Radiological imaging of ovarian lesions.

Dr/ ABD ALLAH NAZEER. MD.

Congenital abnormality of the ovaries.

Abnormalities of the ovaries:1- Agenesis or complete absence on one or both sides.2- Gonadal dysgenesis (streak gonad) as in Turner syndrome.3- Duplicated ovary.4- Failure of descent into the pelvis.5- Ovotestis (true hermaphrodite) In which combined ovarian and testicular tissues seen.6- Adrenal or thyroid tissue on the ovary.

Pelvic inflammatory disease (PID) is a general term indicating infection of the female upper genital tract and the surrounding structures. It is a common and serious complication of sexually transmitted disease. Acute episodes need appropriate care and treatment; however, it is the long-term sequelae of chronic pelvic pain, infertility, and ectopic pregnancy due to scarring and adhesions that burden the healthcare system in an adverse manner.

It encompasses a broad category of diseases, including endometritis, salpingitis, salpingo-oophoritis, tubo-ovarian abscess (TOA), and pelvic peritonitis. The afflicted women may be asymptomatic, present with mild nonspecific symptoms, or may have fulminant disease. Prompt diagnosis and treatment of this condition are critical because the complications of PID can be life and fertility threatening. The varied clinical presentation and imaging findings may make it difficult to diagnose PID, and sometimes it may remain undetected.

Pelvic Inflammatory Diseases.

Pelvic inflammatory disease. Left recurrent tuboovarian abscess. Axial T2-weighted image (a) shows a thick wall, complex, heterogeneously hyperintense, fluid-containing adnexal mass, with internal debris and gas bubbles, that represents the most specific sign of an abscess. On axial T1-weighted with fat suppression image (b) there is no signs of hemorrhagic contents within the mass. The sagittal T2-weighted image (c) demonstrates the involvement of bowel loop characterized by the thickening of the anterior rectal wall.

Loculated complex cystic lesion in the mid pelvis with folds and thick wall enhancement suggestive of pyosalpinx.

Tubo-ovarian abscesses with inflammation extending along the right paracolic gutter up to the subhepatic region and presenting with right upper quadrant pain.

Bilateral tubo-ovarian abscesses.

Cystadenoma and cystadenofibroma.

Serous cystadenoma

High signal intensity on T2-weighted imaging but which remains of high signal intensity on T1 fat-saturated images without enhancement, consistent with hemorrhagic cyst.

Bilateral hemorrhagic cysts.

Polycystic ovary syndrome.

Endometrioma. Axial T2-weighted image (a) shows an ovarian cystic mass with intermediate signal intensity. Axial T1 fat suppression weighted image (b) confirms the hemorrhagic nature of the cyst (endometrioma). Note a mural nodule located posterior on the left side of the wall (b, arrow). 3D fat-saturated T1-weighted Spoiled Gradient Echo images before (c) and after intravenous contrast injection with subtraction of precontrast and postcontrast sequences (d) demonstrate the lack of enhancement of the mural nodule due to blood clot.

Dermoid cyst.

Two cases of mature (cystic) ovarian teratoma.

Ovarian dermoid.

Mucinous cystadenoma.

Ovarian serous adenofibroma.

Ovarian fibroma.

CARCINOMA OF THE OVARY:Pathology. I. Histologic classification. * from all cells of the ovary (epithelial, germinal, and stromal);* 85% = of epithelial origin (from coelomic epithelium or mesothelium from embryonal gonadal ridge);* 15% = from a variety of cell types (the tissue of origin is often identified, but some tumors have more than one cell type)

1. Epithelial cell = 85%:Serous; Mucinous; Endometrioid;Mesonefroid (clear cell);Brenner; Undifferentiated; Carcinosarcoma;II. Stromal cell < 10%: Granulosa; Thecoma; Arrhenoblastoma; Sertoli; gynandroblastoma; LipoidIII. Germ cell < 5%: Teratoma (NOS, dermoid cyst, struma ovarii);Teratocarcinoma;Dysgerminoma;Embryonal carcinoma;Endodermal sinus;Chorioncarcinoma;Gonadoblastoma;Mixed tumors;IV. Mesenchymal cell = 2%

CARCINOMA OF THE OVARYHistologic classification

Serous ovarian cystadenocarcinoma.

Mucinous ovarian cystadenocarcinoma

Brenner tumour with mucinous portion. Collision tumour. Axial T2- (a) and T1-weighted (b) images demonstrate an adnexal multilocular cystic mass with thin septations and a solid posterior hypointense portion (a, arrow). The cystic portion presents multiple loculi with different contents characterized by different signal intensity. The septations and the solid portion present an homogeneous and delayed enhancement on 3D fat-saturated T1-weighted Spoiled Gradient Echo images (c, arrow). The interface between the solid and the cystic mass is regular.

Malignant ovarian mixed germ cell tumour

Ovarian Carcinoma.

Two cases of Ovarian serous cystadenocarcinoma.

Juvenile Granulosa Cell Tumor of the Ovary.

Squamous cell carcinoma arising in mature cystic teratoma (dermoid cyst).

Squamous cell carcinoma arising from a mature cystic teratoma of the right ovary.

Endometrioid ovarian carcinoma

Endometrioid ovarian carcinoma

Two cases of ovarian carcinosarcoma

Grade 2 immature teratoma of the right ovary

Grade 2 immature teratoma of the right ovary.

Grade 3 immature teratoma of the right ovary

Dysgerminoma of the left ovary.

Bilateral dysgerminoma in a 18-year-old.

Yolk sac tumour of the left ovary.

Embryonal carcinoma.

Papillary carcinoma of the ovary.

Malignant mixed germ cell tumour comprising of both embryonal carcinoma and yolk sac tumour of the right ovary.

Malignant mixed germ cell tumour comprising of both embryonal carcinoma and yolk sac tumour of the right ovary

Endodermal Sinus Tumor – staging PET

Cystic metastases to the ovaries

Thank You.