Fig. 5
From: Functional MRI in the pre-operative assessment of GI-RADS 3, 4, and 5 ovarian masses
A 39-year-old female patient presented with menometrorrhagia. US was done and revealed small right ovarian lesion. CA-125 was normal. Conventional MRI (a–d): a–c axial T2, T1, and coronal T2-weighted images show a right adnexal lesion that shows multiple cystic spaces it measures about 5.5 cm; it elicits low T1 and high T2 signals. The lesion demonstrates intense heterogeneous enhancement with small internal cystic areas of breaking down in post-contrast axial fat suppressedT1 (d). Conventional MRI: Findings are suggestive of a benign ovarian tumor regarding its size, signal pattern, absence of septations, vegetations, and mural nodules. e, f Diffusion WI and ADC map demonstrate diffusion restriction of the solid component of the solid with estimated ADC value measures 0.88 × 10−3 mm2/s. g, h DCE with color mapping shows type II curve: initial rapid rise with plateau. MRE%, 117.5%; Tmax, 88 s, WIR, 33.5. i Proton MRS at long TE (288 ms): Spectrum shows a small choline peak, sharp lactate peak, and a small NAA peak. Cho/Cr ratio = 2.2. Multiparametric MRI diagnosis: Findings are in favor of a malignant ovarian tumor. Operative details: Right salpingo-oophorectomy. j, k H&E stain with original magnification power 25 and 40, respectively, revealed granulosa cell tumor with solid growth showing Call-Exner bodies and coffee-bean nuclei. Final pathological diagnosis: Granulosa cell tumor (malignant sex cord stromal tumor)