CHARACTERIZATION OF AN OVARIAN MASS

There is wide variation in the CT appearances of ovarian masses and accurate histologic characterization is not always possible. Tumor markers like CA-125, AFP and HCG are indicative of ovarian cancer and germ cell tumors respectively. However careful consideration of the components and evidence of malignant spread (see next section) are useful from the management aspect.
Presence of fat with or without a fat-fluid level or sebaceous plug (Rokitansky plug) is indicative of a mature benign teratoma (Fig 4). The presence of teeth occurs in mature benign teratomas , but calcifications may also be seen in mucinous cystadenocarcinomas or benign Brenner tumors (5).
Cystic masses that are unilocular or have thin septa are mostly benign epithelial tumors (4) (Fig 5). Multilocular cystic lesions without otherwise worrisome findings may also be benign (Fig 6).
CT Features that suggest malignancy in a predominately cystic ovarian lesion are thick (>3 mm) walls or septa, nodules, papillary projections, or vegetations (Figures 7, 8 and 9).
Solid lesions with necrosis are suspicious for malignant epithelial tumors, malignant germ cell tumors or ovarian metastases (3) (Figures 10, 11, and 12). Any ovarian mass with solid components requires correlation with history, tumor markers and gynecologic workup/consultation.