Anfelter P, Testa A, Chiappa V, Froyman W, Fruscio R, Guerriero S, Alcazar J L, Mascillini F, Pascual M A, Sibal M, Savelli L, Zannoni G F, Timmerman D, Epstein E
Department of Obstetrics and Gynecology, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden.
Ultrasound Obstet Gynecol. 2020 Aug;56(2):276-284. doi: 10.1002/uog.22002.
To describe the clinical and sonographic characteristics of malignant ovarian yolk sac tumors (YSTs).
In this retrospective multicenter study, we included 21 patients with a histological diagnosis of ovarian YST and available transvaginal ultrasound images and/or videoclips and/or a detailed ultrasound report. Ten patients identified from the International Ovarian Tumor Analysis (IOTA) studies had undergone a standardized preoperative ultrasound examination, by an experienced ultrasound examiner, between 1999 and 2016. A further 11 patients were identified through medical files, for whom ultrasound images were retrieved from local image workstations and picture archiving and communication systems. All tumors were described using IOTA terminology. The collected ultrasound images and videoclips were used by two observers for additional characterization of the tumors.
All cases were pure YSTs, except for one that was a mixed tumor (80% YST and 20% embryonal carcinoma). Median age at diagnosis was 25 (interquartile range (IQR), 19.5-30.5) years. Seventy-six percent (16/21) of women had an International Federation of Gynecology and Obstetrics (FIGO) Stage I-II tumor at diagnosis. Fifty-eight percent (11/19) of women felt pain during the ultrasound examination and one presented with ovarian torsion. Median serum α-fetoprotein (S-AFP) level was 4755 (IQR, 1071-25 303) µg/L and median serum CA 125 level was 126 (IQR, 35-227) kU/L. On ultrasound assessment, 95% (20/21) of tumors were unilateral. The median maximum tumor diameter was 157 (IQR, 107-181) mm and the largest solid component was 110 (IQR, 66-159) mm. Tumors were classified as either multilocular-solid (10/21; 48%) or solid (11/21; 52%). Papillary projections were found in 10% (2/21) of cases. Most (20/21; 95%) tumors were well vascularized (color score, 3-4) and none had acoustic shadowing. Malignancy was suspected in all cases, except in the patient with ovarian torsion, who presented a tumor with a color score of 1, which was classified as probably benign. Image and videoclip quality was considered as adequate in 18/21 cases. On review of the images and videoclips, we found that all tumors contained both solid components and cystic spaces, and that 89% (16/18) had irregular, still fine-textured and slightly hyperechoic solid tissue, giving them a characteristic appearance.
Malignant ovarian YSTs are often detected at an early stage, in young women usually in the second or third decade of life, presenting with pain and markedly elevated S-AFP. On ultrasound, malignant ovarian YSTs are mostly unilateral, large and multilocular-solid or solid, with fine-textured slightly hyperechoic solid tissue and rich vascularization. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology..
描述恶性卵巢卵黄囊瘤（YSTs）的临床及超声特征。
在这项回顾性多中心研究中，我们纳入了21例经组织学诊断为卵巢YST且有经阴道超声图像和/或视频片段及/或详细超声报告的患者。从国际卵巢肿瘤分析（IOTA）研究中确定的10例患者在1999年至2016年间由经验丰富的超声检查者进行了标准化的术前超声检查。通过医学档案又确定了另外11例患者，其超声图像从当地图像工作站及图像存档与通信系统中获取。所有肿瘤均使用IOTA术语进行描述。两位观察者使用收集到的超声图像和视频片段对肿瘤进行进一步特征分析。
除1例为混合性肿瘤（80% YST和20%胚胎癌）外，所有病例均为纯YST。诊断时的中位年龄为25岁（四分位间距（IQR），19.5 - 30.5岁）。76%（16/21）的女性在诊断时为国际妇产科联盟（FIGO）I - II期肿瘤。58%（11/19）的女性在超声检查时感到疼痛，1例出现卵巢扭转。血清甲胎蛋白（S - AFP）中位水平为4755（IQR，1071 - 25303）μg/L，血清CA 125中位水平为126（IQR，35 - 227）kU/L。超声评估显示，95%（20/21）的肿瘤为单侧性。肿瘤最大直径中位值为157（IQR，107 - 181）mm，最大实性成分直径为110（IQR，66 - 159）mm。肿瘤分为多房实性（10/21；48%）或实性（11/21；52%）。10%（2/21）的病例发现有乳头状突起。大多数（20/21；95%）肿瘤血供丰富（血流评分，3 - 4分），无一例有声影。除卵巢扭转患者外，所有病例均怀疑为恶性，该卵巢扭转患者的肿瘤血流评分为1分，分类为可能良性。21例中有18例图像和视频片段质量被认为足够。在复查图像和视频片段时，我们发现所有肿瘤均包含实性成分和囊性区域，89%（16/18）有不规则、质地仍细腻且略高回声的实性组织，使其具有特征性外观。
恶性卵巢YSTs常于早期被发现，多见于年轻女性，通常在20多岁或30多岁，表现为疼痛和S - AFP显著升高。超声检查时，恶性卵巢YSTs大多为单侧性、体积大且为多房实性或实性，具有质地细腻、略高回声的实性组织且血供丰富。© 2020作者。《妇产科超声》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
