86-year-old woman with history of medullary thyroid cancer and hypermetabolic pelvic mass seen on PET/CT from 10/26/2015. PELVIS:UTERUS, ADNEXA: There is a large mass arising from the left adnexa (series 7, image 28) which measures up to 88 x 62 mm in maximal axial dimension. This lesion previously measured 57 x 35 mm on the PET/CT from 9/21/2009. This lesion is predominantly solid (small cystic elements versus necrosis noted) and markedly T2 hypointense. This lesion mildly enhances in a heterogeneous pattern. The lesion crosses the midline and abuts the right ovary. Asymmetrically prominent left-sided pelvic varices are noted.BLADDER: The bladder is unremarkable.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. Of note, no ascites or peritoneal nodularity identified.
Large left adnexal mass which has enlarged compared to PET/CT from 2009 and has signal characteristics suggestive of fibrous tumor given the markedly T2 hypointense signal demonstrated. The lesion shows interval growth since 2009 cross-sectional imaging. The differential for a lesion such as this one in a postmenopausal woman includes the following: An ovarian cystadenofibroma (particularly given the solid composition with small cystic elements and the minimal intralesional enhancement) or a fibroma/fibrothecoma (this however typically contains a small to no cystic portion) or a Brenner tumor (considered less likely given that this entity usually shows marked enhancement). Tissue sampling for confirmation recommended. Metastatic disease remains a consideration but medullary thyroid carcinoma has been seen to involve the ovary in only very rare instances. And if the T2 hypointense signal does in fact indicate a predominately fibrous composition, metastatic disease is highly unlikely. Also of note, no additional findings to suggest a primary ovarian malignancy, such as peritoneal nodularity or ascites, is seen. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.