The Multimodal Ultrasound Features of Ovarian Serous Surface Papillary Borderline Tumor

Lijun Xie; Xinxiu Liu; Haiying Li; Liyan Huang; Fang Chen; Xingfu Wang; Lei Jiang; Ling Gan

doi:10.1089/whr.2021.0140

The Multimodal Ultrasound Features of Ovarian Serous Surface Papillary Borderline Tumor

Womens Health Rep (New Rochelle). 2022 May 10;3(1):523-532. doi: 10.1089/whr.2021.0140. eCollection 2022.

Authors

Lijun Xie¹, Xinxiu Liu¹, Haiying Li¹, Liyan Huang¹, Fang Chen¹, Xingfu Wang², Lei Jiang³, Ling Gan¹

Affiliations

¹ Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
² Department of Medical Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
³ Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fujian Medical University Cancer Center, Fuzhou, China.

Abstract

Aim: Ovarian serous surface papillary borderline tumor (OSSPBT) is very rare. Combined with clinical and pathological features, we aim to investigate the multimodal ultrasound features of OSSPBT.

Patients and methods: There were only 18 patients diagnosed with OSSPBT among the 142 patients who were diagnosed with borderline serous ovarian tumor by pathology from June 2008 to December 2020 in our hospital. Their clinical data, conventional ultrasound, two-dimensional contrast-enhanced ultrasound (2D-CEUS), three-dimensional contrast-enhanced ultrasound (3D-CEUS) characteristics, pathology, and prognosis were retrospectively analyzed.

Results: The 18 patients had no specific clinical symptoms. Multiple implantable nodules were found in 8 patients (44.4%), ascites in 13 patients (72.2%), and elevated carbohydrate antigen 125 (CA125) in 15 patients (83.3%). After excluding 2 misdiagnosed patients from 18 patients, 26 tumors in 16 patients (6 unilateral and 10 bilateral) were studied. Conventional ultrasound findings of OSSPBT showed that large solid masses around normal ovary without capsule, and numerous small dense anechoic areas were observed in the parenchyma of the lesion, with strong speckle echo ("blizzard" sign) of varying degrees. The 2D-CEUS and 3D-CEUS showed a normal ovary in the center surrounded by a radial blood supply of OSSPBT with thick and irregular branches. Histopathologically, the papillary fibrous stalk of OSSPBT had a large number of sand bodies and tortuous dilated microvessels. All patients had no recurrence after surgery, and two of them delivered successfully through assisted reproductive technology.

Conclusion: OSSPBT has a good prognosis. Its conventional ultrasound is characterized by irregular solid masses surrounding normal ovaries and a large number of "blizzard" signs. It showed low enhancement of eccentricity with irregular radial branches centered on the ovary by CEUS.

Keywords: contrast-enhanced sonography; multimodal ultrasound; ovary; serous surface papillary borderline tumor.