Source: Panda Radiation
Business Cooperation: [email protected]
First see a case:
Female, 18 years old, showed symptoms such as abdominal distension and poor lesions 1 month ago without any cause. Past menstrual patterns, 3-4 days/30 days.
External Hospital Ultrasound: The left attachment area is about 10×7.6cm in size and mixed echo, the shape is not regular, internal exploration and size are not equal, no echo, the boundary is clear, internal exploration and blood flow signals are found.
blood CA125 1147U/ml
abdominal CT scan + enhanced scanning
left ovarian cyst solid tumor, mixed flat scanning density, multi-articular cyst cavity with varying sizes, from low to high density; the solid part of the enhanced scanning is significantly enhanced. A lot of ascites.
final diagnosis: left ovarian goiter
ovarian thyroid swelling
(struma ovarii, SO)
is a rare benign ovarian tumor that originates from ovarian germ cells. The tumor is mainly composed of thyroid tissue, which is a monodermal teratoma , accounting for about 2.7% of mature teratomas. 5%-20% of ovarian mature teratomas contain thyroid components, and SO is diagnosed when the tumor contains more than 50% of the thyroid components. The incidence rate of
SO is relatively low and is rare in clinical practice. Patients are often asymptomatic, and most of them are treated with physical examinations or abdominal pelvic lumps. A few cases are accompanied by enlarged thyroid or hyperthyroidism, and the corresponding symptoms disappear after the operation. Some patients may develop Meigs syndrome, that is, accompanied by chest and ascites, and even with serum CA125 elevation.
usually occurs unilaterally, and bilaterally occurring rare. Histologically general manifestations are similar to cystic teratoma, generally smooth surface, lobular or separated, the solid part may be composed entirely of thyroid tissue, and the cyst cavity is filled with liquid or amber-like substance.
image manifestations and related pathological characteristics:
① is mostly lesions in the unilateral appendage area, with clear boundaries.
② Masses are mostly cystic (mainly cystic) or cystic, and pure solidity is rare. The fluid density in the capsule is relatively high (CT value >40HU), and a higher density capsule (CT value 70~90HU) can be seen in part, which is related to the strong attenuation X-ray ability of thyroglobulin and thyroid hormone rich in follicles.
③ Enhanced scanning solid parts (including the cystic wall and partition) are strengthened to varying degrees or are significantly strengthened in thyroid tissue. Pathologically, these solid components are composed of mature thyroid tissue, a large number of blood vessels and fibrous tissue. The extremely low signal region and significant enhancement of solid components on
④T2WI are two typical MRI manifestations of SO.
⑤ T2WI cystic region signal strength depends on the concentration of substances in the capsule. When the contents are highly concentrated and have high viscosity and glue substances, T2WI presents extremely low signal, while when the contents are diluted, T2WI presents high signal.
Figure 1 Female, 69 years old, plain scan CT shows a solid pelvic cyst mass, with multiple cyst cavity inside, and the cyst wall scattered in dot-like calcification; after enhancement, the solid nodules are significantly strengthened, and the cyst wall and separator are also strengthened.
Figure 2 Female, 30 years old, CT scans a solid mass of the pelvic cystic (mainly cystic), with a partition inside, the right side of the septal scan was uniform and high density, with a CT value of 78HU; after strengthening, there were a few flake-shaped and small nodules-shaped solid components of the left side of the septal wall, which were significantly strengthened, and there was no strengthening in the capsules on both sides of the septal.
Figure 3 Female, 66 years old, plain scanning CT showed solid small nodules in the right appendix area (arrow); after enhancement, nodules were significantly strengthened (arrow).
Figure 4 Female, 31 years old, cross-sectional fat inhibits T2WI, the lesion is multi-articular cystic, and one of the small capsules shows extremely low T2 signal; enhanced fat inhibits coronal T1WI, and enhanced can be seen in the cyst wall and separator, and no strengthening is seen in the cavities of the large and small capsules.
Differential diagnosis:
① Ovarian endometriosis cyst : Most patients are women of childbearing age and often have a history of dysmenorrhea. CT is mostly manifested as a bilateral attachment multi-arranged cystic density shadow, the boundary may be unclear, often accompanied by adhesion, the density in the capsule varies depending on the bleeding time, and the enhanced scanning cystic wall can be strengthened to varying degrees; SO has no dysmenorrhea, the lesions have multiple edges, clear boundaries with surrounding tissues, and no obvious strengthening to enhance the scanning cystic wall.② Pelvic abscess or fallopian tube ovarian abscess : There are often manifestations of abdominal pain, fever and elevated white blood cells. Anti-infection treatment is often effective. Enhanced scanning abscess wall is often significantly strengthened, with thicker walls, and oozing changes can be seen around it. ③ Ovarian stromal tumor : When the cystic changes are obvious, it is necessary to distinguish them from SO, but the cystic changes of ovarian stromal tumors are often multiple fissures or sheet-like, and the proportion of solid components in the tumor is often higher than 50%. Enhanced scanning of ovarian stromal tumors mostly show mild gradual strengthening, while the soft tissue density in the SO capsule is mostly thyroid-like and uniformly strengthening. ④ Ovarian cystic adenoma : It is divided into serous cystic adenoma and mucinous cystic adenoma. Serrous cystic adenomas are mostly single-room cystic placeholders, with uniform cystic fluid density, watery density, thin capsule walls, no separation or thinness in the capsule, which is easy to distinguish from solid capsule SO; mucous cystic adenomas have uneven thickness and thickness, and the capsule density in different compartments can be uneven, and the capsule fluid can contain mucin and have high density; it is difficult to distinguish from cystic SO. The high-density capsule cavity and T2 extremely low signal capsule cavity on CT help the diagnosis of SO. ⑤ Ovarian cyst cancer : It is more common in elderly patients, with cystic solidity, irregular thickening of the cystic wall or interval, irregular shape of solid components, irregular boundaries of the cystic region, not smooth and sharp, often accompanied by abdominal pelvic effusion, may be accompanied by enlarged lymph nodes, and CA125 is significantly increased; while SO intervals are smooth, most of them are not accompanied by ascites, and CA125 is normal.
Ovarian goiter rarely undergoes malignant changes and is more common in menopause women. The imaging manifestations are mostly cystic solid masses, mainly solid components, and are not specific compared with other ovarian malignant tumors.
In short, ovarian goiter (struma ovarii, SO) is a mature teratoma that is entirely composed of thyroid tissue or mainly thyroid tissue (>50%). It is a highly specific ovarian monodermal mature teratoma, which is rare and has a low malignant variability rate. Imaging characteristics: ① Unilateral cystic solid or multi-atrial cystic lesions; ② After enhancement, the solid part or thickened cystic walls are significantly strengthened; ③ High-density capsules (CT value 70~90HU) can be seen in the lesion, and no strengthening after enhancement; ④ Very low-signal small capsules can be seen in the lesion on MR T2WI, and no strengthening of the enhanced scan; ⑤ Point-shaped calcification or calcification of the cystic walls can be seen in the lesion.
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