Ultrasonography in patients with gynecological cancer

Endometrial cancer is the most common malignancy of the female genital tract, affecting 2-3% of women during their lifetime. The median age at diagnosis is 60-65 years and the most commonly associated risk-factor is obesity.

Uterine sarcomas are rare malignant tumors arising from the mesenchymal tissues of the uterus, i.e. the endometrial stroma, uterine muscle and connective tissue. They represent 1% of female genital tract malignancies and 3-7% of all uterine malignances.

Extragenital primary tumors that metastasize to the endometrium and or uterine cervix are infrequent conditions and represent a diagnostic challenge among clinicians and pathologists.

Struma ovarii is a rare form of ovarian mature teratoma that contains mostly thyroid tissue. Malignant transformation is uncommon, only about 5% of struma ovarii being malignant. The variable sonographic features of struma ovarii and its rare occurrence makes the sonographic diagnosis very challenging.

Dysgerminomas are malignant ovarian germ-cell tumors. Malignant germ-cell tumors of the ovary occur in young women, 75% being diagnosed in the second and third decades of life. At macroscopic evaluation, ovarian dysgerminomas are characteristically solid and well-encapsulated with an average diameter of 15 cm.

Sertoli cell tumors, Sertoli-Leydig cell tumors and Leydig cell tumors are sex cord-stromal tumors, and one of the rarest gynecological malignancies, accounting for 0.5-1 % of ovarian tumors. Sertoli cell tumors and Sertoli-Leydig cell tumors are most common in young patients.

Brenner tumors are surface epithelial–stromal tumors of the ovary, which were first described in detail by Fritz Brenner in 1907. Brenner tumors represent 3.2 % of all ovarian tumors. About 99% of them are benign and most patients are postmenopausal. Brenner tumors are usually unilateral.

Borderline ovarian tumors (BOTs) are epithelial tumors with low grade of malignancy.  BOTs account for 10–15% of epithelial ovarian tumors. These tumors occur in younger women, with almost 30% of patients younger than 40 years, and are often diagnosed at an earlier stage than invasive carcinomas.

Clear cell carcinoma represents 5–25% of all ovarian carcinomas. Tumors can measure up to 30 cm in diameter. In most cases, the cut surface reveals a thick-walled cyst with papillary projections. The histologic patterns include tubulocystic, papillary and solid. The most representative image on ultrasound is a unilateral mass larger than 10 cm with a solid component.

Endometrioid carcinoma represents 10-15% of ovarian epithelial carcinomas. In 15-20% of cases endometrial carcinoma is diagnosed at the same time. Tumors are solid or cystic with a mass protruding into the lumen. The most common microscopic pattern is characterised by a confluent glandular epithelial proliferation.

Mucinous carcinomas comprise 2–3% of ovarian carcinomas. Most mucinous carcinomas are well differentiated, containing areas of cystadenoma and atypical proliferative tumor mixed with areas of carcinoma. The size and laterality of the tumor can suggest whether it is primary or metastatic in nature.

Low grade serous carcinoma (LGSC) is a rare disease whereas high grade serous ovarian carcinoma (HGSC) is the most common ovarian malignancy. Non-invasive LGSCs are often bilateral and papillae on the outer surface of the cyst are frequently present. Invasive LGSCs exhibit a papillary growth.

The ovary is a common site of metastases from malignant tumors. Most metastases in the ovaries originate in the gastrointestinal tract or the breast. The distinction between primary and metastatic ovarian neoplasm is of critical importance, since surgical cytoreduction is the treatment of choice for the former.

This leaflet is to help you understand what cervical cancer is, what tests you need and the implication of being diagnosed and what treatment options are available to you.