A New Insight on Exophytic Serous Borderline Adnexal Tumors: Specific Sonographic Features

Abstract

Objectives-To characterize and compare the sonographic features of exophytic serous borderline ovarian tumors (ESBOT) with those of high-grade serous carcinoma of the ovary (HGSC).Methods-Seven patients with histological diagnosis of ESBOT diagnosed between 2011 and 2019 and 10 consecutive cases of HGSC detected during 2019, both depicting an exophytic growth pattern, were identified retrospectively. The sonographic imaging of the masses was reassessed and characterized according to the International Ovarian Tumor Analysis terms.Results-A unilateral irregular solid adnexal mass was demonstrated in all patients with ESBOT. The mass typically wrapped an apparently normal ovary, with a clear demarcation line depicted between them and it contained tiny cystic inclusions and calcifications. On color Doppler study of all the ESBOT cases, a unique vascular pattern could be demonstrated: an intratumoral vascular bundle originating from the ovarian vessels and supplying a rich radial blood flow to the tumor periphery. These characteristic morphological and color Doppler features could not be observed in any of the HGSC cases (P < .001). In 42.8% of the patients with ESBOT, additional unilocular-solid components (ipsilateral or contralateral) could be detected, whereas all the HGSC patients presented with a multilocular-solid tumor morphology (P < .001). The interface of the external mass border with the adjacent pelvic walls was regular in all the cases with ESBOT, whereas in 80% of HGSC patients, it was irregular, suggesting invasiveness (P = .002).Conclusions-ESBOT can mimic HGSC. Our results suggest that ESBOT has specific B-mode and color Doppler features, enabling differentiation from HGSC and planning appropriate intervention.

Serous surface papillary borderline ovarian tumors: correlation of sonographic features with clinic pathological findings

“…The difference may be attributable to the varying proportions of patients with advanced-stage disease. Serum CA 125 levels were variable and elevated in all cases in our series, which is consistent with the findings of previous work 13 . However, median serum CA 125 level did not differ significantly between early-and advanced-stage disease.…”

“…Ultrasound is the first‐line modality for evaluating adnexal masses because of its low cost, widespread availability, excellent spatial resolution and ability to detect blood flow in solid tissue 11 . However, there are few published reports on the ultrasonographic features of SSPBOT 7,13 , due to the rarity of this condition. Ludovisi et al .…”

“…Ultrasound is the first-line modality for evaluating adnexal masses because of its low cost, widespread availability, excellent spatial resolution and ability to detect blood flow in solid tissue 11 . However, there are few published reports on the ultrasonographic features of SSPBOT 7,13 , due to the rarity of this condition. Ludovisi et al described the ultrasound findings in five premenopausal patients with SSPBOT 7 , all of whom demonstrated grossly normal ovaries that were completely or partially covered by irregular tumors.…”

“…Ludovisi et al described the ultrasound findings in five premenopausal patients with SSPBOT 7 , all of whom demonstrated grossly normal ovaries that were completely or partially covered by irregular tumors. In 2022, Haddad et al described for the first time a specific color Doppler feature of exophytic SBOT: an intratumoral vascular bundle originating from the ovarian vessels and supplying a rich radial blood flow to the tumor periphery 13 . This feature was not observed in patients with HGSC of the ovary.…”

“…This feature was not observed in patients with HGSC of the ovary. They named it the 'fireworks sign' and noted its ability to differentiate between SSPBOT and HGSC 13 . Our findings agree with those of previous studies, in that the ovaries appeared grossly normal but were covered or encased with tumor deposits confined to the surface, with clear demarcation between normal ovarian tissue and surrounding papillary exophytic tumor, and an intratumoral vascular bundle originating from the ovarian vessels and supplying hierarchical branching blood flow to surrounding tumors on color Doppler examination.…”