Abstract：Objective To explore the magnetic resonance imaging(MRI) characteristics of ovarian fibroma-thecoma and adult-type ovarian granulosa cell tumors (OGCTs).Methods The MRI image data of ovarian fibroma-thecoma in 25 patients with ovarian tumors proven by pathology in the Fourth People's Hospital of Zhenjiang from June 2014 to December 2020 were analyzed retrospectively. Among the patients, 20 (7 fibroma cases, 5 fibrothecoma cases, and 8 thecoma cases) were aged 26-75 years old, and 5 patients with adult-type OGCT were aged 34-58 years old. All the patients underwent routine MRI, enhanced scanning, and diffusion-weighted imaging (DWI) examination prior to their operation. The observation targets were as follows: (1) The location, size, morphology, border, signal, and enhancement features of the tumors were analyzed. (2) The average enhancement rate, DWI signs, and apparent diffusion coefficient (ADC) values of the fibromas, thecomas, and adult-type OGCT were compared.Results (1) Among the 20 cases of ovarian fibroma-thecoma, 9 cases were located in the right ovary and 11 cases were located in the left ovary. All tumor boundaries were clear and round in 14 cases and lobulated or irregular in 6 cases with the maximum diameters of 2.0-12.3 cm. Twenty cases of ovarian fibroma-thecoma showed isointensity on T1 weighted imaging(T1WI). Thecomas showed hyperintensity, fibrothecomas exhibited mixed hyperintensity and hypointensity, and fibromas presented hypointensity on T2 weighted imaging(T2WI). Among the cases, 3 cases of fibroma-thecoma had local cystic degeneration. The cystic component showed hypointensity on T1WI and hyperintensity on T2WI. On gadolinium enhancement, fibromas showed weak enhancement, and thecomas showed moderate enhancement. Among the 5 cases of adult-type OGCT, 3 cases were located in the right ovary and 2 cases were in the left ovary. All tumor boundaries were clear, round, or oval with the maximum diameter of 3.0-9.7 cm. Five cases of adult-type OGCT were cystic-solid masses showing mixed hypointensity and isointensity on T1WI and heterogeneous hyperintensity on T2WI. Multiple cysts of various sizes were seen in the masses, and the inner wall of the cysts were smooth. On gadolinium enhancement, the solid part of adult-type OGCT showed significant enhancement. (2) The enhancement rate of adult-type OGCT was 123.70%±5.44%, which was higher than that of thecomas (89.23%±4.19%). The enhancement rate of thecomas was higher than that of fibromas (43.50%±6.33%). These differences were statistically significant (all P values＜0.01). On DWI images, thecomas were hyperintense, fibromas were hypointense, the solid components of adult-type OGCTs were hyperintense, and the cystic components of adult-type OGCTs were hypointense. The ADC value of the thecomas was (1.28±0.25)×10-3 mm2/s, which was higher than that of the solid parts of adult-type OGCT [(0.91±0.18)×10-3 mm2/s]. The ADC value of the solid parts of adult-type OGCT was higher than that of fibromas (0.67±0.14)×10-3 mm2/s. The differences were statistically significant (all P values＜0.01).Conclusions Ovarian fibroma-thecoma and adult-type OGCT have different characteristics on T2WI and enhancement, and DWI may be helpful for further differential diagnosis.
孟砺实, 高瑞芳, 严雨, 严建春. 卵巢纤维-卵泡膜细胞肿瘤与成人型卵巢颗粒细胞瘤的MRI特点对比分析[J]. 中华解剖与临床杂志, 2021, 26(6): 628-633.
Meng Lishi, Gao Ruifang, Yan Yu, Yan Jianchun. Magnetic resonance imaging characteristics of ovarian fibroma-thecoma and adult-type ovarian granulosa cell tumors: a comparative research. Chinese Journal of Anatomy and Clinics, 2021, 26(6): 628-633.
Chung KC, Lee HH, Su MH, et al. Ovarian fibrothecoma mimicking ovarian cancer: using laparoscopy to avoid unnecessary exploratory laparotomy[J]. Taiwan J Obstet Gynecol, 2019, 58(6): 903-904. DOI:10.1016/j.tjog.2019.09.026.
[2]
Shinagare AB, Meylaerts LJ, Laury AR, et al. MRI features of ovarian fibroma and fibrothecoma with histopathologic correlation[J]. AJR Am J Roentgenol, 2012, 198(3): W296-W303. DOI:10.2214/AJR.11.7221.
[3]
Pectasides D, Pectasides E, Psyrri A. Granulosa cell tumor of the ovary[J]. Cancer Treat Rev, 2008, 34(1): 1-12. DOI:10.1016/j.ctrv.2007.08.007.
[4]
Shen Y, Liang Y, Cheng X, et al. Ovarian fibroma/fibrothecoma with elevated serum CA125 level: a cohort of 66 cases[J]. Medicine (Baltimore), 2018, 97(34): e11926. DOI:10.1097/MD.0000000000011926.
Huang GQ, Wang Y, Wang JW. Diagnostic value of MDCT and MRI in ovarian thecofibroma[J]. J Pract Radiol, 2017, 33(1): 79-82. DOI:10.3969/j.issn.1002-1671.2017.01.022.
Ding L, Yang J. Imaging and pathology features of ovarian fibroma and fibrothecoma: a comparative study[J]. 2018, 34(11): 1738-1741. DOI:10.3969/j.issn.1002-1671.2018.11.023.
Li M, Duan CZ, Zhang YW, et al. The characteristic of adult ovarian granulosa cell tumor with pathologic correlation analysis[J]. 2018, 16(6): 89-92. DOI:10.3969/j.issn.1672-5131.2018.06.028.
[8]
Chung BM, Park SB, Lee JB, et al. Magnetic resonance imaging features of ovarian fibroma, fibrothecoma, and thecoma[J]. Abdom Imaging, 2015, 40(5): 1263-1272. DOI:10.1007/s00261-014-0257-z.
[9]
Young RH. Ovarian sex cord-stromal tumours and their mimics[J]. Pathology, 2018, 50(1): 5-15.DOI:10.1016/j.pathol.2017.09.007.
[10]
Yen P, Khong K, Lamba R, et al. Ovarian fibromas and fibrothecomas: sonographic correlation with computed tomography and magnetic resonance imaging: a 5-year single-institution experience[J]. J Ultrasound Med, 2013, 32(1): 13-18. DOI:10.7863/jum.2013.32.1.13.
[11]
Motoshima S, Irie H, Nakazono T, et al. Magnetic resonance imaging findings of granulosa cell tumor of the ovary[J]. Pak J Radiol, 2012, 22(2): 46-51.
[12]
Chen J, Wang J, Chen X, et al. Computed tomography and magnetic resonance imaging features of ovarian fibrothecoma[J]. Oncol Lett, 2017, 14(1): 1172-1178. DOI:10.3892/ol.2017.6228.
Li JH, Li SY, Gu P, et al. Ovarian thecoma-fibroma: MRI imaging findings[J]. Journal of Clinical Radiology, 2018, 37(3): 453-456. DOI:10.13437/j.cnki.jcr.2018.03.023.
[14]
Zhang H,Zhang H,Gu S,et al.MR findings of primary ovarian granulosa cell tumor with focus on the differentiation with other ovarian sex cord-stromal tumors[J]. J Ovarian Res, 2018, 11(1): 46. DOI:10.1186/s13048-018-0416-x.
[15]
Fang M, Dong J, Zhong Q, et al. Value of diffusion-weighted imaging combined with conventional magnetic resonance imaging in the diagnosis of thecomas and their differential diagnosis with adult granulosa cell tumors[J]. Acta Radiol, 2019, 60(11): 1532-1542. DOI:10.1177/0284185119830280.
[16]
Takeuchi M, Matsuzaki K, Nishitani H. Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses[J]. J Comput Assist Tomogr, 2010, 34(2): 173-176. DOI:10.1097/RCT.0b013e3181c2f0a2.
[17]
Zhao SH, Li HM, Qiang JW, et al. The value of MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary: emphasis on diffusion-weighted MR imaging[J]. J Ovarian Res, 2018, 11(1): 73. DOI:10.1186/s13048-018-0444-6.
2021, Vol. 26 
