Mimics of ovarian cancer: don’t be fooled
Number:28ESURABS0017
Type:Educational Electronic Presentation
Authors: Margarida Lima, Teresa Margarida Cunha
Keywords:ovarian cancer mimics, extraperitoneal, pelvic, anatomy
SECTIONS
Educational objective
  •  To review cases of extra-ovarian tumours, initially referred to an oncological specialized hospital as suspected ovarian malignancies
Topic Review

The ovaries lie in the posterolateral aspect of the pelvic peritoneal cavity, suspended by the mesovarium, the utero-ovarian ligament and the suspensory ligament (1). In the same patient, they may present different positions and orientations at different evaluations since it is influenced by the ligament’s attachments and uterine location (2).

Ovarian cancer is the 2nd most common gynaecologic malignancy and the 5th cause of cancer death for women globally, with a five-year relative survival of 49,7%, mostly owing to its late detection, urging early intervention (3). Its heterogeneous appearance, as well as female pelvis complex anatomy, pose a diagnostic challenge (4).

Nevertheless, a misdiagnosis of a mimicker as an ovarian tumour may lead to invasive intervention.

These mimics may have gastrointestinal, genitourinary, mesenchymal, neural and...

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Figure 1. T2-weighted images (A and B): A well-defined solid mass is observed in the pelvis, with hyperintense regions suggestive of cystic areas and solid components presenting intermediate signal intensity. Both ovaries are identified compressed laterally by the tumour by the bilateral cortical inclusion cyst (white arrows). The tumour arised from the left obturator fossa (dashed arrow). Sagittal T2-weighted image (C): Well-defined solid mass posterior to the uterus, causing compression of the uterus and rectum, suggesting an extraperitoneal location. The tumour is compressed posteriorly by the sacral promontory (white arrow). Axial fat-suppressed contrast-enhanced T1-weighted image (D): Enhancement of the solid components is seen
Figure 2. Coronal T2-weighted image (A): Large, predominantly hyperintense tumour occupying most of the abdomen and pelvis.   Axial T2-weighted image (B): Peripheral displacement of the intestinal loops is seen, as well as bulging of the anterior abdominal wall.   Sagittal T2-weighted image (C): Compression of pelvic structures and posterior uterine displacement is shown (white arrow).   Axial contrast-enhanced T1-weighted image with fat suppression (D): The inferior aspect of the tumour is solid, and we can see the feeding vessels (white arrow), in the right parametrium entering the tumour. The cervix is pushed to the left by the tumour (dashed arrow). The superior aspect is solid with central necrosis.
Conclusions

The diagnosis of extra-ovarian tumours relies on the knowledge of the imaging features and anatomic relations to adjacent organs.

Imaging remains essential for assessing tumour size, location in the pelvic compartment, anatomic extent and displacement of surrounding structures.

Knowledge of the most common and rare pelvic tumours that may mimic ovarian masses, benefits radiologists, avoid misdiagnosis and allows accurate pre-operative conduct.

 

 

References

 

  1. Taylor EC, Irshaid L, Mathur M. Multimodality Imaging Approach to Ovarian Neoplasms with Pathologic Correlation. Radiographics. 2021 Jan-Feb; 41(1):289-315. doi: 10.1148/rg.2021200086.
  2. Oktem O, Oktay K. The ovary: anatomy and function throughout human life. Ann N Y Acad Sci. 2008 Apr; 1127:1-9. doi:...

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