Takeyama Nobuyuki, Ueda Yasuo, Omatsu Mutsuko, Nemoto Tetsuo, Ogawa Takashi, Miyamoto Shingo, Ichizuka Kiyotake, Nakayama Ken, Morioka Miki, Fujisawa Hidefumi
Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama-City, Tsuzuki-ku, Japan.
Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, Yokohama-City, Kanagawa, Japan.
Radiol Case Rep. 2025 Mar 8;20(5):2513-2520. doi: 10.1016/j.radcr.2025.01.091. eCollection 2025 May.
The MR images of the two cases of ovarian clear cell carcinomas (CCCs), presenting as entirely solid-masses, revealed a band-like peripheral area and a geographic central area: The peripheral area images resembled those of the renal cortex, while the central area images resembled those of the renal medulla. Compared to the iliac muscle, the band-like peripheral area appeared iso-hyperintense on T2-weighted imaging (T2WI), isointense on unenhanced T1-weighted imaging (T1WI), hyperintense on diffusion-weighted imaging (DWI), and hypo-isointense on an apparent diffusion coefficient (ADC) map, with gradual enhancement on dynamic contrast-enhanced T1WI. The geographic central area of the tumor appeared hyperintense on T2WI, hypointense on T1WI, hypointense on DWI, and hyperintense on an ADC map, with less enhancement on dynamic contrast-enhanced T1WI. Simple total hysterectomy, salpingo-oophorectomy, and partial omentectomy were performed in both cases. Both tumors were entirely solid, and histopathological analysis revealed cancer cell proliferation accompanied by an increase in stromal fibrous tissue in the peripheral area. Edematous stroma and fibrosis were predominantly observed with minimal cancer cells in the central area. The patients were diagnosed with ovarian CCC (pT1a). The mechanism behind the appearance of peripheral and central areas with renal corticomedullary contrast in such cases remains unknown, and MRI can provide valuable insights for the differential diagnosis of epithelial ovarian cancer.
两例表现为完全实性肿块的卵巢透明细胞癌（CCC）的磁共振成像（MR）显示出带状外周区域和地图状中央区域：外周区域图像类似于肾皮质，而中央区域图像类似于肾髓质。与髂肌相比，带状外周区域在T2加权成像（T2WI）上呈等-高信号，在未增强的T1加权成像（T1WI）上呈等信号，在扩散加权成像（DWI）上呈高信号，在表观扩散系数（ADC）图上呈低-等信号，在动态对比增强T1WI上呈逐渐强化。肿瘤的地图状中央区域在T2WI上呈高信号，在T1WI上呈低信号，在DWI上呈低信号，在ADC图上呈高信号，并在动态对比增强T1WI上强化较少。两例均行单纯全子宫切除术、输卵管卵巢切除术和部分大网膜切除术。两个肿瘤均为完全实性，组织病理学分析显示外周区域癌细胞增殖伴间质纤维组织增多。中央区域主要观察到水肿性间质和纤维化，癌细胞极少。患者被诊断为卵巢CCC（pT1a）。此类病例中外周和中央区域出现肾皮质髓质对比表现的背后机制尚不清楚，而MRI可为上皮性卵巢癌的鉴别诊断提供有价值的见解。
