Factors that Differentiate between Endometriosis-associated Ovarian Cancer and Benign Ovarian Endometriosis with Mural Nodules

Yasuhito Tanase, Ryuji Kawaguchi, Junko Takahama, Hiroshi Kobayashi
Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine · 2017 · vol. 17(3) , pp. 231–237 · doi:10.2463/mrms.mp.2016-0149 · PMID:28824051 · W2746064390
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This study identified mural nodule height, nodule height-width ratio, cyst diameter, and patient age as independent predictors differentiating endometriosis-associated ovarian cancer from benign ovarian endometriosis with mural nodules.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This retrospective study evaluated 82 patients pathologically diagnosed with ovarian endometriosis (OE) with mural nodules (n=42) versus malignant transformation of OE to endometriosis-associated ovarian cancer (EAOC) (n=40), using contrast-enhanced MRI performed before surgery. The authors compared demographics, clinical/pathologic features, and MRI signal and morphology characteristics, finding that malignant cases tended to be older and had larger cyst and mural nodule dimensions, a taller-than-wider (greater “Height” and Height-Width ratio) mural nodule appearance, and distinct T1/T2 signal patterns; most benign mural nodules (78.6%) were retracted blood clots. Multivariate logistic regression identified mural nodule Height (>1.5 cm) and Height-Width ratio (>0.9), maximum cyst diameter (>7.9 cm), and age (>43 years) as independent predictors. This paper is centrally about endometriosis — it differentiates endometriosis-associated ovarian cancer from benign ovarian endometriosis with mural nodules using preoperative MRI features.

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Abstract

PURPOSE: Mural nodules and papillary projections can be seen in benign ovarian endometriosis (OE) and malignant transformation of OE (endometriosis-associated ovarian cancer [EAOC]), which can pose a challenging diagnostic dilemma to clinicians. We identify the preoperative imaging characteristics helpful to the differential diagnosis between benign OE with mural nodules and EAOC. MATERIALS AND METHODS: This was a retrospective study of 82 patients who were diagnosed pathologically to have OE with mural nodules (n = 42) and malignant transformations of these tumors (n = 40) at the Nara Medical University Hospital from January 2008 to January 2015. All patients were assessed with contrast-enhanced MRI before surgery. Patient demographics, and clinical and pathologic features were analyzed to detect the significant differences between the two groups. RESULTS: WI, and were more likely to show an anterior location of the cyst. In the multivariate logistic regression analysis, "Height" (>1.5 cm) and "Height-Width ratio (HWR)" (>0.9) of mural nodules, maximum diameter of the cyst (>7.9 cm), and age at diagnosis (>43 years) were independent predictors to distinguish EAOC from OE with mural nodules. CONCLUSION: The "Height" and "HWR" of the mural nodules in the cyst may yield a novel potential diagnostic factor for differentiating EAOC from benign OE with mural nodules.
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Abstract

Purpose: Mural nodules and papillary projections can be seen in benign ovarian endometriosis (OE) and malignant transformation of OE (endometriosis-associated ovarian cancer [EAOC]), which can pose a challenging diagnostic dilemma to clinicians. We identify the preoperative imaging characteristics helpful to the differential diagnosis between benign OE with mural nodules and EAOC.

Materials and methods

This was a retrospective study of 82 patients who were diagnosed pathologically to have OE with mural nodules (n = 42) and malignant transformations of these tumors (n = 40) at the Nara Medical University Hospital from January 2008 to January 2015. All patients were assessed with contrast-enhanced MRI before surgery. Patient demographics, and clinical and pathologic features were analyzed to detect the significant differences between the two groups.

Results

Histological examinations of resected OE tissue specimens revealed that a majority (78.6%) of the mural nodular lesions were retracted blood clots. We found that the patients with malignant mural nodules, when compared to those with benign nodules, were older, had larger cyst diameters and larger mural nodule sizes, and were more likely to exhibit a taller than wider lesion. They were also more likely to present with various signal intensities on T1-weighted images (T1WI), high-signal intensity on T2-weighted images (T2WI), a lower proportion of shading on T2WI, and were more likely to show an anterior location of the cyst. In the multivariate logistic regression analysis, “Height” (>1.5 cm) and “Height-Width ratio (HWR)” (>0.9) of mural nodules, maximum diameter of the cyst (>7.9 cm), and age at diagnosis (>43 years) were independent predictors to distinguish EAOC from OE with mural nodules.

Conclusion

The “Height” and “HWR” of the mural nodules in the cyst may yield a novel potential diagnostic factor for differentiating EAOC from benign OE with mural nodules. © 2018 by Japanese Society for Magnetic Resonance in Medicine This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license. https://creativecommons.org/licenses/by-nc-nd/4.0/ Favorites & Alerts Recently viewed articles

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Cell Transformation, Neoplastic Endometriosis Endometriosis Magnetic Resonance Imaging Ovarian Neoplasms Ovarian Neoplasms Adult Cell Transformation, Neoplastic Diagnosis, Differential Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Middle Aged Ovarian Neoplasms Ovarian Neoplasms Retrospective Studies

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