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Magnetic resonance imaging in sclerosing stromal tumor of the ovary
International Journal of Gynecology and Obstetrics 83 (2003) 319–321
Brief communication
Magnetic resonance imaging in sclerosing stromal tumor of the ovary M. Mikami*, K. Tanaka, S. Komiyama Department of Obstetrics and Gynecology, Department of Clinical Research, National Saitama Hospital, Wako, Saitama, Japan Received 5 May 2003; received in revised form 17 June 2003; accepted 18 June 2003 Keywords: Sclerosing stromal tumor; Ovarian neoplasm; MRI
Sclerosing stromal tumor of the ovary (SST) is an extremely rare benign ovarian tumor, which occurs most frequently in young women. Since Chalvardjian and Scully w1x first reported SST in 1973, there have been only three reports w2–4x that have described diagnostic imaging of SST. We compare magnetic resonance imaging (MRI) findings with histological findings in two cases. T2-weighted images of tumors showed an irregular mix of areas of low and high intensity signal, with nodular low intensity components, and the tumor was encapsulated in a thick-walled capsule of low intensity signal (Figs. 1 and 2a). Microscopical examination showed a pseudolobular pattern with alternating edematous and cellular components (Fig. 3). In addition, markedly fibrous tumor tissue was visible in islet patterns (Figs. 3 and 4a). Cells with spindle-shaped nuclei were sporadically observed in the edematous parts (Fig. 4b). Areas replete with cellular components were comprised of oval cells accompanied by vascular and connective tissue hyperplasia (Fig. 4c). An area of connective tissue hyperplasia was formed along the outside of the tumor margin (Fig. 4d). *Corresponding author. Tel.: q81-48-462-1101; fax: q8148-464-1138. E-mail address: [email protected] (M. Mikami).
Moisture content is the most important factor in T2-weighted images of soft tissues, as signal intensity is low in tissue where there is little moisture such as collagen or fibrous tissue. It is apparent that the tumor margin, as shown in Fig. 4d, is comprised of fibrous tissue containing large amounts of collagen. MRI T2-weighted images (Figs. 1 and 2a) show low signal intensity at the tumor margins. In MRI T2-weighted images, areas of low signal intensity include the nodules and the irregular walls inside the tumor. These areas correspond to tissue that is highly fibrous (Fig. 4a,d), whereas the areas of high signal intensity on MRI T2-weighted images surrounding these parts can be understood to be edematous (Fig. 4b). Although histologically predicable, as well due to the presence of vascular hyperplasia (Fig. 3), the MRI taken after T1-weighted imaging shown in Fig. 2b was as expected, with the components that were displayed with low signal intensity in T2-weighted images, i.e. the cellular and edematous components (Fig. 4c,b), visibly enhanced at an early stage. The SST tissue structure could be inferred from the MRI findings. Should a solid ovarian tumor be encountered in a young woman, the rare possibility of SST must also be kept in mind, when deciding on a preop-
0020-7292/03/$30.00 䊚 2003 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0020-7292(03)00297-2
320
M. Mikami et al. / International Journal of Gynecology and Obstetrics 83 (2003) 319–321
Fig. 1. Case 1: pelvic MRI T2-weighted image—transverse plane. The tumor margin is displayed as low signal intensity, and the interior as a mixture of low and high intensity signals. Nodular components of low signal intensity are also visible.
Fig. 2. (a) Case 2: MRI T2-weighted image. The tumor is shown as an irregular mixture of high and low intensity signals encapsulated by a thick-walled capsule of low intensity signal. Nodular components of low signal intensity are also visible. (b) Case 2: MRI after T1-weighted imaging. The irregular interior walls and thick capsule seen in T2-weighted images are enhanced.
Fig. 3. Case 1: HE-stained sample =10. Areas replete with cellular components or fibrous tissue are mixed together with edematous areas. Capsule formation at the tumor margin is indistinct. Cells replete with fibrous tissue form the outermost layer of the tumor with edematous tissue located to the inside. Dilated blood vessels are also visible.
Fig. 4. (a) Case 1: HE-stained sample =100. These portions are replete in collagen fibers with a comparatively small amount of cellular component. They appear as nodular areas of low intensity signal on MRI T2-weighted images. (b) Case 1: HE-stained sample =100. Cells with spindle-shaped nuclei are sporadically visible in edematous areas, which appear as areas of high intensity signal on MRI T2-weighted images. (c) Case 1: HE-stained sample =100. Areas replete with cellular components are comprised of oval cells accompanied by connective tissue and vascular hyperplasia. (d) Tumor margin HEstained =100. An area of connective tissue hyperplasia is formed along the outside of the tumor margin, with an edematous region formed adjacent to this along the entire inner periphery of the margin.
M. Mikami et al. / International Journal of Gynecology and Obstetrics 83 (2003) 319–321
erative diagnosis, possibly using MRI to consider treatment using minimally invasive techniques such as laparoscopy. References w1x Chalvardjian A, Scully RE. Sclerosing stromal tumor of the ovary. Cancer 1973;31:664 –670.
321
w2x Ihara N, Togashi K, Todo G, Nakai A, Kojima A, Ishigaki T, et al. Sclerosing stromal tumor of the ovary: MRI. J Comput Assist Tomogr 1999;23:555 –557. w3x Joja I, Okuno K, Tsunoda M, Takeda Y, Sugita K, Mizutani Y, et al. Sclerosing stromal tumor of the ovary: US, MR, and dynamic MR findings. J Comput Assist Tomogr 2001;25:201 –206. w4x Matsubayashi R, Matsuo Y, Doi J, Kudo S, Matsuguchi K, Sugimori H. Screlosing stromal tumor of the ovary: radiologic findings. Eur Radiol 1999;9:1335 –1338.
Brief communication
Magnetic resonance imaging in sclerosing stromal tumor of the ovary M. Mikami*, K. Tanaka, S. Komiyama Department of Obstetrics and Gynecology, Department of Clinical Research, National Saitama Hospital, Wako, Saitama, Japan Received 5 May 2003; received in revised form 17 June 2003; accepted 18 June 2003 Keywords: Sclerosing stromal tumor; Ovarian neoplasm; MRI
Sclerosing stromal tumor of the ovary (SST) is an extremely rare benign ovarian tumor, which occurs most frequently in young women. Since Chalvardjian and Scully w1x first reported SST in 1973, there have been only three reports w2–4x that have described diagnostic imaging of SST. We compare magnetic resonance imaging (MRI) findings with histological findings in two cases. T2-weighted images of tumors showed an irregular mix of areas of low and high intensity signal, with nodular low intensity components, and the tumor was encapsulated in a thick-walled capsule of low intensity signal (Figs. 1 and 2a). Microscopical examination showed a pseudolobular pattern with alternating edematous and cellular components (Fig. 3). In addition, markedly fibrous tumor tissue was visible in islet patterns (Figs. 3 and 4a). Cells with spindle-shaped nuclei were sporadically observed in the edematous parts (Fig. 4b). Areas replete with cellular components were comprised of oval cells accompanied by vascular and connective tissue hyperplasia (Fig. 4c). An area of connective tissue hyperplasia was formed along the outside of the tumor margin (Fig. 4d). *Corresponding author. Tel.: q81-48-462-1101; fax: q8148-464-1138. E-mail address: [email protected] (M. Mikami).
Moisture content is the most important factor in T2-weighted images of soft tissues, as signal intensity is low in tissue where there is little moisture such as collagen or fibrous tissue. It is apparent that the tumor margin, as shown in Fig. 4d, is comprised of fibrous tissue containing large amounts of collagen. MRI T2-weighted images (Figs. 1 and 2a) show low signal intensity at the tumor margins. In MRI T2-weighted images, areas of low signal intensity include the nodules and the irregular walls inside the tumor. These areas correspond to tissue that is highly fibrous (Fig. 4a,d), whereas the areas of high signal intensity on MRI T2-weighted images surrounding these parts can be understood to be edematous (Fig. 4b). Although histologically predicable, as well due to the presence of vascular hyperplasia (Fig. 3), the MRI taken after T1-weighted imaging shown in Fig. 2b was as expected, with the components that were displayed with low signal intensity in T2-weighted images, i.e. the cellular and edematous components (Fig. 4c,b), visibly enhanced at an early stage. The SST tissue structure could be inferred from the MRI findings. Should a solid ovarian tumor be encountered in a young woman, the rare possibility of SST must also be kept in mind, when deciding on a preop-
0020-7292/03/$30.00 䊚 2003 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0020-7292(03)00297-2
320
M. Mikami et al. / International Journal of Gynecology and Obstetrics 83 (2003) 319–321
Fig. 1. Case 1: pelvic MRI T2-weighted image—transverse plane. The tumor margin is displayed as low signal intensity, and the interior as a mixture of low and high intensity signals. Nodular components of low signal intensity are also visible.
Fig. 2. (a) Case 2: MRI T2-weighted image. The tumor is shown as an irregular mixture of high and low intensity signals encapsulated by a thick-walled capsule of low intensity signal. Nodular components of low signal intensity are also visible. (b) Case 2: MRI after T1-weighted imaging. The irregular interior walls and thick capsule seen in T2-weighted images are enhanced.
Fig. 3. Case 1: HE-stained sample =10. Areas replete with cellular components or fibrous tissue are mixed together with edematous areas. Capsule formation at the tumor margin is indistinct. Cells replete with fibrous tissue form the outermost layer of the tumor with edematous tissue located to the inside. Dilated blood vessels are also visible.
Fig. 4. (a) Case 1: HE-stained sample =100. These portions are replete in collagen fibers with a comparatively small amount of cellular component. They appear as nodular areas of low intensity signal on MRI T2-weighted images. (b) Case 1: HE-stained sample =100. Cells with spindle-shaped nuclei are sporadically visible in edematous areas, which appear as areas of high intensity signal on MRI T2-weighted images. (c) Case 1: HE-stained sample =100. Areas replete with cellular components are comprised of oval cells accompanied by connective tissue and vascular hyperplasia. (d) Tumor margin HEstained =100. An area of connective tissue hyperplasia is formed along the outside of the tumor margin, with an edematous region formed adjacent to this along the entire inner periphery of the margin.
M. Mikami et al. / International Journal of Gynecology and Obstetrics 83 (2003) 319–321
erative diagnosis, possibly using MRI to consider treatment using minimally invasive techniques such as laparoscopy. References w1x Chalvardjian A, Scully RE. Sclerosing stromal tumor of the ovary. Cancer 1973;31:664 –670.
321
w2x Ihara N, Togashi K, Todo G, Nakai A, Kojima A, Ishigaki T, et al. Sclerosing stromal tumor of the ovary: MRI. J Comput Assist Tomogr 1999;23:555 –557. w3x Joja I, Okuno K, Tsunoda M, Takeda Y, Sugita K, Mizutani Y, et al. Sclerosing stromal tumor of the ovary: US, MR, and dynamic MR findings. J Comput Assist Tomogr 2001;25:201 –206. w4x Matsubayashi R, Matsuo Y, Doi J, Kudo S, Matsuguchi K, Sugimori H. Screlosing stromal tumor of the ovary: radiologic findings. Eur Radiol 1999;9:1335 –1338.