MRI for discriminating metastatic ovarian tumors from primary epithelial ovarian cancers

Full Text 
(small study/references to related research)

Published: 28 August 2015 

Study subjects

This retrospective study was approved by the institutional review boards of Shanghai First People’s Hospital, Shanghai, China. The informed consent requirement was waived. We searched for data of patients with ovarian tumors from January 2012 to December 2014 on a hospital information system—a picture archiving and communication system (PACS). We encountered 11 consecutive cases (median age, 42 years; range, 21–58 years) of metastatic ovarian tumors confirmed by pathology. Six gastric cancers, two colon cancers, one cervical cancer, one breast cancer and one thyroid cancer were found among the patients. It is obvious that the most common site of primary origin of metastatic ovarian cancers was stomach. Meanwhile, we detected 26 consecutive cases (median age, 56 years; range, 17–82 years) with pathologically confirmed primary epithelial ovarian cancers. None of these cases witnessed the history of malignant tumors except the present cancers. All the primary epithelial ovarian cancers had undergone surgery. Then the cancers were confirmed by histopathological pathologists in Shanghai First People’s Hospital. Consequently, ten serous cystadenocarcinoma, six clear cell cancers, five borderline malignancy, three mucinouscystadenocarcinoma and two endometrioid adenocarcinomas were found (Table 1). (see below)

Conclusions

In conclusion, metastatic ovarian tumors seem to be smaller in size, more bilateral, more uniform in locules and more moderate enhancement in solid portions than those of primary ovarian cancers. Metastatic ovarian tumors were with less elevated levels of CA125 and HE4 in contrast with primary ovarian cancers. (note: see Table 3)  Although the sensitivity, specificity, and accuracy of any features are not sufficient for diagnoses, the combination of three key features (patients’ age, small size, and bilaterality) tends to have a high sensitivity, specificity, and accuracy for identifying metastatic ovarian tumors. The radiologist must depend on a combination of the imaging features as well as the clinical examinations in order to diagnose metastatic ovarian tumors.

Table 1

Summary of the cases

Tumor type		Total cases	Histopathologically confirmed cases
Metastatic ovarian tumors	Gastric cancer	6	6
	Colon cancer	2	2
	Thyroid cancer	1	1
	Uterine cervical cancer	1	1
	Breast cancer	1	1
	Subtotal	11	11
Primary ovarian tumors	Serous cystadenocarcinoma	10	10
	Clear cell carcinoma	6	6
	Borderline malignancy	5	5
	Mucinous cystadenocarcinoma	3	3
	Endometrioid adenocarcinoma	2	2
	Subtotal	26	26
Total		37	37