Solid or complex masses
(a) Endometrial carcinoma-
(b) Clear cell carcinoma- Thought to arise from the mullerian duct, their US appearances are non-specific and they are usually seen as predominantly solid complex masses.
(c) Brenner's tumor- This is a rare epithelial tumor which is benign and may occur at any age. The tumors are mostly solid, although cystic lesions have been described.
(d) Undifferentiated carcinoma- Usually solid, hypoechoic tumors but may have a complex appearance with areas of cystic necrosis. Prognosis is usually poor.
(e) Germ cell tumors- teratomas/ dermoids- These are common tumors in adolescent and young Women but may also occur in the elderly. Malignant teratomas are rare. Between 10 and 15 percent of dermoids are bilateral; they often contain fat, teeth and hair and thus have variable appearance on US. The majority of dermoids are very echogenic and they may shadow. These appearances may be mimicked by bowel or calcified flbroicls. Cystic tumors with an echogenic mural focus may occur. Hair within may float on top of fatty material (‘tip of the iceberg' sign). Fat/fluid level may also occur.
(f) Gpnadal stromal tumors- Stromal tumors are uncommon They include granulosa tumors, fibroma, fibrosarcoma and Sertoli-Leydig tumors. They are functioning tumors and therefore present early. Sonographically they appear solid; they may be bilateral. Ovarian thecoma, fibroma or Brenner’s tumor may be associated with Meigs’ syndrome, which represents a clinical triad of hydrothorax, benign ascites and an ovarian tumor.
(g) Krukenberg's tumors- These represent metastases; 50% are of GIT Origin (stomach, colon and pancreas). The most common appearance is of a pelvic mass, usually showing homogeneous low level echoes. Appearances identical to cystadenocarcinoma may occur. Echogenic masses containing variable anechoic spaces have been described.
(h) Lymphoma- Lymphoma of the ovaries is usually a part of more extensive disease and often results from dissemination from other sites. Like lymph nodes, ovarian lymphoma deposits are solid but echo poor. The ovaries are usually enlarged.
(i) Other ovarian tumors- These include dysgerminoma, choriocarcinoma, embryonal carcinoma and polyembryoma mixed germ cell tumor. Sonographically they are seen as solid or complex masses.
(j) Solid non-neoplastic masses- Ectopic pregnancy, PID and salpingitis may all present as solid adnexal masses indistinguishable from ovarian masses on sonography alone.
NB- Color flow and pulsed Doppler may help differentiate between malignant lesionad benign lesions; however, there is an overlap\between benign and malignant lesions, with infImmatory masses and functioning benign ttimors mimicking malignant lesions. Corpus lutum flow cannot be differentiated from flow to malignant lesions.
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