Imaging in gynecological disease: clinical and ultrasound characteristics of recurrent ovarian stromal cell tumors

Abstract

ABSTRACTObjectivesTo describe the clinical and ultrasound characteristics of recurrent granulosa cell and Sertoli Leydig cell tumors.MethodsThis is a retrospective observational study performed at Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Rome. Patients with a histological diagnosis of recurrent granulosa cell tumor or Sertoli Leydig cell tumor were identified from the database of the department of gynecological oncology. Those who had undergone a preoperative ultrasound examination at the Gemelli center were included. If a patient had more than one episode of relapse, information from all episodes was collected. If there was more than one recurrent tumor at the same ultrasound examination, all tumors were included. The recurrent tumors were described using International Ovarian Tumor Analysis (IOTA) terminology. One author reviewed all available ultrasound images trying to identify typical ultrasound patterns using pattern recognition.ResultsThirty patients with a histological diagnosis of recurrent granulosa cell (25 patients) or Sertoli‐Leydig cell (5 patients) tumor were identified from the database of the department of gynecological oncology. All had undergone a pre‐operative ultrasound examination at the Gemelli center and were included. A preoperative ultrasound examination had been performed in 34 of a total of 66 episodes of relapse. One recurrent tumor was detected at ultrasound examination in 22/34 (64.7%) episodes of relapse, two tumors in 4/34 (11.8%), and three or more tumors in 8/34 (23.5%) episodes of relapse. In all, there were 62 recurrent tumors detected on ultrasound. Most recurrent granulosa cell tumors (38/55, 69.1%) and recurrent Sertoli‐Leydig tumors (6/7, 85.7%) were classified as multilocular‐solid or solid tumors. However, 8/55 (14.5%) recurrent granulosa cell tumors and 1/7 (14.3 %) recurrent Sertoli‐Leydig cell tumors were described as unilocular cysts, and 9/55 (16.4 %) recurrent granulosa cell tumors as multilocular cysts. The nine unilocular cysts had anechoic (n =2) or low level cyst contents (n = 7), had either smooth (n = 4) or irregular (n = 5) internal cyst walls, and ranged from 8 to 38 mm size with three being <20 mm and five 20 ‐ 30 mm. On retrospective review of the images, two typical ultrasound patterns were described: 1) small solid tumor measuring less than 2 cm (24.1%, 15/62), 2) tumor with vascularized echogenic ground glass‐like content (12/62, 19.4%).ConclusionsSome granulosa cell and Sertoli‐Leydig cell recurrences manifest typical ultrasound patterns. However, some were described as unilocular cysts. Unilocular cysts are usually classified as benign, but in patients in follow‐up for a granulosa cell tumor or Sertoli‐Leydig cell tumor, they should be considered suspicious of recurrence.This article is protected by copyright. All rights reserved.