DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20200866

Computed tomography features of benign adnexal mass lesions

Ezzat Khalda, Ashok Kumar Mandal, Hafizur Rahman

Abstract


Background: Adnexal masses originating from gynaecologic and nongynecologic sources may be benign or malignant. The objective of this study was to describe multi-detector computed tomography features of benign adnexal masses for diagnostic accuracy and disease understanding.

Methods: Study retrospectively evaluates the multidetector computed tomography features of benign adnexal mass lesions, which were referred for MDCT examination with a primary diagnosis of adnexal masses on clinical or USG. Patients who underwent MDCT and subsequently underwent surgery and proved to benign adnexal mass lesion on histopathological examination were included in this study.

Results: Forty five percent benign adnexal mass were in the age group of 36-50 years followed by 32.7% in the age group of 21-35 years. Common presenting symptoms of benign adnexal masses were pain abdomen or pelvic pain (65.5%) followed by mass abdomen (42%) while in one fourth of the patients it was asymptomatic and detected as incidental finding. Pathologic diagnosis of most common benign adnexal mass detected were serous cyst adenoma (54.5%), followed by mature cystic teratoma (18.2%), mucinous cyst adenoma (14.5%) and par ovarian cyst (9.1%). Benign ovarian mass had a characteristic CT appearance of cystic lesion (83.6%), unilocular (65.5%) with regular/well defined and thin wall (83.6%) with occasional septations (21.8%) and papillary projections (14.5%). Ascitis (5.5%) was an uncommon finding of a benign adnexal mass lesion. Computed tomography was most accurate to characterize mature cystic teratoma with a typical cystic lesion having fat deposition and calcifications.  Serous cyst adenoma had a CT appearance of thin walled cyst mass with no septations or solid component. Mucinous cyst adenoma ovary had a characteristic multilocular cystic lesion with different fluid attenuation and thin septations.  Endometrioma had a variable CT appearance with uni or multilocular cystic lesion and hyperdense lesion with focal calcifications.

Conclusions: Multi detector computed tomography may provide accurate and valuable diagnostic information about benign nature of an adnexal mass lesion.


Keywords


Adnexal mass, Benign, Computed tomography, Multidetector

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References


Soper DE. Pelvic masses. In: Shingleton HM, Hurt WG. eds. Postreproductive Gynecology. New York, Edinburgh, London, Melbourne: Churchill Livingstone. 1990:259-275.

American Cancer Society. Cancer facts and figures. Atlanta, Ga.: American Cancer Society; 2007. Available at: http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf. Accessed on 3rd August 2019.

Ries LA, Melbert D, Krapcho M, eds. SEER cancer statistics review, 1975-2004. Bethesda, Md.: National Cancer Institute. Available at: http://seer.cancer.gov/csr/1975_2004. Accessed on 3rd August 2009.

Dressman HK, Berchuck A, Chan G, Zhai J, Bild A, Sayer R, Cragun J, et al. An integrated genomic-based approach to individualized treatment of patients with advanced-stage ovarian cancer. J Clin Oncol. 2007;25:517-25.

Curtin JP. Management of the adnexal mass. Gynecol Oncol. 1994;55:S42-46.

NIH consensus conference. Ovarian cancer. Screening, treatment, and follow-up. NIH Consensus Development Panel on Ovarian Cancer. JAMA. 1995;273:491-7.

Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004;291:2705-12.

Padilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol. 2000;96:593-8.

Bhosale P, Iyer R. Diagnostic imaging in gynecologic malignancy. Minerva Ginecol. 2008;60:143-54.

Heinz-Peer G, Memarsadeghi M, Niederle B. Imaging of adrenal masses. Curr Opin Urol. 2007;17:32-8.

Jung SE, Lee JM, Rha SE. CT and MRI of ovarian tumors with emphasis on the differential diagnosis. Radiograph. 2002;22:1305-25.

Varras M. Benefits of ultrasonographic evaluation of uterine adenexal lesions in early detection of ovarian cancer. Clin Exp Obstet Gynecol. 2004;1:85-98.

Dalrymple NC, Prasad SR, Freckleton MW, Chintapalli KN. Informatics in radiology (infoRAD): introduction to the language of three-dimensional imaging with multidetector CT. Radiograph. 2005;25:1409-28.

Byrom J, Widjaja E, Redman CW, Jones PW, Tebby S. Can pre-operative computed tomography predict resectability of ovarian carcinoma at primary laparotomy? BJOG. 2002;109:369-75.

Koonings PP, Campbell K, Mishell DR, Grimes DA. Relative frequency of primary ovarian neoplasm: A 10-year review. Obstet Gynecol. 1989;74:921-6.

Mubarak F, Alam MS, Akhtar W, Hafeez S, Nizamuddin N. Role of multidetector computed tomography (MDCT) in patients with ovarian masses. Int J Womens Health. 2011;3:123-6.

Outwater EK, Siegelman ES, Junt JL. Ovarian teratomas: Tumor types and imaging characteristics. Radiograph. 2001;21:475-90.

Talerman A. Germ cell tumors of the ovary. In: Kurman RJ, ed. Blaustein's Pathology of the Female Genital Tract, New York: Springer Verlag; 2002:967-1033.

Yamashita Y, Hatanaka Y, Torashima M. Mature cystic teratomas of the ovary without fat in the cystic cavity: MR features in 12 cases. AJR Am J Roentgenol. 1994;163:613-6.

Sala EJS, Atri M. Magnetic resonance imaging of benign adnexal disease. Top Magn Reson Imag. 2003;14:305-27.

Jung SE, Lee JM, Rha SE. CT and MRI of ovarian tumors with emphasis on the differential diagnosis. Radiograph. 2002;22:1305-25.

Bazot M, Nassar-Slaba J, Thomassin-Naggara I. MRI compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors; correlation with final histology. Eur Radiol. 2006;16:2687-99.

Clement PB. Diseases of the peritoneum. In: Kurman RJ, ed. Blaustein's Pathology of the Female Genital Tract, New York: Springer; 2002:448-489.

Woodward PJ, Sohaey R, Mezzetti TP. Endometriosis: radiologic pathologic correlation. Radiograph. 2001;21:193-216.

Baek IK, Kim HS, Jeon DS, Park YS, Kim HJ, Rhee HS. CT findings of endometrioma: differential points from other benign complex cystic adnexal masses. J Korean Radiol Soc. 1997;37(4):725-32.