Diagnostic Ultrasound - Abdomen and Pelvis

Sex Cord-Stromal Tumor
Diagnoses: Female Pelvis
TERMINOLOGY
• Group of ovarian tumors arising from either embryonic sex
cords or mesenchyme
○ Fibroma, thecoma, fibrothecoma
○ Granulosa cell tumor
○ Sertoli-Leydig tumor (androblastoma)
○ Sclerosing stromal tumor, steroid cell tumors,
gynandroblastoma, and sex cord tumor with annular
tubules
IMAGING
• Ultrasound findings of sex cord-stromal tumors are diverse
and nonspecific
• Range from small, solid tumors to large, multicystic masses
• Sex cord-stromal tumors are generally solid or have
significant solid components
• Hormonally active tumors may be small and difficult to find
• Granulosa cell tumors
○ More often contain cysts with sponge-like appearance
KEY FACTS
○ Cysts may be complex and contain hemorrhagic fluid
• Fibrothecomas
○ Hypoechoic with posterior acoustic attenuation
○ May have appearance similar to uterine leiomyoma
TOP DIFFERENTIAL DIAGNOSES
• Ovarian carcinoma
○ Sex cord-stromal tumors less likely to have papillary
projections
• Germ cell tumors
○ Much more heterogeneous with calcifications, fluid-fluid
levels, etc.
CLINICAL ISSUES
• Symptoms related to hormone production
• Some are estrogen producing tumors: Bleeding in
postmenopausal patient
• May be associated with Meigs syndrome
(Left) Endovaginal US shows
right adnexal hypoechoic solid
mass (calipers) with dense
posterior acoustic shadow st,
greater than expected given
hypoechoic appearance of the
mass. The ovary is not
identified separately and the
imaging appearance is most
consistent with an ovarian
fibroma. (Courtesy A. Kamaya,
MD.) (Right) Axial T2 FS MR in
the same patient shows the
mass ſt is homogenously T2
dark and associated with a
small claw of normal ovarian
tissue st consistent with an
ovarian fibroma.
(Left) Color Doppler
endovaginal US in a
perimenopausal woman with
heavy vaginal bleeding shows
a heterogeneous left adnexal
mass , which is
predominately solid and
vascular but also contains
small cystic foci ſt. This was
confirmed to be granulosa cell
tumor at pathology. (Right)
Color Doppler endovaginal
ultrasound in the same patient
shows a thickened
endometrium with multiple
cysts consistent with
hyperplasia in the setting of a
granulosa cell tumor.
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