Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis

Mascilini, F.; Savelli, L.; Scifo, Maria Cristina; Exacoustòs, C.; Timor‐Tritsch, I. E.; Blasis, I. De; Moruzzi, Maria Cristina; Pasciuto, Tina; Scambia, Giovanni; Valentin, Lil; Testa, Antonia Carla

doi:10.1002/uog.17216

Cited by 24 publications

(22 citation statements)

References 24 publications

(38 reference statements)

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“…Tajima et al 28 used six patterns of echogenicity to distinguish between benign masses and BOT/malignant ovarian tumors, but likewise did not highlight any defining features unique to BOTs and grouped them with malignant entities. Mascilini et al 29 and Moro et al 30 employed the IOTA criteria with the previously described five benign and five malignant features 18 and determined that BOTs were likely to have between two and 10 loculations on imaging. Pascual et al 23 studied BOTs and, using multivariate analysis, determined that the only predictive sonographic feature was the presence of papillae.…”

Section: Discussionmentioning

confidence: 99%

“…To confirm the novelty and importance of our findings, we carried out a PubMed search of the English-language literature published between 2010 and 2018, seeking to determine if this microcystic tissue pattern of papillary projections, solid component(s) and/or septa has been described previously. Figure S3 is a composite of images found on review of 23 articles 6,[16][17][18][22][23][24][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] identifying 163 individual sonographic pictures of ovarian cysts labeled as BOT by the authors. Although the quality of these images is variable, on close examination it is clear that almost all of them feature a 'bubbly' microcystic nature of papillae or solid component(s).…”

Section: Discussionmentioning

confidence: 99%

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New sonographic marker of borderline ovarian tumor: microcystic pattern of papillae and solid components

Timor‐Tritsch

Foley

Brandon

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To describe and evaluate the utility of a new sonographic microcystic pattern, which is typical of borderline ovarian tumor (BOT) papillary projections, solid component(s) and/or septa, as a new ultrasound marker that is capable of distinguishing BOT from other adnexal masses, and to present/obtain histologic confirmation. Methods In this retrospective study, we identified women with a histologic diagnosis of BOT following surgical resection who had undergone preoperative transvaginal ultrasound (TVS) examination. All images were reviewed for presence or absence of thin-walled, fluid-filled cluster(s) of 1-3-mm cystic formations, associated with solid component(s), papillary projections and/or septa. From the same cases, histopathologic slides of each BOT were examined for presence of any of these microcystic features which had been identified on TVS. To confirm that the microcystic TVS pattern is unique to BOTs, we also selected randomly from our ultrasound and surgical database 20 cases of epithelial ovarian cancer and 20 cases of benign cystadenoma, for review by the same pathologists. To confirm the novelty of our findings, we searched PubMed for literature published in the English language between 2010 and 2018 to determine whether the association between microcystic tissue pattern and BOT has been described previously. Results Included in the final analysis were 62 patients (67 ovaries) with preoperative TVS and surgically confirmed BOT on pathologic examination. The mean patient age at surgery was 39.8 years. The mean BOT size at TVS was 60.7 mm. Of the 67 BOTs, 47 (70.1%) were

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

New sonographic marker of borderline ovarian tumor: microcystic pattern of papillae and solid components

Timor‐Tritsch

Foley

Brandon

et al. 2019

Ultrasound in Obstet & Gyne

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“…13,14 Recent articles have described the use of the IOTA models to diagnose ovarian cancer during pregnancy. 9,12 The results of the available studies are extremely encouraging, although limited by the inevitably low number of patients enrolled. In the present case report, the description of the mass in accordance with the terminology proposed by the IOTA group allowed us to correctly diagnose the presence of a borderline ovarian mass in this pregnant adolescent patient.…”

Section: Discussionmentioning

confidence: 99%

“…From the beginning of this century, the role of ultrasound in the first trimester of pregnancy has been useful to study adnexal masses occasionally found during fetal examination. 9 Studies about the risk of malignancy of pelvic masses are few and retrospective, with inevitably limited results. [10][11][12] The International Ovarian Tumor Analysis (IOTA) protocol has been recently suggested as a very useful tool to identify description patterns to standardize the ultrasonographic examinations.…”

mentioning

confidence: 99%

“…In fact, during pregnancy, the hormones may have an impact on the characteristics of ovarian lesions, thus increasing the difficulties to understand imagines, especially when they are complex and mutate week after week. 12 Few studies have investigated the use of the IOTA models in pregnancy 9,12 and none has tested this tool in the differential diagnosis of a BOT in a pregnant adolescent.…”

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confidence: 99%

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The Case of a Serous Borderline Ovarian Tumor in a 15-Year Old Pregnant Adolescent: Sonographic Characteristics and Surgical Management

et al. 2020

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Objective This study aimed to describe a rare case of a serous borderline ovarian tumor (BOT) diagnosed during pregnancy in a 15-year old adolescent. Results The suspect of BOT was raised at a transvaginal ultrasound scan in early first trimester (at 5 weeks of amenorrhea), due to the presence of a moderately vascularized irregular papilla in the context of a unilocular low-level right ovarian cyst. The patient and her parents required termination of pregnancy, irrespective of the diagnosis of an ovarian lesion. After termination of pregnancy, the patient underwent laparoscopic enucleation of the ovarian mass, omentectomy, and peritoneal biopsies. No intra-abdominal spillage of the ovarian mass occurred, and the surgical specimens were put in an endobag and extracted transvaginally. Final pathological examination confirmed the diagnosis of a serous borderline ovarian tumor. The patient of free of disease after 8 months of follow-up. Conclusion Although rare, borderline ovarian tumors can be diagnosed in an adolescent during pregnancy. The combination of specific sonographic assessment and minimally invasive conservative surgery appears as a very effective approach in this type of patient. Key Points

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Reaffirming microcystic ultrasound appearance of borderline ovarian tumors using three‐dimensional ‘silhouette’ rendering

Timor‐Tritsch

Monteagudo²,

Popiolek

et al. 2022

Ultrasound in Obstet & Gyne

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Borderline ovarian tumors (BOTs) are primary epithelial tumors with histological features of malignancy. Clinically, they exhibit a relatively benign course, since they are minimally invasive, and fertility-sparing surgery can be employed 1 . The International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization recognize BOTs as an intermediate entity, referring to them as tumors with 'borderline malignancy' or of 'low malignant potential' 2 . BOTs comprise approximately 4-14% of all epithelial tumors 3 . They tend to affect women of reproductive age and are therefore often first encountered by general gynecologists rather than gynecologic oncologists.When a BOT is detected early, the long-term prognosis and survival rate are good 3,4 . Transvaginal sonography (TVS) is the best diagnostic tool for their detection [4][5][6][7] . The most common signs of BOT on ultrasound (US) are reported to be: a septate cyst with solid component(s) and/or mural nodules containing blood vessels in papillary projections [6][7][8] . Furthermore, we have described a new sonographic marker of BOT 9 : microcystic tissue pattern resembling a cluster of tiny bubbles, seen in papillary projections, solid component(s) and/or septa. This appearance was observed on TVS in 89.6% (60/67) of our sample of BOTs, including 97.9% (46/47) of the serous BOTs, 73.3% (11/15) of the mucinous BOTs and 60.0% (3/5) of the seromucinous BOTs. Herein, we provide further evidence of this finding, supporting its credibility, using a dedicated three-dimensional (3D) display rendering application: 'silhouette' mode.This was a retrospective Internal Review Boardapproved (#i21-0104) gynecologic US study. From the

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Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis

Cited by 24 publications

References 24 publications

New sonographic marker of borderline ovarian tumor: microcystic pattern of papillae and solid components

New sonographic marker of borderline ovarian tumor: microcystic pattern of papillae and solid components

The Case of a Serous Borderline Ovarian Tumor in a 15-Year Old Pregnant Adolescent: Sonographic Characteristics and Surgical Management

Reaffirming microcystic ultrasound appearance of borderline ovarian tumors using three‐dimensional ‘silhouette’ rendering

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