Fig. 3
From: Functional MRI in the pre-operative assessment of GI-RADS 3, 4, and 5 ovarian masses
A 36-year-old female presented with chronic pelvic pain. US revealed right predominantly cystic adnexal lesion showing papillary projections (GI-RADS 4). CA-125 was elevated. a–d Conventional MRI: a–c axial T2, axial T1, and coronal T2 WI depict a large right adnexal predominantly cystic lesion that shows thickened mural nodules. It elicits isointense T1 and high T2 signals. It measures 8 cm. d Post-contrast axial T1 WI shows intense post-contrast enhancement of its mural nodules. Conventional MRI findings: Suggestive of a borderline ovarian tumor. e, f Diffusion WI and ADC map demonstrate diffusion restriction of the mural nodules. ADC value measures 0.24 × 10−3 mm2/s. g DCE with color mapping shows type II curve: initial rapid rise followed by a plateau with delayed washout. MRE%, 26.7%; Tmax, 135.2 s; WIR, 9.8. h Proton MRS at intermediate TE (144 ms): ROI placed within the mural vegetation shows small choline that is observed around 3.2 ppm and NAA peaks and is observed around 2 ppm with a large lipid/lactate peak is observed around 1.3 and 0.9 ppm. Cho/Cr, 0.25. Multiparametric MRI diagnosis: Findings suggest the borderline ovarian tumor. Operative details: right salpingo-oophorectomy. i H&E stain with original magnification power 40 revealed an ovarian cyst with papillary projections. The cyst wall and the papillae had fibrous hyalinosed stroma; they were lined by cuboidal cells, with tufting and papillation. The cells showed hypercellularity and low to moderate grade nuclear atypia. No invasion of the cyst wall or the papillary core. Final pathological diagnosis: Right borderline serous tumor