MR appearance of non-Hodgkin's lymphoma of the ovary

MR imaging findings of ovarian lymphoma: differentiation from other solid ovarian tumors

PURPOSE

To evaluate magnetic resonance imaging (MRI) findings for distinguishing ovarian lymphomas from other solid ovarian tumors.

METHODS

This retrospective multicenter study included 14 women (median age, 46.5 years; range, 26-81 years) with surgically proven ovarian lymphoma and 28 women with solid ovarian tumors other than lymphoma. We conducted a subjective image analysis of factors including laterality, shape, composition, T2 signal intensity (SI), heterogeneity, diffusion restriction, enhancement, and presence of peripheral follicles. A generalized estimating equation was used to identify MRI findings that could be used to distinguish ovarian lymphomas from other solid ovarian tumors. Diagnostic performance of the identified MRI findings was assessed using the area under the receiver-operating characteristic curve (AUC).

RESULTS

Ovarian lymphoma more frequently showed homogeneous high SI on T2-weighted imaging (81.8% vs. 19.4%, P < 0.001) and peripheral ovarian follicles (40.9% vs. 8.3%, P = 0.01) than other ovarian solid tumors did. Bilaterality, shape, size, diffusion restriction, and enhancement did not differ between the two groups (P > 0.05 for all). Homogeneous high SI on T2-weighted imaging was the only independent MRI finding (OR = 15.19; 95% CI 3.15-73.33; P = 0.001) in the multivariable analysis. Homogeneous high SI on T2-weighted imaging yielded an AUC of 0.82 with a sensitivity of 81.8% and specificity of 80.6% in distinguishing ovarian lymphomas from other solid ovarian tumors.

CONCLUSION

Homogeneous high signal intensity on T2-weighted imaging was helpful in distinguishing ovarian lymphomas from other solid ovarian tumors. Peripheral ovarian follicles might be an additional clue that suggests a diagnosis of ovarian lymphoma.

Imaging of ovarian lymphoma

OBJECTIVE

The aim of the study is to describe the radiological spectrum of appearances of ovarian lymphoma (OL). The manuscript describes the radiological aspects of OL to assist the radiologist in achieving correct orientation of the diagnosis.

METHODS

We conducted a retrospective evaluation of imaging studies of 98 cases of non-Hodgkin's lymphoma, with extra-nodal localisation (ovaries) in three cases (1 primary, 2 secondary). A literature review was also performed.

RESULTS

Of the three evaluated women, one had a primary ovarian involvement and two had a secondary ovarian involvement. The most common lesion characteristics were a well-defined, solid homogeneous and hypoechoic mass at US. CT depicts OL as a well-defined, non-infiltrating, homogeneous hypodense solid mass, with mild contrast enhancement. On T1-weight MRI, OL appears as a homogeneous mass of low signal intensity, which enhances avidly following intravenous gadolinium.

CONCLUSION

Clinical and serological presentation of OL can be similar to that of primary ovarian cancer. As imaging plays a central role in the diagnosis of OL, the radiologist should be familiar with US, CT and MRI appearances of this condition to correctly orient the diagnosis and so avoid unnecessary adnexectomy.

Ovarian solid tumors: MR imaging features with radiologic-pathologic correlation

Ovarian solid tumors have variable histological types including benign and malignant tumors. In addition, non-neoplastic lesions sometimes show a tumor-like appearance. It is important to differentiate benign from malignant tumors. In general, low signal intensity (SI) on T2-weighted imaging (T2WI), low SI on diffusion-weighted imaging (DWI), and gradual increased pattern on dynamic contrast-enhanced magnetic resonance (MR) imaging are known to be suggestive of a benign tumor. Conversely, there are some cases in which these rules do not apply. We should, therefore, strive for a greater understanding of these exceptional cases. Several tumors show characteristic findings on MR imaging reflecting pathologic features, which leads to the correct diagnosis. Additionally, MR imaging provides important information other than the nature of tumors, such as secondary uterine changes. Furthermore, clinical findings and laboratory examination data also help in determining the correct diagnosis.

Imaging in secondary tumors of the ovary

Metastatic involvement of the ovaries is not rare. The most common tumor types metastasizing to the ovaries, from non-gynecological organs, are breast, colorectal, gastric, and appendix tumors. Lymphogenous, hematogenous, and transcoelomic pathways have all been proposed among potential pathways. Early diagnosis and treatment have an important potential to improve the patient outcome. Krukenberg tumors typically appear as complex semisolid masses with varying amounts of solid and cystic components. Ovarian metastases from the colon primaries are predominantly cystic in nature. Secondary lymphomatous involvement of ovary is mostly bilateral and solid with heterogeneous signal intensity on MRI. Metastatic breast cancer to the ovaries is typically bilateral and tends to be of small size. Among all the other imaging characteristics, bilateral involvement of secondary tumors of the ovary appears to be most potentially helpful finding in differentiating from primary ones.

Imaging of Extranodal Genitourinary Lymphoma

The genitourinary (GU) system is commonly affected by disseminated lymphoma. Rarely, lymphoma can originate from and remain localized to one of the GU organs and thus presents as primary extranodal disease. Up to 40% of lymphomas present as extranodal disease, with only 3% having the GU system as the primary site of involvement. This article describes and correlates the radiologic and pathologic features of extranodal lymphomatous disease affecting the GU system with specific focus on the kidneys, adrenal glands, testicles, and ovaries. Lymphoma of the uterine body and cervix, external female genitalia, urinary bladder, and prostate gland is briefly discussed.

Primary lymphomas of the female genital tract: imaging findings

Primary lymphomas of the female genital tract are extremely rare, and a definitive diagnosis requires correlation of the clinical, radiological, and pathological findings. Unlike nonlymphomatous malignant tumors, the treatment of lymphoma is typically nonsurgical, thus raising the possibility of lymphoma in the differential diagnosis of a pelvic mass, a radiologist can significantly change the approach to the disease. Although some imaging findings may appear nonspecific, others may suggest the possibility of lymphoma, such as the presence of one or more solid, well-defined, homogeneous masses without necrosis despite a large size or the presence of diffuse infiltration leading to organomegaly with architectural preservation. Additionally, pelvic lymphadenopathy may be evident. In this pictorial essay, we discuss the radiological appearances of gynecological primary lymphomas, grouped by organ, in ultrasonography, computed tomography, and magnetic resonance imaging.

Characteristics and outcome of pediatric non-Hodgkin lymphoma patients with ovarian infiltration at presentation

BACKGROUND

Ovarian infiltration in pediatric non-Hodgkin lymphoma (NHL) at presentation is rare and information on outcome is scarce and mainly based on case reports and small series.

PROCEDURE

Evaluation of clinical characteristics and outcome of ovarian infiltrated pediatric NHL cases of a single center, and an extensive review of the all cases reported so far in literature.

RESULTS

At presentation, 6/60 female NHL cases of our center had ovarian infiltration, and combining these cases with earlier case reports, a total of 42 cases were identified. Median age at presentation was 10.9 years (range 0-18), and all but one had a B-cell immunophenotype, with 32/42 cases being classified as Burkitt. Bilateral involvement was reported in 26/41 cases, of which 22 were bilaterally ovariectomized as first treatment. All cases were treated with chemotherapy. Relapses were reported in 9/36 and death in 16/36. After follow-up in our center (median 13.4 years), in 2 cases anti-Müllerian hormone (AMH) values were available (2.1 and 0.9 µg/L), in non-ovarian cases median 2.2 µg/L.

CONCLUSIONS

We conclude that in case of ovarian tumors with negative markers, NHL should be considered in order to avoid unnecessary surgery.

Primary gynecologic lymphoma: imaging findings

OBJECTIVE

The purpose of this article is to review the imaging features, particularly on MR images, useful in identifying primary gynecologic lymphoma.

CONCLUSION

Primary gynecologic lymphoma is rare. Nonetheless, the distinction between primary and secondary involvement is important because of critical differences in prognosis and treatment. The prospective diagnosis of primary gynecologic lymphoma enables immediate chemotherapy or radiation therapy and avoids unnecessary surgery, which delays treatment. Diagnostic imaging can be key in differentiating lymphoma from the far more common pelvic malignancies.

Burkitt's Lymphoma Presented as Advanced Ovarian Cancer without Evidence of Lymphadenopathy: CT and MRI Findings

Burkitt's lymphoma is a rare non-Hodgkin's lymphoma which can occasionally involve the ovary and may cause confusion for the clinician since its presentation might mimic other much more frequent tumors. We present a case of a 23-year-old woman with sporadic Burkitt's lymphoma presented as advanced ovarian cancer with bilateral ovarian masses, peritoneal carcinomatosis, ascites, and marked elevation of CA-125. Liver involvement and atypical bone lesions, such as the cranial vault and the iliac wing, were also detected without evidence of lymphadenopathy. We describe the MRI and CT findings of simultaneous ovarian and bone lesions, which have never been reported in literature in a patient with Burkitt's lymphoma, before and after one cycle of chemotherapy. In evaluating any ovarian neoplasm in a young woman, Burkitt's lymphoma should be considered as a possibility, particularly if associated with bone lesions. MRI is the most useful tool to characterize the ovarian lesions and suggest the diagnosis before the histopathological results.

Extranodal lymphoma from head to toe: part 2, the trunk and extremities

OBJECTIVE

Lymphoma can affect virtually every tissue in the body, producing a variety of imaging appearances. In this article, the extranodal manifestations of this disease in the trunk and extremities are illustrated and the imaging features that aid in the diagnosis are reviewed.

CONCLUSION

Knowledge of the imaging appearances of extranodal lymphoma can aid the differential diagnosis of mass lesions encountered in tissues throughout the body on different imaging modalities.

Primary non-Hodgkin's lymphoma of the ovaries: imaging findings

Primary ovarian lymphoma is very rare. We report a case of primary ovarian Burkitt-type non-Hodgkin's lymphoma, describing the imaging appearance on ultrasound, CT and MRI, and review the literature.

MR imaging evaluation of the adnexa

MR imaging has become an important tool in the evaluation of patients with adnexal disease, and its role continues to evolve. Some benign entities can be diagnosed by MR imaging with a high grade of confidence, such as teratomas, endometriomas, simple and hemorrhagic cysts, fibromas, and hydrosalpinx. In cases of malignant lesions, MR imaging may be more accurate than other modalities for lesion characterization, staging, and follow-up.

Secondary ovarian tumors: spectrum of CT and MR features with pathologic correlation

The ovaries represent common sites for metastatic disease. The common primary sites for metastatic disease to the ovaries include the colon, stomach, breast, and the genitourinary tract. Hematologic malignancies, including lymphoma and leukemia, also involve the ovaries. Ovarian metastasis may occasionally represent the initial manifestation of disease, especially in cancers of the gastrointestinal tract. The accurate diagnosis of this condition is always crucial since the misinterpretation of such tumors may cause significant adverse consequences for patients. CT and MR features of secondary ovarian tumors differ according to the origins of the primary malignancies. The great majority of metastases from gastric cancer are Krukenberg tumors, which are typically bilateral and characterized by lobulated solid tumors. Metastases from colon cancer are usually cystic tumors with solid components of variable size. Metastases from appendiceal tumor may present as ruptured mucinous ovarian tumors associated with pseudomyxoma peritonei. Metastatic tumors from breast cancer are characterized by the relatively small size of the lesion. Ovarian involvement by hematologic malignancies is typically bilateral, homogeneous solid masses. Recognition of radiologic features of a variety of secondary ovarian tumors is beneficial for suspecting the secondary tumors under certain clinical conditions, and thus determining the appropriate management of the patients.

Magnetic resonance imaging findings of small round cell tumors of the ovary: a report of 5 cases with literature review

OBJECTIVE

To study the magnetic resonance imaging characteristics of the ovarian involvement of small round cell tumors.

METHODS

Magnetic resonance imaging findings were retrospectively reviewed in 5 patients seen at this institution and in 7 patients reported in the literature with ovarian small round cell tumors. Laterality, signal intensity, existence of hemorrhage, calcification, necrosis, septa, cerebroid appearance, and peripheral cysts were evaluated.

RESULTS

Seven patients had bilateral disease, and the others had unilateral disease. The signal intensity was low on T1-weighted imaging (T1WI) in all cases. Signal on T2-weighted imaging (T2WI) and the degree of contrast enhancement varied. No case showed hemorrhage or calcification. Only 1 case demonstrated necrosis. Septa were observed in 3 cases, and a cerebroid appearance was observed in 5 cases. Six patients of reproductive age had multiple small cysts at the periphery of the masses.

CONCLUSION

Despite the limited number of cases, peripheral small cysts in the large lobulated solid mass seemed to be a characteristic of the ovarian small round cell tumors in patients of reproductive age.

MRI of gynaecological solid masses

Differential diagnosis of gynaecological masses is sometimes difficult, as there are so many histological types. However, magnetic resonance characteristics of some gynaecological tumours have been reported past several years. On the basis of the recent literature, we have made a decision tree for differential diagnosis of solid gynaecological tumours, in which there are some important divergences. Bilateral disease and invasive growth are malignant signs in most cases. Specific findings for different tumour types include: fibrovascular septa in dysgerminomas; preserving ovarian follicles in round cell tumours; pseudolobular patterns in young patients in sclerosing stromal tumours; and extremely hypointense masses on T2WI in Brenner tumours. Distinguishing between sex-cord stromal tumours, Brenner tumours and metastatic tumours may be hard, however, especially in middle age, because they all tend to show well-demarcated, hypointense masses on T2WI. Disproportionately clear zonal anatomy of the uterus, enlarged uterus and thickened endometrium, which are indirect findings of oestrogen-producing tumours, are useful diagnostic findings in children and postmenopausals.