)iJdU;Ji!J}~ ~ 22 3 pp. 412 - 422, 1986

Journal of Korean Radiological Society, Vo1.22, No.3, 1986

R

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l A

- Abstract -

Ultrasonographic and Pathologic Study of Ovarian Tumors

Ock Lyeoun Moon, M.D., Seon Young Yoo , M.D. and )eung Suk Lee, M.D.

Department of Radiololg Incheon Christian Hospital

Sung Mee Kim, M .D

Department or Obstercs and Cyneco)ogy, Incheon CiI Hospital

This is a retrospecti ve study of 161 ovarian neopl asrn s, al l of w hich were surgically rellloved and had

preoperati ve sonographic exarn inations

They were evaluated respect to age, turno r size and its echoenl c ll y

The reslllts were as fo llows

1. Of all1 61 t llmors, phys iologic les ions lVere 67 cases (-11.6"0), germ cell tu rnors \vere 28 cases (1 7.-106) and

serolls tumo rs were 19 cases (1 1.8%)

2. O f ill l 161 tllmo rs, righ t ova ri an lesions wcre 82 cases (50.9"6), left \vere 59 cases (36 .7"6), and bilateral le-

sions were 20 cases (1 2.-106)

3. The most charac teri sti c fi ndings of tlllll o rs were as fo llows

1) Physiol ogic tumo rs were 2-9cm sized (88 .1"0), anechoice-50o echogenic (79.1 00), and deve loped dllring

4th & 5th decades (9'I .OO)

2) Inflammatory turnors werc 9cm sized (94.1 %), 5006-totall y echogenic (765%), and during 4th & 5th decades

(94.1 %)

3) Serous tum o rs were 2-9cm sized (60.306), anecho ic-5% echogenic (89.5%), and during 3rd & 4th decad es

(84.2%)

4) IV\ucinous tumo rs \vere 5-19clll sized (77 .800). anechoic-Soo echogenic ( .80o), and dll ring 2nd-8th decades

w ith d iffuse di stri buti on

5) Endornetrioid turnors vere 5-14cm sized (1 00.0%), variable echogenic, and during 3rd & 4th decades (90.9%)

6) Germ cel l t ll l110rS vcre ',-1-1 (111 sized (75.00{,), va riablc echogenic, d ll ring 3rd & -1 th decades (82 .1 "6) 1 986 4 f:I 30 l 1 986 5 30 B .

- 412 -

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Parovarian cysts were 2-14cm sized (90.0%), anechoic-5% echogenic (100.0%), with diffuse age d istribution

4. The malignant and borderline malignant tumors were 9 cases with more than 10cm sized (77 .8%), and developed

during older than 4th decade (1 00.0%)

Anechoic 3 cases, 1-5% echogenic 2 cases, and totally echogenic 4 cases were fo und

1.

g !:lo >1 1 l

1) 1817 Ephraim Mc Dowell

*t;fi!( jl 1fHn- ~rcj 2) 1958

Donald i!

3) fq!(o ff

- I/{Mr.\(~.~*;tt: : 22 3 Wt 1986

Table 2. Tumor Inc idence

Tumor No . of cases (%)

Phys iologic tumor

lnflammatory tumor .

Srous tumor

'I'!ucinous tumor

Endometroid tumor

Germ cell tumor .

Parovarian cyst

Total .... .. .............. ..

67 (416)

17 (1 06)

19 (1 1 8)

9 (56)

11 (6 8)

28 (1 7.4)

10 (6 .2)

161 (1 00.0)

30 50 40 13

.

49 .

1l 50

J (complication) 18 ~ 32

. 1l 10 J, 6 ( to-

rsion) 2 ~ 12 IJ

9 {ffU, k 8 O

1 (Tabl e 5).

2 8

(Character i stic sonographic findin g )

5~9 c 63 4 cm

48 1O ~14 cm 22 (Table 6).

20 cm 3 2

i 2 parovan an l .

(pure cysti c )

72 1~5% 33 5~

50% 28 50%

15 13 % (Table 7).

(1) (physi ologic tumor)

CDLn (simple cyst)

3.5~7 cm

. 7

(Fi g. 1) 3 10 %

(ma inly cystic)

3 2 Ht!l ( sonol ucency in

Cul - d e-sac ) .

Fig. 1. Simple cyst. Longituclinal scan 2cm to the left of the midline . Left ovary shows 5cm diametered purely cystic mass with posterior enhancement

Table 3. TUlllor Site

Tumor No.of Site

cases (%) Right(%) Left(%) Bilatera l(%)*

Physiologic tumor . 67 (1 00.0) 30 (44 .8) 25 (37.3) 12 (1 7.9)

Inflammatory tumor 17 (1 00.0) 7 (412) 8 (470) 2 (1 1 8)

Serous tumor 19 (100.0) 9 (47 .4) 8 (42 .1) 2 (10.5)

Mucinous tU I1lor 9 (1 00 .0) 6 (66 .7) 3 (333) 0(00)

Endometrioid tumor ...... ...... .... .. 11 (100.0) 9 (81 8) 2 (1 8.2) 0(0.0)

Germ ce ll tU I1lor 28 (1 00.0) 16 (57.2) 10 (35.7) 2 (71)

Parovarian cyst 10 (100.0) 5 (500) 3 (300) 2 (200)

Total . l fi l (1 00 .0) 82 (50 .9) 59 (3fi.7) 20 (1 2.4)

*Bilateral: Both ovaries involvecl by one c1 isease entity

- 414-

- ~.-k : Vll !IIJ lli~'~ NjJ'l'. (I(j I -

@ tJ!9 (ollicle cyst)

4cm 8 . 5~7 cm 3 .

40 8cm ( 34 ) ( Fi g 3)

1 ~5% ( 30 ) .

8 f1J * (Fig 2) 3

t 1~5%

Q 1 1 ~5% 50 %

.

10 U 6 ': 1

(moderat e or d e nse) 3L 1

6cm h J (Fi g.4) tJ

.

@ ! (corpus lut ea l cyst) TilIi 3 1 1

Table 4 , Patienl Age

1Lll1101 No Dec lde

cases 2nd :Jrd 4th :1 t h

- }i50% Echogenic

Mi xecl

- )CE. l tH!TU ii!l J0jJ1Il( Ni -

.

1

l . 12 cm

- 50%

u g~

.

@ Theca (Theca lutein cyst)

4cm . 5~9 cm . 10~14 cm

2. ~ . 1~5 %

. 50% 2

Fig. 2. Follicle cys t. Transverse scan 5cm cephalad to the pubic symphysis. Left ovary shows small pure cystic mass, combined with left hydrosalpinx.

Fig. 3. Corpus letea l cys t. Long ituclinal scan 2cm to the left of the miclline. Left ovary shows 4 x 6cm sizecl purely cystic oval s hapecl mass with posteriol enhancelllent

.

(2) (inflammatory tumor)

17 16 10 cm (Fig.4).

1 14 cm lI

. 1 g~J

.

(3) (serous tumor)

@ ~fi (serous cystadenna)

frx

Xe F

Fig. 4. Corpus leteal hematollla. Transverse scan 6cm cephalacl to the pubic symphsis. Right ovary shows irregular shaped , inhomogenous echogenic solid mass. Another similar sizecl echo-colllplex mass with cystic component in left aclnexa , tubo-ovarian abscess

Fig. 5. Serous cystaclenoma. Longi tuclinal scan 2cm to the right of the miclline. Right ovary shows 9 x 7cm sizecl , sOlllewhat lobulatecl purely cystic mass with posterior enhancelllent

- 417 -

- . 22~ 3 1986 -

15 10 cm 11 ll~20 cm

4 . (Fig. 5) 10

. 1~5 % 3 1

. 50%

50% l .

@ (serous cystadenofibroma)

1 2 {

. 17 , 14 , 3 cm

2fjU, 1~5 % (Fig . 6) 1 .

@ % 1 (serous cystadenocarcinoma)

15 cm

. 48

.

Fig. 6.Serous cystaclenofibroma. Borclerline malignancy Transverse scan 5.5cl11 cephalacl to the pubic sy l1l physis . Right ovary shows well clemarkatecl , 10 x 6 X 8l1l sizecl irregularly lobulatecl cystic mass with Iinear or curvilinear thin inte rnal septat ion

(4) * (Mucinous tumor)

@ i (Mucin ous cystadenoma)

6fjU 5~9 cm 3 15~19 cm 2

28 cm l . 5

(F ig. 7) , 1 10 cm ..2?..~

.

@ i (Mucinous cystadenocarcinoma)

2 l 51 , 70 ,

50 .

12

17 cm Jifr

Fig. 7.Mucinous cystaclenoma. Longituclinal scan l cm to the right of the miclline . Right ovary shows huge mass , occuping enti re pelvic cavity an cl loer ab. clo l1l inal cavity. i [h irregula r internal septation

Fig. 8. Enclometrioicl cys t. Transverse scan 5cm cephalacl to the pubic symphysis . Right ovary shows well clemarkatecl , 5c l1l cl iameterecl rouncl purely cystic mass with posterior enhance l1lent

30 cm

.

(5 ) (Endometrioicl tumor)

@ (Enclometrioid cyst)

9 5~ 14 cm . 4

(Fig. 8) 4 50 %

f (Fi g.9 ) l l

.

lJj

- 4 18-

5( F. :JJ!'J mH !'hJJc: ifliJ." (I(J Nr -

Fig. 9. Endollletrioid cys t. Longitudinal scan l CJll to the right of the Ill idline . Right ovary shows we ll de Jllarkated , 7C Jll dialllete red rOllncl mass , vit h flllicl/bloocl c\ot" level

6 . 15~ 19 cm 3 20 cm 3 . 4 cm

l .

!

6 (Fi g . 10 ).

30 cm 2 |

f6 * fi 1>t 'I~ JIJj

.

@ Ml3 (Embryona l carcinoma) 1 15 cm l

.

. } 1: l

f PM |

Stage Ia ?.

(7) Parovari an

10 9 3~ 12 cm

(Fig. 11). 1 1 ~5%

.

.

@ (Endometrial carci noma )

U Pmfl 7 cm

!\tl. .

(6) }]f )J!I (Germ ce ll tum or)

(f)lJi: 1 (De rmoid cyst) Pffi 3 1fIH

27 5~9 CJll 14 {j . 1O ~14 cm | 1

Fig. 10. Oermoid cys t. Transverse scan 5clll cephalad to the pu bic sym phsis. Left ovary shows ir regular shaped , 6 x 5clll sized echo-complex mass with several irregular dense echoes ancl posterior acoustic shadowings due to hai r COJll poncnls

- 4 19-

N.

f@;[

*&* &%l--t

l"ig. 11. Parovarian cys t. Longitllclinal scan 2cm to the left of the midline. Left aclnexa shows 3 x 2cm sized round pllre cystic mass with posterior en hancement

- !t(!l't*~-" i . 22 3 1986 -

.

2cm

5 6) @ 2cm

2 cm

7)

~ 80~95 %

6-9) 72

% .

~ 2 x 3 x2 cm

~ 3~4 cm 10-13)

1~2 2 x 1.5 x 0.5 cm, 2~4 1. 5X0 .75XO.5cm

. 3~4 cm

~ JlI 1E

(postmenopausa l visi b le ovarian synd rome)

13) 2 1

parovar i an. Moy l e l 3 )

6 4 2 .

(Physiologic tumor)