case_images: PMC2698088_01
case_images: Sclerosing stromal tumor of the left ovary in a 16-year-old girl.. A. Peripheral arc-like vessels with a vertically oriented centripetal vascular network (the so-called "spoke-wheel appearance") in an oval-shaped left adnexal mass are clearly demonstrated at power Doppler ultrasonography.. B. Axial T1-weighted MR image depicts a left adnexal mass (arrows). The peripheral portion of the mass is slightly hyperintense relative to muscle, and the central portion is hypointense.. C. Axial T2-weighted MR image shows a slightly hyperintense peripheral portion relative to muscle, and a hyperintense central portion with a peripheral low signal rim. Slight ascites is present (*).. D. Sagittal gradient-echo (GE) image obtained 40 seconds after the administration of Gd-DTPA reveals strong enhancement of the peripheral portion of the mass.. E. Sagittal GE image obtained 140 seconds after demonstrates progressive centripetal enhancement (arrows).. F. At the sectioned surface of the tumor, a central whitish edematous and collagenous area (arrowheads) is visible, and this is surrounded by yellowish solid tissue, with a whitish ovarian capsule at its outermost rim.. G. Microscopic image of the cellular portion reveals an admixture of fibroblasts (arrows) and rounded vascuolated cells (curved arrows), and prominent thin-walled vessels (arrowheads) are noticeable (H&E staining, x200).
case_images: kjr-4-194-g001.jpg
case_images: PMC2698088_01_kjr-4-194-g001.jpg
case_images: F1
case_images: Power Doppler examination revealed the presence of multiple tortuous vessels, extending from the periphery to the central portion, and with a "spoke-wheel" appearance (Fig. 1A). In order to further characterize the mass, MR imaging was performed, and this revealed that its central portion had the same signal intensity as water and was wider than the cystic portion seen at ultrasonography; homogeneous low signal intensity was apparent at T1-weighted imaging (Fig. 1B), and high signal intensity at T2-weighted imaging (Fig. 1C). Dynamic contrast-enhanced MRI demonstrated early strong enhancement of the peripheral portion of the mass, a finding similar to that of the vessels (Fig. 1D). Delayed imaging demonstrated progressive centripetal and prolonged enhancement (Fig. 1E), though the central portion was entirely unenhanced. A small amount of ascites surrounded the mass (Fig. 1C). The cut surface was lobulated, yellowish white in color, and there were central areas of edema (Fig. 1F). The nodules were an admixture of fibroblasts and rounded vacuolated cells, with prominent thin-walled vessels (Fig. 1G).
case_images: PMC2698088_02
case_images: Sclerosing stromal tumor of the left ovary in a 26-year-old woman.. A. Axial T1-weighted MR image demonstrates a round, left adnexal mass (arrows), with a slightly hyperintense peripheral portion relative to muscle and a homogeneous central hypointense area.. B. Coronal T2-weighted image reveals a left adnexal mass with a marked hyperintense central portion and slightly hyperintense peripheral portion. The mass is surrounded by a low-signal peripheral rim.. C. Gadolinium-enhanced MR image demonstrates strong peripheral nodular enhancement.
case_images: kjr-4-194-g002.jpg
case_images: PMC2698088_02_kjr-4-194-g002.jpg
case_images: F2
case_images: T1- and T2-weighted imaging, a thin low-intensity rim was visible, and at the periphery, signal intensity was slightly higher than that of muscle. The central zone of the mass was hypointense at T1-weighted imaging and bright at T2-weighted imaging (Figs. 2A, B). After IV administration of gadolinium-DTPA, peripheral nodular enhancement was demonstrated (Fig. 2C); in this case, dynamic images were not obtained.
case_images: PMC2698088_03
case_images: Sclerosing stromal tumor of the left ovary in a 39-year-old woman.. A. Transvaginal ultrasonography reveals a homogeneously echogenic solid mass in the left adnexa. At the left of the mass, a cyst is present (*).. B. Axial T1-weighted MR image depicts a left adnexal mass which, relative to muscle, showed slightly high signal intensity. Signal void tubular structures are seen peripherally.. C. Axial T2-weighted image of the mass, demonstrating heterogeneous high signal intensity and peripheral signal-void tubular structures. Elongated cysts surround the mass (*), and a cul-de-sac contains a small amount of ascites.. D, E, F. Dynamic contrast-enhanced MR images obtained 30 seconds (D), 60 seconds (E), and 5 minutes (F) after the administration of Gd-DTPA reveal, except in small scattered areas of the cyst and cleft, marked, early, peripheral nodular enhancement, and progressive centripetal enhancement.. G. Microscopic examination reveals a pseudolobular pattern with cellular nodules separated by less cellular areas of edematous connective tissue (H&E staining, x100).
case_images: kjr-4-194-g003.jpg
case_images: PMC2698088_03_kjr-4-194-g003.jpg
case_images: F3
case_images: Transvaginal ultrasonography revealed the presence of a large mainly solid mass in the left adnexal region (Fig. 3A), and at the periphery, three oval-shaped anechoic cystic lesions were visible. T1-weighted MR imaging of the mass demonstrated homogeneous signal intensity, slightly higher than that of muscle (Fig. 3B). At T2-weighted imaging, the mass was heterogeneously hyperintense (Fig. 3C), and both T1- and T2-weighted images revealed signal-void tubular structures around it. Dynamic contrast-enhanced MR imaging demonstrated marked early nodular enhancement of the peripheral portion of the mass, which was as high as that of the vessels (Fig. 3D). Delayed imaging revealed progressive centripetal enhancement, except in small scattered areas of the cyst and cleft (Figs. 3E, F). Microscopic examination revealed a pseudolobular growth pattern, with mixed cellular and hypocellular areas (Fig. 3G).