A Pediatric Radiology Textbook and Pediatric Radiology Digital Library
Pediatric Ovarian Tumor
Etiology: — Epithelial cell tumors (70%): Serous or mucinous — Germ cell tumors (20%): Teratoma or dysgerminoma or endometrial sinus tumor or choriocarcinoma — Sex cord tumors (10%): Granulosa tumor or Sertoli-Leydig cell tumor — Others: Metastases or lymphoma or leukemia
Imaging:
DDX:
Complications: Peritoneal metastasis
Treatment: Surgical
Clinical:
Radiology Cases of Ovarian Tumor
Radiology Cases of Ovarian Cystadenoma
Axial, coronal and sagittal images from a CT with contrast of the abdomen shows a large cystic mass with thin separations on the right side of the abdomen above the bladder. The uterus and left ovary were unremarkable.Coronal (above left), sagittal (above right) and axial (below) CT with contrast of the abdomen show a large, well circumscribed, homogenous, non-enhancing, fluid density mass that fills the width of the lower abdomen and pelvis and lies superior and separate from the bladder and uterus. Neither ovary was clearly identified.Coronal (left) and axial (right) CT with contrast of the abdomen show a large multiseptated mass superior to the bladder. The left ovary was normal while the right ovary was not clearly identified.
Radiology Cases of Ovarian Dysgerminoma
Transverse and sagittal US of the pelvis (above) shows an echogenic and inhomgenous solid mass superior to the bladder. Neither ovary could be visualized. Axial CT with contrast of the abdomen shows a solid non-enhancing midline mass. The mass was found to be tossed in the operating room.
Radiology Cases of Ovarian Endodermal Sinus Tumor
AXR (above left) shows displacement of the bowel loops to the left upper quadrant. Sagittal US of the abdomen (above right) shows a large solid heterogenous intraperitoneal mass in the lower right abdomen whose organ of origin was uncertain. There was a large amount of ascites. Coronal (below left) and sagittal (below right) T1 MRI with contrast of the abdomen shows a large right-sided mass that was oval in shape with smooth contour with multiple cystic lobulations with enhancing septae within it superiorly with it being more solid inferiorly and which appeared to be adherent to the right ovary.
Clinical Cases of Ovarian Tumor
Clinical Cases of Ovarian Endodermal Sinus Tumor
AP (above) and lateral (below) clinical images show the abdomen to be distended with superficial collateral veins. A large mass was palpable. A fluid wave was present, along with tympany.
Surgery Cases of Ovarian Tumor
Surgery Cases of Ovarian Dysgerminoma
Surgical image (above) shows a mass arising from the left ovary. Surgical image (below) shows the left adnexal pedicle to be twisted in the center of the image. The mass and the left ovary and the fallopian tube were found to be torsed.
Surgery Cases of Ovarian Endodermal Sinus Tumor
Surgical image shows a tumor arising from the right ovary being delivered from the peritoneal cavity without spillage of tumor. A portion of the omentum (right superior aspect of image) was adherent to the tumor. The patient had a right salpingo-oophorectomy with partial omentectomy.
Gross Pathology Cases of Ovarian Tumor
Gross Pathology Cases of Ovarian Dysgerminoma
The surgical specimen measured 11 x 8 x 5 cm in size and was oval in shape with a tan outer surface. The lesion was soft but solid with extensive hemorrhage and necrosis. Gross pathological image of the cut specimen shows extensive hemorrhage and necrosis.
Gross Pathology Cases of Ovarian Endodermal Sinus Tumor
Gross pathological image (above) shows a large lesion adjacent to the fallopian tube. The cut surface of the lesion (below) is hemorrhagic and cystic.
Histopathology Cases of Ovarian Tumor
Histopathology Cases of Ovarian Dysgerminoma
Histopathological image H&E stained section shows a largely necrotic tumor comprised of sheets of relatively uniform cells and scattered lymphocytes. Around rare blood vessels, a few viable neoplastic cells were characterized by prominent nucleoli and abundant cytoplasm.Histopathological image H&E stained section shows a largely necrotic tumor comprised of sheets of relatively uniform cells and scattered lymphocytes. Around rare blood vessels, a few viable neoplastic cells were characterized by prominent nucleoli and abundant cytoplasm.Histopathological image H&E stained section shows the uniformity of the neoplastic cells with prominent nucleoli and abundant, clear cytoplasm; scattered small clusters of lymphocytes are present.
Histopathology Cases of Ovarian Endodermal Sinus Tumor
Histopathological image H&E stained section shows a reticular / glandular pattern and neoplastic cells with irregular nuclei, variably prominent nucleoli and occasional intracytoplasmic eosinophilic globules; mitotic figures are present.Histopathological image H&E stained section shows the distinctive Shiller-Duval body characterized by a papilla projecting into a simple space.Histopathological image H&E stained slide shows nests and cords of neoplastic cells with a moderate amount of cytoplasm. Within the center of the photograph is a Schuller-Duvall body which is the diagnostic hallmark of this tumor.Histopathological image PAS stained slide shows the PAS-positive globules within the cytoplasm of some tumor cells. These globules contain alpha-fetoprotein, which is usually correspondingly elevated in the serum.
