tubular or s shaped and show a “waist sign.”
In parts 1 through 3 of this 4-part series on adnexal pathology, we presented images detailing common benign adnexal cysts, including:
- simple and hemorrhagic cysts (Part 1:Telltale sonographic features of simple and hemorrhagic cysts)
- mature cystic teratomas (dermoid cysts) and endometriomas (Part 2: Imaging the endometrioma and mature cystic teratoma)
- hydrosalpinx and pelvic inclusion cysts (Part 3: “Cogwheel” and other signs of hydrosalpinx and pelvic inclusion cysts)
In this conclusion to the series, we detail imaging for ovarian neoplasias (including cystadenoma and cystadenocarcinoma).
OVARIAN NEOPLASIA
A woman’s lifetime risk of undergoing surgery for suspected ovarian malignancy is 5% to 10% in the United States, and only about 13% to 21% of those undergoing surgery will actually be diagnosed with ovarian cancer.1 Therefore, the goal of diagnostic evaluation is to exclude malignancy.
Diagnostic evaluation includes:
- imaging
- lab work
- history
- physical findings.
The preferred imaging modality for a pelvic mass in asymptomatic premenopausal and postmenopausal women is transvaginal ultrasonography according to the American College of Obstetricians and Gynecologists (ACOG) practice bulletin, which was reaffirmed in 2013.1 “No alternative imaging modality has demonstrated sufficient superiority to transvaginal ultrasonography to justify its routine use.”1
Transvaginal ultrasonography with color Doppler interrogation has demonstrated a sensitivity of 0.86% and a specificity of 0.91% for discriminating between malignant and benign ovarian masses.
Sonographic features that are worrisome for malignancy include:
- Multiple thin septations (if indeterminate, the mass may possibly be benign)
- Thick (> 3 mm), irregular septations
- Focal areas of wall thickening (> 3 mm)
- Mural nodules or papillary projections
- Levine and colleagues note that a cyst with a mural nodule with internal blood flow on color Doppler has the highest likelihood of being malignant2
- Moderate or large amount of ascitic fluid in pelvis (in conjunction with ovarian mass showing the above characteristics)
Various morphology indices have been developed that combine these criteria with ovarian mass volume to determine the preoperative predictive value for malignancy.
In the images that follow, we present 14 cases that demonstrate cystadenoma, low malignant potential tumors, and ovarian neoplasia.
CASE 1. Right ovarian mucinous cystadenoma in 68-year-old woman with uterine prolapse and history of ovarian cyst
CASE 2. Borderline serous cystadenoma in 56-year-old woman with right lower quadrant pain, nausea, and loss of appetite
CASE 3. Mucinous cystadenoma in 38-year-old woman undergoing sonography for spontaneous abortion
CASE 4. Mucinous cystadenoma in 54-year-old woman undergoing follow-up ultrasound for persistent ovarian cyst
CASE 7. Mature cystic teratoma in 31-year-old woman with progressively heavier bleeding and pelvic pain
CASE 11. Sex-cord stromal tumor in 61-year-old woman with postmenopausal bleeding
CASE 12. Juvenile granulosa cell tumor in 19-year-old patient with secondary amenorrhea
CASE 14. Mucinous borderline tumor in 55-year-old woman with pelvic discomfort
