PMC6159154_01
Imaging and macroscopic findings of case 1-4. T2WI (Cases 1-4) shows the tumours consisting of cystic and solid lesions. Reflecting abundant stroma, the components are of low signal intensity, and are of various shapes, including papillary projections on T2WI (Cases 2-4). Together with the high intensity on T1WI (data not shown), multicystic portions are assumed to have bloody content, but show variable intensity. The MR images are reminiscent of malignant tumours arising from endometriosis such as endometrioid carcinoma or clear cell carcinoma. T1WI, T1 weighted image; T2WI, T2 weighted image.
bjrcr.20170062.g001.jpg
PMC6159154_04_bjrcr.20170062.g001.jpg
f1
On this occasion the left ovarian tumour was unchanged in size when compared to the previous MRI scan, but there was now solid areas with strong enhancement within the haemorrhagic cyst on MRI (Figure 1 lower right, Figure 6b-e).
Imaging of Case 1. (a) Sagittal T2 weighted image shows multicystic tumour. Each locule shows different signal intensity and also include papillary lesion in the middle of the tumour. (b) On sagittal T1 weighted image, some of the locules showed high signal intensity, indicating haemorrhagic content within the cyst. (c) Gadolinium enhanced T1 weighted image, middle part of the locules and papillary lesion within the locule were well enhanced and indicated the presence of solid component. (d) FDG-PET image shows strong uptake with irregular shape at the right side of the pelvis. According to the contrast enhanced CT image (e), those uptake corresponds to the right ovarian tumour, especially, solid component within the tumour. FDG-PET, fluorodeoxyglucose positron emission tomography.
bjrcr.20170062.g002.jpg
PMC6159154_01_bjrcr.20170062.g002.jpg
f2
MRI revealed a complex solid and cystic lesion measuring 9 cm in the right ovary (Figure 1, upper left; Figure 2a-c). A large enhanced solid component showed marked fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) (Figure 2d).
Microscopic images of endometrioid borderline tumours (EBT) of case 1-4 stained with hematoxylin and eosin. Case 1, adenofibromatous type EBT. Islands of atypical endometrioid glands are proliferating in fibrous stroma. Case 2, intracystic type EBT. Papillary proliferation of atypical endometrioid epithelium is noted in the cyst. Case 3, intracystic type EBT. Papillary and glandular proliferation of atypical columnar endometrioid cells are noted. An area with fusion of crowded glands is visible but does not exceed 5 mm in size, and lacks destructive stromal invasion. Case 4, intracystic type EBT. Note papillary growth of atypical endometrioid cells.
bjrcr.20170062.g003.jpg
PMC6159154_04_bjrcr.20170062.g003.jpg
f3
In FFPE specimens, a left ovarian cyst was identified, with intracystic proliferation of papillary endometrioid epithelium with cellular and structural atypia (Figure 3, lower right).
PMC6159154_02
Imaging and macroscopic findings of case 1-4. T2WI (Cases 1-4) shows the tumours consisting of cystic and solid lesions. Reflecting abundant stroma, the components are of low signal intensity, and are of various shapes, including papillary projections on T2WI (Cases 2-4). Together with the high intensity on T1WI (data not shown), multicystic portions are assumed to have bloody content, but show variable intensity. The MR images are reminiscent of malignant tumours arising from endometriosis such as endometrioid carcinoma or clear cell carcinoma. T1WI, T1 weighted image; T2WI, T2 weighted image.
bjrcr.20170062.g001.jpg
PMC6159154_04_bjrcr.20170062.g001.jpg
f1
On this occasion the left ovarian tumour was unchanged in size when compared to the previous MRI scan, but there was now solid areas with strong enhancement within the haemorrhagic cyst on MRI (Figure 1 lower right, Figure 6b-e).
Microscopic images of endometrioid borderline tumours (EBT) of case 1-4 stained with hematoxylin and eosin. Case 1, adenofibromatous type EBT. Islands of atypical endometrioid glands are proliferating in fibrous stroma. Case 2, intracystic type EBT. Papillary proliferation of atypical endometrioid epithelium is noted in the cyst. Case 3, intracystic type EBT. Papillary and glandular proliferation of atypical columnar endometrioid cells are noted. An area with fusion of crowded glands is visible but does not exceed 5 mm in size, and lacks destructive stromal invasion. Case 4, intracystic type EBT. Note papillary growth of atypical endometrioid cells.
bjrcr.20170062.g003.jpg
PMC6159154_04_bjrcr.20170062.g003.jpg
f3
In FFPE specimens, a left ovarian cyst was identified, with intracystic proliferation of papillary endometrioid epithelium with cellular and structural atypia (Figure 3, lower right).
Imaging of Case 2. (a) On sagittal T2 WI, large cystic tumour is located above the uterus. Cystic lesion and papillary projection mixing low and high signal intensity were observed within the cyst. (b) On sagittal T1WI, upper half of the tumour shows high signal intensity, indicating haemorrhagic content. The rest of the lesion showing low signal intensity on T1WI were enhanced on gadolinium enhanced T1 WI (c). Enhnaced lesion shows high signal intensity on diffusion weighted image (d). T1WI, T1 weighted image; T2WI, T2 weighted image.
bjrcr.20170062.g004.jpg
PMC6159154_02_bjrcr.20170062.g004.jpg
f4
T2WI and were well enhanced indicating solid components (Figure 1 upper right, Figure 4a-c). This lesion showed restricted water diffusion on diffusion weighted imaging (DWI) (Figure 4d).
PMC6159154_03
Imaging and macroscopic findings of case 1-4. T2WI (Cases 1-4) shows the tumours consisting of cystic and solid lesions. Reflecting abundant stroma, the components are of low signal intensity, and are of various shapes, including papillary projections on T2WI (Cases 2-4). Together with the high intensity on T1WI (data not shown), multicystic portions are assumed to have bloody content, but show variable intensity. The MR images are reminiscent of malignant tumours arising from endometriosis such as endometrioid carcinoma or clear cell carcinoma. T1WI, T1 weighted image; T2WI, T2 weighted image.
bjrcr.20170062.g001.jpg
PMC6159154_04_bjrcr.20170062.g001.jpg
f1
On this occasion the left ovarian tumour was unchanged in size when compared to the previous MRI scan, but there was now solid areas with strong enhancement within the haemorrhagic cyst on MRI (Figure 1 lower right, Figure 6b-e).
Microscopic images of endometrioid borderline tumours (EBT) of case 1-4 stained with hematoxylin and eosin. Case 1, adenofibromatous type EBT. Islands of atypical endometrioid glands are proliferating in fibrous stroma. Case 2, intracystic type EBT. Papillary proliferation of atypical endometrioid epithelium is noted in the cyst. Case 3, intracystic type EBT. Papillary and glandular proliferation of atypical columnar endometrioid cells are noted. An area with fusion of crowded glands is visible but does not exceed 5 mm in size, and lacks destructive stromal invasion. Case 4, intracystic type EBT. Note papillary growth of atypical endometrioid cells.
bjrcr.20170062.g003.jpg
PMC6159154_04_bjrcr.20170062.g003.jpg
f3
In FFPE specimens, a left ovarian cyst was identified, with intracystic proliferation of papillary endometrioid epithelium with cellular and structural atypia (Figure 3, lower right).
Imaging of Case 3. (a) On contrast enhanced CT image, complex solid and cystic tumour is located at the right side of the uterus. On both T1 (b) and T2 weighted image (c), each locule shows different signal intensities with shading due to haemorrhage within the cyst. Papillary lesion was observed on the tumour septum on T2WI and enhanced on post contrast CT and higher signal intensity on Diffusion weighted image (d). (e) PET-CT shows strong uptake to the solid component. PET-CT, positron emission tomography CT.
bjrcr.20170062.g005.jpg
PMC6159154_03_bjrcr.20170062.g005.jpg
f5
A papillary lesion was observed on the tumour septum on T2WI and enhanced on post-contrast CT (Figure 1 lower left, Figure 5a-c). PET-CT showed strong uptake within the solid component (Figure 5d,e).
PMC6159154_04
Imaging and macroscopic findings of case 1-4. T2WI (Cases 1-4) shows the tumours consisting of cystic and solid lesions. Reflecting abundant stroma, the components are of low signal intensity, and are of various shapes, including papillary projections on T2WI (Cases 2-4). Together with the high intensity on T1WI (data not shown), multicystic portions are assumed to have bloody content, but show variable intensity. The MR images are reminiscent of malignant tumours arising from endometriosis such as endometrioid carcinoma or clear cell carcinoma. T1WI, T1 weighted image; T2WI, T2 weighted image.
bjrcr.20170062.g001.jpg
PMC6159154_04_bjrcr.20170062.g001.jpg
f1
On this occasion the left ovarian tumour was unchanged in size when compared to the previous MRI scan, but there was now solid areas with strong enhancement within the haemorrhagic cyst on MRI (Figure 1 lower right, Figure 6b-e).
Microscopic images of endometrioid borderline tumours (EBT) of case 1-4 stained with hematoxylin and eosin. Case 1, adenofibromatous type EBT. Islands of atypical endometrioid glands are proliferating in fibrous stroma. Case 2, intracystic type EBT. Papillary proliferation of atypical endometrioid epithelium is noted in the cyst. Case 3, intracystic type EBT. Papillary and glandular proliferation of atypical columnar endometrioid cells are noted. An area with fusion of crowded glands is visible but does not exceed 5 mm in size, and lacks destructive stromal invasion. Case 4, intracystic type EBT. Note papillary growth of atypical endometrioid cells.
bjrcr.20170062.g003.jpg
PMC6159154_04_bjrcr.20170062.g003.jpg
f3
In FFPE specimens, a left ovarian cyst was identified, with intracystic proliferation of papillary endometrioid epithelium with cellular and structural atypia (Figure 3, lower right).
Imaging of Case 4. (a) MRI 4 years before the operation. The content of the cyst in the left ovary showed high intensity on T2WI with T2 dark spot sign and intermediate-to-low intensity on T1WI (not shown) indicating endometriotic cyst. (b) MRI 1 month before the operation. On axial T2WI, small tumour is observed at the left side of the uterus. There was papillary projections with low signal intensity were observed within the cyst. Haemorrhage is observed at the peripheral of the tumour on T1WI (c) and CT (d). Papillary projections within the cyst were well enhanced on gadolinium enhanced T1WI (e) and shows strong uptake at FDG-PET (f). FDG-PET, fluorodeoxyglucose positron emission tomography; T1WI, T1 weighted image; T2WI, T2 weighted image.
bjrcr.20170062.g006.jpg
PMC6159154_04_bjrcr.20170062.g006.jpg
f6
MRI at the age of 37 revealed an endometriotic cyst in her left ovary; the cyst showing high intensity on T2WI and intermediate-to-low intensity on T1WI without any solid component (Figure 6a). On this occasion the left ovarian tumour was unchanged in size when compared to the previous MRI scan, but there was now solid areas with strong enhancement within the haemorrhagic cyst on MRI (Figure 1 lower right, Figure 6b-e). PET-CT demonstrated FDG uptake in the solid portion of the left ovarian tumour (Figure 6f).