Fig. 4
From: Functional MRI in the pre-operative assessment of GI-RADS 3, 4, and 5 ovarian masses
A 32-year-old female presented with pelvic pain and abdominal distension. US revealed the right large complex adnexal lesion with large solid components and cystic areas (GI-RADS 5). CA-125 was elevated. a–d Conventional MRI: a–c axial T2, axial T1, and sagittal T2-weighted images show huge right complex (solid/cystic ) adnexal lesion; it measures (18.5 cm), it elicits mixed (intermediate/hyperintense) T2 signal and mixed (low/hyperintense) T1 signal, it shows cystic and solid components which show avid enhancement in the post-contrast series (d). Pelvic ascites was also noted (white arrow). Conventional MRI findings are suggestive of a malignant ovarian tumor. e, f Diffusion WI and ADC map demonstrate diffusion restriction of the solid component of the solid with estimated ADC value measures 0.82 × 10−3 mm2/s. g DCE with color mapping shows type III curve: initial rapid rise with early washout. MRE%, 165%; Tmax, 112.5 s; WIR, 12.2. h at long TE (288 ms): Multi-voxel selected within the solid component of the lesion (i) showed large choline peak is observed around 3.2 ppm, and small lactate peak is observed around 1.3 ppm. Cho/Cr, 1.86. Multiparametric MRI diagnosis: Findings are suggestive of right malignant ovarian lesion. i H&E stain with original magnification power 40 revealed an ovarian tissue formed of invasive malignant growth and was exhibiting papillary structures. The papillae had thin fibro-vascular cores and lined by malignant serous cells with moderate anaplasia. Final pathological diagnosis: Right high grade invasive papillary serous cystadeno-carcinoma (malignant epithelial tumors)