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

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.