PMC8203387_01
Pelvic MRI. T2-weighted axial image (a). Dynamic study (b). T2-weighted coronal image (c, d). There is a complex cystic lesion of the left ovary, with some solid papillary projections, which avidly enhance after contrast. Involving both ovaries there is another mixed mass, with the same characteristics of the previously described but arising from the right ovary. Both ovaries have multiple follicles, the right with polycystic appearance. Pedunculated leiomyoma (*) of the right broad ligament. Small volume of peritoneal effusion in pelvic situation (1.5 T MRI machine).
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Imaging parameters are provided in the figure legends (shown in Figures 1 and 2). T2 sequences, next to the right uterine horn, measuring 1.2 cm, suggesting pedunculated leiomyoma of the right broad ligament. The endometrium was fine and regular. There was a small volume of peritoneal effusion in pelvic situation, and there was no evidence of suspected pelvic lymph nodes (shown in Figures 1 and 2).
Axial diffusion-weighted (b1000) image (a) and diffusion coefficient map (b) show that papillary projections are nonrestricted on diffusion-weighted imaging.
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Imaging parameters are provided in the figure legends (shown in Figures 1 and 2). T2 sequences, next to the right uterine horn, measuring 1.2 cm, suggesting pedunculated leiomyoma of the right broad ligament. The endometrium was fine and regular. There was a small volume of peritoneal effusion in pelvic situation, and there was no evidence of suspected pelvic lymph nodes (shown in Figures 1 and 2).
Macroscopic examination. Left ovary 6.5 x 3.5 x 1.5 cm, on the surface with friable nodular pink lesion, 4 x 5 x 1.4 cm. After opening, the ovary is replaced by a cystic formation, with translucent and filant content, with abundant lobulated nodules adhering to the inner surface, the largest with 1.5 cm in diameter, equally pink and friable. The cystic wall is thin and elastic (a). The contralateral annex (*) shows a 6 cm horn and a 3 x 2.5 x 2 cm ovary, with a mostly pink and smooth surface, with an exophytic and lobulated lesion, with 2 x 1.5 cm. It is also identified a cystic formation with 1 cm, with a vegetation with 0.9 cm, which encompasses most of the cystic lesion (b).
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Between the two ovaries, the lesion measured about 4.5 cm (shown in Figure 3).
Pathological examination. Neoplasm with exophytic growth on the ovarian surface and, internally, in the macroscopically observed cystic areas. The lesion is mainly composed of papillae with large fibrovascular axes, with progressive and hierarchical branching, often with edema, hyaline sclerosis, and stromal calcifications. Tumor cells have eosinophilic cytoplasm and oval, hyperchromatic nuclei with mild atypia, with few mitotic figures being identified. There is no destructive invasion of stroma (H&E, 40x (a) and 100x (b)).
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Autoimplants of the left ovary surface with dimensions ranging from 4 to 11 mm of larger axis, morphologically nodular, and consisting of abundant desmoplastic stroma, which involves small aggregates of neoplastic cells (H&E, 40x (a) and 100x (b)).
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Immunohistochemistry study. Neoplastic cell positivity for WT1 (a), RE (80%) (b), RP (80%) (c), p53 wild-type labeling (faint 60%) (d), p16 (70%) (e), Ki-67 30% (f), and AR showing diffuse positivity (g) (100x).
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