Ovarian fibromas and cystadenofibromas are neoplasms that share a similar distinctive tissue component of dense fibrous tissue. We sought to describe the MRI features of these neoplasms and to determine if the fibrous component shows distinctive characteristics. Fourteen patients in whom MR images performed with multicoil and fast-spin-echo images and who subsequently underwent surgery for resection of ovarian fibromas or cystadenofibromas were identified from two institutions. Five patients had ovarian fibromas, and nine patients had fourteen cystadenofibromas. 1.5-T MR studies used T1-weighted spin echo and multiplanar T2-weighted fast-spin-echo images, with fat saturation gadolinium-enhanced fast multiplanar gradient-echo images in seven patients. Studies were reviewed for findings of low (approximately equal to skeletal muscle) signal intensity solid components on T2-weighted images, characteristics of gadolinium enhancement, and associated endometrial findings. Images were obtained ex vivo from three adnexal surgical specimens with an 8-cm field of view and correlated with histology. All five of the fibromas showed predominantly very low signal intensity, similar to skeletal muscle, on T2-weighted images. Two of five fibromas were in patients with endometrial polyps and increased amounts of fluid in the pelvis. Thirteen cystadenofibromas were multicystic masses with bands of very low signal intensity ranging from 2 to 20 mm in the wall of the mass, and one was predominantly solid fibrous tissue. Pathologic correlation with specimen images showed that the low signal intensity material was the subepithelial fibrous component of the cystadenofibromas. Fibrous components of ovarian fibromas and cystadenofibromas are demonstrable by MR as solid components representing fibrous tissue of very low signal intensity on T2-weighted images.
Papillary projections are distinctive pathologic features of epithelial ovarian neoplasms. We sought to determine whether these structures have recognizable features on MRI. A search of a database of 125 patients on whom MRI was performed with pelvic phased-array coil and abdominal surgical exploration was performed for suspected gynecologic disease identified 15 patients who had either MRI reports or pathology reports mentioning papillary projections in an adnexal mass. The MR images were reviewed to characterize the size, structure, and signal intensity of papillary projections. Pathologic correlation was performed on these and on four surgical specimens imaged with high resolution technique. Pathologic correlation showed that larger papillary projections had a distinctive structure of a fibrous stalk supporting clumps of edematous papillae with signal intensity similar to that of fluid on T2-weighted images. Smaller papillae showed nondescript intracystic projections of intermediate signal intensity on T2-weighted images. All papillary projections in vivo enhanced after injection of gadopentetate dimeglumine. Papillary projections have an appearance on MRI that reflects their histologic structure.
Twenty-two cases of spermatocytic seminoma are reported. This neoplasm comprises 4.4% of all seminomas seen during the period under study. Nineteen patients were older than 40 years. Painless testicular enlargement was the presenting symptom in 19 patients. The duration of symptoms was more than six months in 12 patients. Macroscopically the tumor was soft, friable, grey, and edematous. Microscopically it is characterized by cellular pleomorphism, round cells and nuclei, scanty stroma, and absence of lymphocytes and granulomas. In none of the cases was the tumor associated with other neoplastic germ cell elements or with classical seminoma. Metastases were not encountered in any of the cases. Apart from 3 patients who died from unrelated causes, all the patients were alive and well for periods varying from two months to 27 years. Spermatocytic seminoma is a distinctive clinicopathological entity. It is unique among germ cell neoplasms because it occurs only in the testis and is not associated with other neoplastic germ cell elements. It has good prognosis and is not associated with metastases. Orchidectomy is the treatment of choice and there is no good evidence indicating that it should be followed by radiotherapy.
Typical patterns of MR appearance of the ovary and functional cysts correlate with the regional histopathologic anatomy of the ovary. T2-weighted imaging of the ovary revealed cyst walls, corpora lutea, and ovarian medulla.
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