Answer for BIR CoW 12 June 2022
Serous cystadenoma ovary
Findings
Large septated cystic lesion with thin walls in the left adnexal region. Right adnexal moderate sized septated cystic lesion. No evidence of endometriotic / hemorrhagic / fat component within the lesions. No mural nodular components with restricted diffusion noted within. DIAGNOSIS :Bilateral ovarian septated lesions correspond to O-RADS MRI 3.
Discussion
Benign and commonest epithelial ovarian tumour account for ~60% of ovarian serous tumors.Patients are generally asymptomatic, If symptoms are present usually related to mass effect with displacement of adjacent structures Unilocular (typically) or multilocular cystic mass with thin regular wall or septum, and usually no endocystic or exocystic vegetation.Cysts can be large in size and have the potential to be seen filling most of the lower pelvis with extension into the upper abdomen. MRI -T1: cyst content is generally of hypointense signal in uncomplicated cases,T2hyperintense signal with enhancement of cyst wall sometimes occurs after contrast administration. ORADS MRI The Ovarian-Adnexal Reporting and Data System aims to ensure a uniform, unambiguous MRI evaluation of ovarian or other adnexal lesions, accurately assigning each lesion to a risk category of malignancy being present, which informs the appropriate management to be instituted. For risk stratification, the O-RADS MRI system uses five categories (O-RADS 1–5), O- incomplete evaluation ,1-normal ovaries ,2- <0.5% ; almost certainly benign, 3- ~5%; low risk,4- ~50%; intermediate risk, 5-~90%; high risk. O-RADS 1 include no ovarian lesion,follicle /hemorrhagic cyst/ corpus luteum which is ≤3 cm size in a premenopausal women. O-RADS 2 - Unilocular cyst of any type of fluid as content. Endometriotic cyst, Lesion with lipid content,Lesion with dark T2/dark DWI solid tissue,Dilated fallopian tube with simple fluid content. O-RADS 3 Cyst with proteinaceous, hemorrhagic or mucinous fluid content and smooth enhancing wall & no enhancing solid tissue.Multilocular cyst with smooth septae and wall with enhancement Lesion with solid tissue (excluding T2 dark/DWI dark)low-risk time-intensity curve on DCE MRI Dilated fallopian tube with non-simple fluid( thin wall/folds) or simple fluid(thick, smooth wall/folds) no enhancing solid tissue O-RADS 4 Lesion with solid tissue (excluding T2 dark/DWI dark):intermediate-risk time-intensity curve on DCE MRI Lesion with solid tissue that is enhancing less than or the same as myometrium at 30-40 sec on non-DCE MRI. Lesion with lipid content:large volume-enhancing solid tissue O-RADS 5 Lesion with solid tissue (excluding T2 dark/DWI dark):high-risk time-intensity curve on DCE MRI Lesion with solid tissue that is enhancing more than myometrium at 30-40 sec on non-DCE MRI Peritoneal, mesenteric or omental nodularity or irregular thickening +/- ascites
References: 1. https://www.acr.org/-/media/ACR/Files/RADS/O-RADS/O-RADS-MR-Lexicon-Terms-Table-November-2020.pdf. Accessed on February 3, 2021. 2. American College of Radiology Committee on O-RADS™ (Ovarian and Adnexal) Risk Stratification System Table September 2020 Available at https://www.acr.org/-/media/ACR/Files/RADS/O-RADS/O-RADS_US-Risk-Stratification-Table.pdf . Accessed on October 29, 2020. 3.Hunter SM, Anglesio MS, Sharma R, Gilks CB, Melnyk N, Chiew YE, deFazio A, Australian Ovarian Cancer Study Group. Longacre TA, Huntsman DG, Gorringe KL, Campbell IG. Copy number aberrations in benign serous ovarian tumors: a case for reclassification? Clin Cancer Res. 2011 Dec 01;17(23):7273-82.
Findings
Large septated cystic lesion with thin walls in the left adnexal region. Right adnexal moderate sized septated cystic lesion. No evidence of endometriotic / hemorrhagic / fat component within the lesions. No mural nodular components with restricted diffusion noted within. DIAGNOSIS :Bilateral ovarian septated lesions correspond to O-RADS MRI 3.
Discussion
Benign and commonest epithelial ovarian tumour account for ~60% of ovarian serous tumors.Patients are generally asymptomatic, If symptoms are present usually related to mass effect with displacement of adjacent structures Unilocular (typically) or multilocular cystic mass with thin regular wall or septum, and usually no endocystic or exocystic vegetation.Cysts can be large in size and have the potential to be seen filling most of the lower pelvis with extension into the upper abdomen. MRI -T1: cyst content is generally of hypointense signal in uncomplicated cases,T2hyperintense signal with enhancement of cyst wall sometimes occurs after contrast administration. ORADS MRI The Ovarian-Adnexal Reporting and Data System aims to ensure a uniform, unambiguous MRI evaluation of ovarian or other adnexal lesions, accurately assigning each lesion to a risk category of malignancy being present, which informs the appropriate management to be instituted. For risk stratification, the O-RADS MRI system uses five categories (O-RADS 1–5), O- incomplete evaluation ,1-normal ovaries ,2- <0.5% ; almost certainly benign, 3- ~5%; low risk,4- ~50%; intermediate risk, 5-~90%; high risk. O-RADS 1 include no ovarian lesion,follicle /hemorrhagic cyst/ corpus luteum which is ≤3 cm size in a premenopausal women. O-RADS 2 - Unilocular cyst of any type of fluid as content. Endometriotic cyst, Lesion with lipid content,Lesion with dark T2/dark DWI solid tissue,Dilated fallopian tube with simple fluid content. O-RADS 3 Cyst with proteinaceous, hemorrhagic or mucinous fluid content and smooth enhancing wall & no enhancing solid tissue.Multilocular cyst with smooth septae and wall with enhancement Lesion with solid tissue (excluding T2 dark/DWI dark)low-risk time-intensity curve on DCE MRI Dilated fallopian tube with non-simple fluid( thin wall/folds) or simple fluid(thick, smooth wall/folds) no enhancing solid tissue O-RADS 4 Lesion with solid tissue (excluding T2 dark/DWI dark):intermediate-risk time-intensity curve on DCE MRI Lesion with solid tissue that is enhancing less than or the same as myometrium at 30-40 sec on non-DCE MRI. Lesion with lipid content:large volume-enhancing solid tissue O-RADS 5 Lesion with solid tissue (excluding T2 dark/DWI dark):high-risk time-intensity curve on DCE MRI Lesion with solid tissue that is enhancing more than myometrium at 30-40 sec on non-DCE MRI Peritoneal, mesenteric or omental nodularity or irregular thickening +/- ascites
References: 1. https://www.acr.org/-/media/ACR/Files/RADS/O-RADS/O-RADS-MR-Lexicon-Terms-Table-November-2020.pdf. Accessed on February 3, 2021. 2. American College of Radiology Committee on O-RADS™ (Ovarian and Adnexal) Risk Stratification System Table September 2020 Available at https://www.acr.org/-/media/ACR/Files/RADS/O-RADS/O-RADS_US-Risk-Stratification-Table.pdf . Accessed on October 29, 2020. 3.Hunter SM, Anglesio MS, Sharma R, Gilks CB, Melnyk N, Chiew YE, deFazio A, Australian Ovarian Cancer Study Group. Longacre TA, Huntsman DG, Gorringe KL, Campbell IG. Copy number aberrations in benign serous ovarian tumors: a case for reclassification? Clin Cancer Res. 2011 Dec 01;17(23):7273-82.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!