Diagnostic ultrasound ( PDFDrive )

1880 PART V Pediatric Sonography
Bladder
Bladder
A
B
FIG. 54.16 Benign Ovarian Teratomas. (A) Transverse sonogram of pelvis in 6-year-old girl with constipation and large abdominal mass
revealed very large, complex mass illing pelvis and lower two-thirds of abdomen, containing multiple shadowing, echogenic foci (arrow) consistent
with calciications. (B) Midline sonogram in a 12-year-old girl with right lower quadrant pelvic pain demonstrates a complex, primarily cystic mass
(arrows) that contains a small area of shadowing calciication in the dermal plug. (C) Young girl with a history of urinary tract infection. Sonography
demonstrates a complex, round, primarily brightly echoic mass (arrows) with smaller, hypoechoic cystic areas.
C
Ovarian Masses in Children
Benign ovarian teratomas (almost 60%)
Dysgerminoma
Embryonal carcinoma
Endodermal sinus tumor
Epithelial tumors of ovary (postpuberty)
Granulosa theca cell tumor (precocious puberty)
Arrhenoblastoma (rare, virilizing)
Gonadoblastoma (in dysplastic gonads—e.g., Turner
syndrome)
Acute leukemia
Benign teratomas have a wide spectrum of sonographic
characteristics (Fig. 54.16). Teratomas may be predominantly
cystic. he most common sonographic appearance is a cystic
mass with an echogenic mural nodule, the so-called “Rokitansky
nodule” or “dermoid plug.” 46-49 Cystic teratomas are usually freely
mobile on a pedicle; 10% are bilateral, and 90% are less than
15 cm in diameter. 50
Dysgerminoma is the most common malignant germ cell
tumor of the ovary in childhood. his tumor frequently occurs
before puberty, and 10% are bilateral. he tumor is usually a
large, solid, encapsulated, rapidly growing mass containing
hypoechoic areas as a result of hemorrhage, necrosis, and cystic
degeneration. Retroperitoneal lymph node metastases may occur.
Dysgerminoma is more radiosensitive than the other malignant
ovarian tumors. 47,48
Embryonal carcinoma and endodermal sinus tumors are
less common malignant germ cell tumors. Choriocarcinoma
is rare in children. All these are rapidly growing, highly
malignant, solid neoplasms. Embryonal carcinoma is oten
associated with abnormal hormonal stimulation. hese tumors
tend to spread by direct extension to the opposite adnexa and
retroperitoneal lymph nodes. Peritoneal seeding and hematogenous
metastases to liver, lung, bone, and mediastinum are
common.
Epithelial tumors of the ovary, which include serous and
mucinous cystadenoma or cystadenocarcinoma, represent 20%
of ovarian tumors in children. 51 Epithelial lesions are rare before
puberty. On sonography, they are predominantly cystic masses
with septa of variable thickness. It is oten diicult to diferentiate
benign from malignant and serous from mucinous cystadenomas
or cystadenocarcinomas based only on sonographic criteria.
Granulosa theca cell tumor is the most common stromal
tumor in children. It is oten associated with feminizing efects
and precocious puberty as a result of estrogen production. Of
these tumors, 10% are bilateral; only 3% are malignant. Sonographic
appearance is nonspeciic, and they may be solid, cystic,
or mixed. 47-49 Arrhenoblastoma (Sertoli-Leydig cell tumor) is
rare but may result in virilization. Gonadoblastoma is composed
of germ cells admixed with sex cell and stromal elements and
usually arises in dysplastic gonads. Bilateral involvement occurs
in one-third of cases, and 50% contain dysgerminoma
elements.
In leukemic iniltration, the ovaries, as well as the testes and
central nervous system, are sanctuary sites for acute leukemia.
Ovarian involvement in autopsy series ranges from 11% to 50%.
In leukemia with ovarian relapse, most patients have large,
hypoechoic, pelvic masses with smooth, lobulated margins. he
tumor can iniltrate the pelvic organs and bowel loops to such
a degree that the uterus and ovaries cannot be separately identiied.
Secondary hydronephrosis may develop. Bickers and colleagues 52
suggested that pelvic sonography should be used to monitor and
detect early leukemic relapse in the ovaries of children in clinical
remission. he ovaries may also be a site for metastatic spread
from neuroblastoma, lymphoma, and colon carcinoma. he
tumors rarely grow large enough to produce a mass and are
usually asymptomatic. Typically, the secondary neoplasms appear
on sonography as enlargement of one or both ovaries, which are
hypoechoic or hyperechoic to the uterus. Less oten, a discrete
solid or complex mass is seen.
It was originally thought that Doppler sonography would
serve to diferentiate between benign and malignant ovarian
masses. In adolescents and adult women, malignant ovarian