CT of Epithelial Ovarian Tumors

Abstract

Ovarian cancer is the second most common gynecologic malignancy in the United States and causes more deaths than any other cancer of the female reproductive system. Approximately two-thirds of patients have tumors that have spread beyond the pelvis at the time of diagnosis. Ovarian tumors arise from the surface epithelium or mesothelium, germ cells, or the gonadal stroma. Epithelial ovarian tumors include serous, mucinous, endometrioid, clear cell, and undifferentiated tumors. In general, the likelihood of malignancy increases with increasing solid-tissue elements and thicker septa. Surgery is central to the management of ovarian cancer. At the initial exploratory laparotomy, surgicopathologic staging and debulking of the tumor are undertaken. Patients with advanced cancer frequently undergo second-look surgery after chemotherapy to detect any residual disease. CT can provide staging information for preoperative planning and determination of surgical resectability, demonstrate tumor response to therapy, and allow detection of persistent or recurrent disease. However, a major limitation of CT is the lack of sensitivity for detection of small tumor implants, especially on the small intestine or mesentery. Dedicated CT of the pelvis is best performed with spiral CT. Ovarian carcinoma can spread by means of intraperitoneal implantation, lymphatic invasion, and hematogenous dissemination.

Aberrant expression of MUC4 in ovarian carcinoma: diagnostic significance alone and in combination with MUC1 and MUC16 (CA125)

“…4,5 Unfortunately, the clinical utility of these strategies for the early detection of EOC using these modalities have been limited due to the lack of specificity and predictive value. [6][7][8] Owing to the surface epithelial origin of EOC, mucins can be interesting biomolecules to serve as markers of diagnostic significance. 9,10 To date, 20 human mucins have been identified and categorized into two classes (secreted/gel forming and membrane bound) based on their structural characteristics and physiological fates.…”

Decreased intraperitoneal disease recurrence in epithelial ovarian cancer patients receiving intraperitoneal consolidation treatment with yttrium‐90‐labeled murine HMFG1 without improvement in overall survival

“…The CT-scan modality has a poor sensitivity for detection of small tumor implants, especially on the small intestine or mesentery, but improvement of the CT modality has allowed detection of 28-50% of the peritoneal implants as small as 5 mm in diameter. 16 In conclusion, this retrospective analysis of a large prospective and randomized trial identifies a difference in pattern of disease recurrence in patients with ovarian cancer assigned to receive a single IP administration of 90 Y-muHMFG1 with no significant effect on total overall and progression-free survival because of the higher incidence of extraperitoneal disease recurrence.…”

Role of Imaging in Peritoneal Surface Malignancies

“…A stellate pattern of tumour deposit has been described with secondaries from pancreatic, colonic, breast and ovarian cancers [41].…”