Analysis of magnetic resonance imaging features of ovarian thecoma

Abstract

To investigate the magnetic resonance imaging (MRI) findings in ovarian thecoma and improve preoperative diagnostic accuracy. Retrospective analysis was performed on 45 patients with surgically and pathologically confirmed ovarian thecoma. Patients were grouped into those with maximum lesion diameter ≥5 cm and <5 cm. Diagnostic scores (up to 6 points) were evaluated on the basis of MRI performance. The ≥5 cm group contained 36 cases (cystic necrosis, 32 cases) with the following findings: T1WI: isointense signal, 22 cases; slightly hypointense signal, 14 cases; T2WI: isointense signal, 6 cases; slightly hypointense signal, 21 cases; slightly hyperintense signal, 9 cases; Diffusion-weighted imaging (DWI): hyperintense signal, 23 cases; mixed hyperintense signal, 13 cases; slight enhancement on dynamic enhanced scans; pelvic fluid accumulation, 31 cases. The diagnostic score evaluations yielded 6 points in 31 cases, 5 points in 1 case, 4 points in 2 cases, and 3 points in 2 cases. The <5 cm group contained 9 cases (cystic necrosis, 3 cases) with the following findings: T1WI: isointense signal, 3 cases; slightly hypointense signal, 6 cases; T2WI: isointense signal, 2 cases; slightly hypointense signal, 4 cases; slightly hyperintense signal, 3 cases; DWI, hyperintense signal; slight enhancement in 8 cases and significant enhancement in 1 case; pelvic fluid accumulation, 4 cases. The diagnostic score evaluations yielded 6 points in 3 cases, 5 points in 1 case, 4 points in 4 cases, and 3 points in 1 case. (iii) Incidence of pelvic fluid accumulation and cystic necrosis differed depending on the size of the lesion (P = .007, .000). Larger lesions show hyperintense or mixed hyperintense signals on DWI along with pelvic fluid and cystic necrosis; whereas, smaller lesions show a hyperintense signal on DWI, cystic necrosis is rare. MRI characteristics along with the patient age and laboratory findings can improve the accuracy of preoperative diagnosis of these lesions.

Diagnostic utility of a conventional MRI-based analysis and texture analysis for discriminating between ovarian thecoma-fibroma groups and ovarian granulosa cell tumors

“…Regarding OGCTs and OTFGs, the ADC value may be affected by the degree of cellularity (the number of granulosa cells or fibroblasts), minor degeneration, or edematous changes. Previous studies reported that a high density of granulosa cells in OGCTs may be related to reduced values, while the likelihood of degeneration in OTFGs may result in an increase in the ADC value; however, there is an overlap between the two diseases [ 8 , 10 , 27 ].…”

Ovarian thecoma presenting with acute ovarian torsion in pregnancy; report of a rare case

“…Thecoma and fibromatous tumors can also be associated with ascites and sometimes pleural effusion. 2,[5][6][7] In the present case, the main complaint was abdominal pain, and pelvic fluid was noticed in ultrasound examination, in addition to the ovarian torsion. However, the patient's emergency situation made it impossible to assess other clinical and paraclinical manifestations.…”

“…Nearly, one‐third of these tumors can manifest hormonal production such as estrogen with clinical presentations such as abnormal menstrual bleeding, virilization, menstrual irregularities, and even infertility. Thecoma and fibromatous tumors can also be associated with ascites and sometimes pleural effusion 2,5–7 …”

“…Thecoma and fibromatous tumors can also be associated with ascites and sometimes pleural effusion. 2 , 5 , 6 , 7 …”

Comprehensive review of imaging features of sex cord-stromal tumors of the ovary

“…A study by Zhang et al demonstrated that thecomas/fibrothecomas were mostly homogenous solid masses with similar signal intensity to myometrium on DWI and similar ADC values to leiomyomas [31]; however, they demonstrated higher signal intensity on T2-weighted images and more avid enhancement on post-contrast images compared to predominantly fibrous tumors [31]. Another study reported large tumors (> 5 cm) demonstrate hyperintense or mixed hyperintense signals on DWI as well as cystic changes and pelvic fluid, whereas small tumors (< 5 cm) demonstrate a hyperintense signal on DWI but cystic changes were uncommon [32]. Malignant tumors are usually detected on positron emission tomography-computed tomography (PET/ CT) by demonstrating increased fluorodeoxyglucose F 18 ( 18 F-FDG) activity; however, thecomas occasionally can produce false-positive results confounding the diagnosis [33].…”