The Multimodal Ultrasound Features of Ovarian Serous Surface Papillary Borderline Tumor

Abstract

Aim: Ovarian serous surface papillary borderline tumor (OSSPBT) is very rare. Combined with clinical and pathological features, we aim to investigate the multimodal ultrasound features of OSSPBT. Patients and Methods: There were only 18 patients diagnosed with OSSPBT among the 142 patients who were diagnosed with borderline serous ovarian tumor by pathology from June 2008 to December 2020 in our hospital. Their clinical data, conventional ultrasound, two-dimensional contrast-enhanced ultrasound (2D-CEUS), three-dimensional contrast-enhanced ultrasound (3D-CEUS) characteristics, pathology, and prognosis were retrospectively analyzed. Results: The 18 patients had no specific clinical symptoms. Multiple implantable nodules were found in 8 patients (44.4%), ascites in 13 patients (72.2%), and elevated carbohydrate antigen 125 (CA125) in 15 patients (83.3%). After excluding 2 misdiagnosed patients from 18 patients, 26 tumors in 16 patients (6 unilateral and 10 bilateral) were studied. Conventional ultrasound findings of OSSPBT showed that large solid masses around normal ovary without capsule, and numerous small dense anechoic areas were observed in the parenchyma of the lesion, with strong speckle echo (“blizzard” sign) of varying degrees. The 2D-CEUS and 3D-CEUS showed a normal ovary in the center surrounded by a radial blood supply of OSSPBT with thick and irregular branches. Histopathologically, the papillary fibrous stalk of OSSPBT had a large number of sand bodies and tortuous dilated microvessels. All patients had no recurrence after surgery, and two of them delivered successfully through assisted reproductive technology. Conclusion: OSSPBT has a good prognosis. Its conventional ultrasound is characterized by irregular solid masses surrounding normal ovaries and a large number of “blizzard” signs. It showed low enhancement of eccentricity with irregular radial branches centered on the ovary by CEUS.

Serous surface papillary borderline ovarian tumors: correlation of sonographic features with clinic pathological findings

“…Morotti et al reported that serum CA 125 level was elevated in 24-61% of patients with SBOT 16 . In the study of Xie et al 14 , 83.3% of patients with SSPBOT presented with variously high levels of CA 125. The difference may be attributable to the varying proportions of patients with advanced-stage disease.…”

“…reported that serum CA 125 level was elevated in 24–61% of patients with SBOT 16 . In the study of Xie et al 14 ,. 83.3% of patients with SSPBOT presented with variously high levels of CA 125.…”

“…Xie et al 14 . studied recently the ultrasound features of 26 tumors in 16 patients with SSPBOT using conventional ultrasound and two‐ and three‐dimensional contrast‐enhanced ultrasound.…”

“…Xie et al 14 studied recently the ultrasound features of 26 tumors in 16 patients with SSPBOT using conventional ultrasound and two-and three-dimensional contrast-enhanced ultrasound. The latter displayed the overall blood perfusion of ovarian tumors in a stereoscopic, intuitive and continuous manner 14,15 . They also reported that contrast-enhanced ultrasound showed a normal ovary in the center surrounded by a radial blood supply of SSPBOT with thick and irregular branches.…”

“…Therefore, this specific characteristic of SSPBOT (fireworks sign) was also confirmed by the spatial distribution of tumor vessels on contrast-enhanced ultrasound. Xie et al 14 observed a large number of speckled strong echo signals in the tumors of patients with SSPBOT on conventional ultrasound imaging. They described this phenomenon as the 'blizzard sign', which is related closely to pathological sand bodies.…”