ovaries

Theca lutein cyst

high hcg

• multiple pregnancy

• molar pregnancy

• OHSS

Multilocular cystic ‘spoke wheel’ appearance

cumulus oophora

collection of cells in a mature dominant follicle, imminent ovulation

ovary hot on PET

premenopausal: can be normal outside of first week

post menopausal: cancer

endometrioma

T1 Bright

T2 Dark(iron)- shading sign- old blood

1% Clear cell carcinoma

hemorrhagic cyst

posterior acoustic enhancement

lacy ‘fishnet appearance’

T1 Bright, Fat sat bright

T2 bright - fresh blood

No enhancement

dermoid

20-30s

tip of iceberg sign-USS beam absorption

Dot- dash sign (hair on USS)

cystic mass with rokitansky nodule-hyperechoic solid mural nodule

T1 Bright(fat)

T1 FS Dark(fat)

T2 Bright

1% SCC

Endometrioid ovarian cancer

2nd most common

15% bilateral

25% are mets from endometrial primary

ovarian fibroma

middle aged

T1 and T2 dark

benign

rarely calcified

Meigs Syndrome-ascites and pleural effusion

Gorlin Goltz syndrome- odontogenic keratocysts, basal cell carcinoma, bifid ribs

Brenner tumour

50-70s

T2 dark

CT: calcification

aka epithelial tumour of the ovary

Struma Ovarii

teratoma

contains thyroid tissue- hyperthyroidism

T1 mixed

T2 mixed(dark due to gelatinous colloid)

ovarian mets most common primary

Colon

stomach - Krukenburg tumour

breast

lung

other ovary

hydrosalpinx

cogwheel appearance- crosssection showing thickened folding inwards

string sign- incomplete septae

waist sign- indentation on opposing walls

peritoneal inclusion cyst

no wall

entrapment of ovary

conforms to shape of surrounding structure

hydatidiform mole

complete: diploid, snowstorm, bunch of grapes

partial: triploid, fetus present

Theca Lutein cysts

Invasive mole

USS: echogenic tissue in myometrium

MR: focal myometrial mass, dilated vessels, areas of hemorrhage and necrosis

choriocarcinoma

rising hcg post evacuation of molar pregnancy

USS: echogenic solid mass

Tx:methotrexate