Ovarian Neoplasms ~ Stromal Tumors

Solid adnexal masses that arise from the sex cords of the embryonic gonadal or ovarian stroma.

Sex-cord Stromal Tumors

Sex cord {stromal tumors} types:

• Granulosa cell tumor

• Thecomas

• Fibromas

• Sertoli-Leydig cell tumors

Sex cord {stromal tumors} are ___________ but _________ on ultrasound.

Hypoechoic, solid

What age group is it most common to find Fibroma in?

• Middle age

• Menopausal

• Postmenopausal

Characteristics that describe a Fibroma.

• Solid

• Unilateral

• Variable size

  • May be pedunculated – torsion factor

What is the ultrasound appearance of a Fibroma?

• Variable attenuation (fibroid)

• Hypoechoic mass with substantial attenuation

What is this US image?

Ovarian Fibroma

What is this US image?

Ovarian Fibroma

What is Meig’s Syndrome?

• Fibroma associated with:

  • Massive ascites

  • Pleural effusion {R side}

What is a different diagnosis for Meig’s Syndrome?

• Ovarian CA with ascites and pleural effusion

  • Pseudo-Meig’s syndrome

What is this US image?

Meig’s Syndrome

Considered most common hormonally functioning ovarian tumor (estrogen).

Thecomas

Thecomas are usually _______.

Benign

What age group is it most common to find Thecomas in?

Postmenopausal w/ bleeding

Thecomas are occasionally associated with _________ or ______ ___________.

• Ascites

• Meig’s syndrome

What is the sonographic appearance of a Thecomas?

• Hyperechoic

• Posterior shadowing

  • May show areas of necrotic degeneration

Granulosa tumors are ______.

Rare

Granulosa tumors are __________ neoplasms.

Feminizing

• Cells resembling the Graafian follicle

• Hormone-active estrogenic ovarian tumor

Granulosa tumors are ____ to _____% associated endometrial CA.

5-15%

What age group is it most common to find Granulosa in?

Postmenopausal

What is the sonographic appearance of Granulosa?

• Small - predominately solid (Fibroid appearance)

  Large – multiloculated and cystic

What is this US image?

Granulosa

What are other names for Sertoli - Leydig Cell Tumor.

• Arrhenoblastomas

• Androblastomas

Androblastomas is a __________ ovarian tumor.

Masculinizing

What age group is it most common to find Sertoli - Leydig Cell Tumor in?

Peak is 25-45 years old

Androblastomas are found _________ and can vary in size.

Unilaterally

What may be a result of Androblastomas?

• Amenorrhea

• Infertility

What is percentage for malignant potential of an Androblastoma?

22%

What is the sonographic appearance of Androblastomas (Sertoli – Leydig Cell)?

• Solid mass

• Cystic components

• Lobulated – well encapsulated

What is this US image?

Sertoli - Leydig Cell Tumor

Metastatic Disease can have spread from:

• Bowel

• Breast

• Endometrium

• Melanoma

• Lymphoma

What is the sonographic appearance of Metastatic Disease?

• Bilateral

• Ascites

• Solid or “moth eaten” appearance

When mets has spread to bowel, the tumor is known as __________ _______.

Krukenberg’s tumor

What is this US image?

Metastatic Disease