PMC7755876_01
Ultrasound (A) shows an oval cystic mass with an uneven wall thickness (white and black arrows). Magnetic resonance imaging shows a lobulated cystic mass with a cystic wall and septum of uneven thickness. T1-weighted imaging (B) and T2-weighted imaging (C) show slightly high signal intensity (indicated by white arrows both in (B and C). Short time inversion recovery imaging (D) shows low signal intensity (white arrow), and dynamic contrast-enhanced magnetic resonance imaging (E) shows slight and localized enhancement on the cystic wall (white arrow). Histological examination shows an undifferentiated adenocarcinoma with cystic wall and papillary architecture (H&E staining, x100) (F). Positive immunohistochemical results for WT-1 (IHC, x400) (G).
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The mass was anechoic with an uneven wall thickness (Figure 1A). The mass showed a slightly high signal intensity on T1-weighted imaging (T1WI) (3.0 T; TR 400 ms, TE 7 ms, flip angle 90 ), slightly high signal intensity on T2-weighted imaging (T2WI) (3.0 T; TR 2800 ms, TE 108 ms, flip angle 90 ) and low signal intensity on short time inversion recovery (STIR) imaging (3.0T; TR 7800 ms, TE 52 ms, IT 175 ms, flip angle 90 ). The cystic wall and septum of the mass were unevenly thick and showed slight and localized enhancement on dynamic contrast-enhanced MRI (DCE-MRI) (3.0T; TR 4 ms, TE 2 ms, flip angle 14 , Gd-DTPA 0.1 mmol/kg) (Figure 1B-E). Immunohistochemically, the tumor cells were positive for estrogen receptor (ER) and Wilms tumor 1 (WT-1) and negative for gross cystic disease fluid protein 15 (GCDFP-15) (Figure 1F-G).