Functioning Ovarian Tumors: Direct and Indirect Findings at MR Imaging

Abstract

There are many kinds of ovarian tumors and tumorlike conditions that produce estrogen or androgen. Magnetic resonance imaging can demonstrate not only ovarian tumors but also an enlarged uterus with a thick endometrium, even in cases of a clinically latent excess of estrogen. These clinical and indirect imaging findings can aid in the differential diagnosis of ovarian tumors. Granulosa cell tumor and thecoma are well-known estrogen-producing tumors. In pediatric or postmenopausal patients, they manifest as precocious pseudopuberty or postmenopausal bleeding, respectively. Conversely, Sertoli-Leydig cell tumor is representative of hormone-producing tumors that cause virilization. However, there are other functioning ovarian tumors besides the sex cord-stromal tumors. It is well known that metastatic ovarian tumors often have androgen-producing stroma and that mucinous cystadenoma sometimes produces estrogens. Most other ovarian tumors can produce sexual hormones in their stroma. In addition, some endocrinologic abnormalities (eg, polycystic ovary syndrome) also cause virilization.

Ovarian Endometrioid Adenocarcinoma with Functioning Stroma Accompanied with Endometrial Endometrioid Adenocarcinoma: Immunohistochemical Study and Literature Review

“…To reveal an estrogenic manifestation, ovarian mucinous tumor is most frequent [5]. The definitions of attributing origin of the hormonal alterations to the ovarian tumor are 1) the disappearance of hormonal manifestations after the tumor removal, and 2) histochemical detection of lipids in stromal cell cytoplasms [4].…”

“…In our case, α-inhibin reacted with clusters of stromal vacuolated cells, ovarian tumor was tan-yellow in color grossly and contained oil-red-O-positive lipids in the α-inhibin-positive foamy stromal cells. Ovarian stromal hyperplasia and hyperthecosis is known to be associated with estrogenic and androgenic stimulation, and are considered to be the origin of excessive steroid hormones in the circulation [5,14]. Main source of the excess steroid hormones in ovarian stromal hyperthecosis can be proven from the marked decrease in the plasma levels of steroid hormones after ovarian wedge resection or oophorectomy [15].…”

“…tumors has been reported to cause both estrogenic and androgenic manifestation, but the most commonly encountered are primary ovarian mucinous tumor to have an estrogenic manifestation [5]. Whatever the oncogenic stimuli is, synchronous development of the same form of epithelial tumors in the ovary and endometrium is not a rare event [6][7][8].…”

Pitfalls in Imaging of Female Pelvic Masses

“…Pure thecomas tend to display greater hyperintensity on T2-weighted images (due to oedema or cystic degeneration) and more avid contrast uptake when compared to more fibrous tumours, such as fibromas [27] (Fig. 17).…”

Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma

“…However, this modality is most useful in differentiating an ovarian tumour from a uterine myoma or during pregnancy (31). Androgen-secreting ovarian tumours are frequently small solid masses with non-specific ultrasonographic or MRI appearances (32). Rarely extra-ovarian sources of androgens may also be detected by this examination (33).…”