What is the basis for differential diagnosis of ovarian tumors

Ovarian tumor refers to a tumor that occurs on the ovary. It is one of the common tumors of the female reproductive organs. Ovarian malignant tumors are also the tumor with the highest mortality rate among gynecological malignant tumors. Although great progress has been made in both basic research and clinical diagnosis and treatment of ovarian malignant tumors in recent years, unfortunately, its 5-year survival rate has not improved significantly. So, how to differentially diagnose ovarian tumors? The following experts will introduce to you how to differentially diagnose ovarian tumors.

1. CT localization diagnosis of tumors

Pay attention to the differentiation from subserosal uterine fibroids: observe the CT images comprehensively, use coronal and sagittal reconstruction techniques when necessary to understand the relationship between the tumor and the uterus, and compare the changes in CT values ​​of the uterus and tumor before and after enhancement, which will help with the differentiation.

Giant ovarian tumors may be located at the pelvic entrance, near the midline, above the bladder, or even in the lower abdomen. It is important to differentiate them from intra-abdominal tumors and to comprehensively observe the relationship between each level in order to determine the source of the tumor.

2. CT qualitative diagnosis of benign and malignant tumors

The benign or malignant nature of a tumor can be determined comprehensively from the following aspects:

① Benign tumors have smooth contours, mostly round or oval; malignant tumors are often irregularly lobed, with small nodular protrusions on the edges.

② Among benign tumors, except for the characteristic changes of mature cystic teratoma, other tumors generally have a relatively uniform density, which is cystic or solid; while malignant tumors have uneven density, mostly cystic and solid, and some are mainly solid.

③ Benign tumors are cystic, with uniform thin walls, or even imperceptible. Those with compartments are thin strip-like septa; malignant tumors have uneven wall thickness, with irregular thick walls, and papillary nodules can be seen inside the wall.

④Mature teratomas have calcification, bones, and teeth; while the calcification of malignant tumors is amorphous.

⑤ Enhanced scanning: benign tumors have no cystic enhancement, solid tumors show uniform mild enhancement; malignant tumors show uneven and obvious enhancement.

CT is valuable in differentiating benign from malignant tumors. The following signs support the diagnosis of malignant tumors:

① Ovarian cystic solid mass, but it contains more solid soft tissue components, presenting as small nodules or papillary protrusions, or with a larger solid mass part.

② There are low-density necrotic areas inside the solid mass, or thickened and tortuous blood vessels.

③ Although the tumor is a cystic structure, the cyst wall is thickened and irregular, with multiple compartments inside the cyst, and the thickest part is greater than 3mm.

④ Enhanced scanning showed obvious enhancement effect on the above-mentioned solid parts, nodular protrusions and thickened cystic wall.

⑤If signs of metastasis appear, the diagnosis can be confirmed.

Malignant transformation of cystic teratoma: a broad-based cauliflower-shaped solid mass can be seen invading the inner wall of the cystic cavity, protruding into the cavity and intersecting the cystic wall at an obtuse angle, with irregular boundaries; it can also be manifested as a small nodular protrusion on the outer edge of the tumor. Enhanced scanning can show an enhanced effect.