CT Findings of Metastatic Ovarian Tumors: Histopathological Correlation of Low Density Areas

Baek, Jung Hwan; Koh, Byung Hee; Song, Soon Young; Kim, Yong Soo; Rhim, Hyun Chul; Cho, On Koo; Kim, Wan Seop; Jang, Se Jin

Abstract

PURPOSE
The purpose of this study was to correlate CT and pathologic findings of metastatic ovarian tumors, with an emphasis on intratumoral low density area.
MATERIALS AND METHODS
Twenty three metastatic ovarian tumorsin 18 patients were included in this study. The primary sites were the stomach in all the Krukenberg tumorgroup(n=10), and the colon (n=6), stomach (n=1), unknown primary site (n=1) in the non-Krukenberg group (n = 8). Low density areas which were lower than back muscle density in post enhanced CT scan were divided into twosubgroups : well-defined and ill-defined. The well-defined low density areas were subdivided into two types, round and amorphous.
RESULTS
Well-defined low density areas on CT (n=18) corresponded on histopathological examinationto cystic degeneration(n=2), dysfunctional cysts(n=7), cystic degeneration with dysfunctional cysts (n=3), and dilated mucin producing glands(n=6). All the cystic degeneration and dysfunctional cysts, which were seen in 10 of12 (83 %) Krukenberg tumors, were round in appearance. Dilated mucin-producing glands(n=6), which were seen onlyin non-Krukenberg tumors, were amorphous(n=4), or round(n=2) in shape. Enhancement of the wall of well-defined low density areas(n=8) was demonstrated only in Krukenberg tumors (n=8). Ill-defined low density areas(n=16) corresponded to myxoid degeneration(n=10) in Krukenberg tumors, and necrosis(n=6) in non-Krukenberg tumors.
CONCLUSION
The presence of a round well-defined intratumoral low density area, or wall enhancement, which corresponds to cystic degeneration or dysfunctional cyst on pathology, may suggest a Krukenberg tumor in thestomach, while an amorphous well-defined low density area, which corresponds to dilated mucin producing glands, issuggestive of a non-Krukenberg tumor in extragastric organs.