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Recurrent Ovarian Cancer: Spectrum of Imaging Findings

Jin Wei Kwek1 and Revathy B. Iyer1

1 Both authors: Department of Diagnostic Imaging, Unit 57, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009.


Figure 1
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  		Fig. 1A —58-year-old woman treated with tumor reductive surgery and chemotherapy for stage IV papillary serous adenocarcinoma of the ovary. Patient showed good initial response to chemotherapy, with reduction in size of residual tumor and hepatic metastases. She presented with dizziness and left-sided weakness 1 year after initial diagnosis. T2-weighted axial unenhanced MR image of brain (A) shows heterogeneous metastasis (long arrow) in pons with mass effect on fourth ventricle. Another similar lesion is noted in left cerebellum (short arrow). T1-weighted axial MR image of brain after administration of IV gadolinium (B) shows heterogeneous enhancement in both metastatic lesions.

 

Figure 2
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  		Fig. 1B —58-year-old woman treated with tumor reductive surgery and chemotherapy for stage IV papillary serous adenocarcinoma of the ovary. Patient showed good initial response to chemotherapy, with reduction in size of residual tumor and hepatic metastases. She presented with dizziness and left-sided weakness 1 year after initial diagnosis. T2-weighted axial unenhanced MR image of brain (A) shows heterogeneous metastasis (long arrow) in pons with mass effect on fourth ventricle. Another similar lesion is noted in left cerebellum (short arrow). T1-weighted axial MR image of brain after administration of IV gadolinium (B) shows heterogeneous enhancement in both metastatic lesions.

 

Figure 3
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  		Fig. 2A —68-year-old woman with stage IIIC high-grade papillary serous adenocarcinoma of the ovary treated with cytoreductive surgery and six cycles of carboplatin and paclitaxel. Patient presented 4 years after initial diagnosis with focal jerking of right arm and leg that progressed to a generalized seizure and loss of consciousness for 30 min. T2-weighted axial MR image of brain shows heterogeneous mass (arrow) in right temporal lobe and surrounding edema.

 

Figure 4
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  		Fig. 2B —68-year-old woman with stage IIIC high-grade papillary serous adenocarcinoma of the ovary treated with cytoreductive surgery and six cycles of carboplatin and paclitaxel. Patient presented 4 years after initial diagnosis with focal jerking of right arm and leg that progressed to a generalized seizure and loss of consciousness for 30 min. T1-weighted axial MR image of brain after administration of IV gadolinium shows heterogeneously enhancing metastasis (arrow). Patient underwent right temporal craniotomy and excision of tumor. Histology was consistent with poorly differentiated metastatic adenocarcinoma.

 

Figure 5
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  		Fig. 3A —52-year-old woman with stage IV recurrent ovarian carcinoma. Axial CT section of chest shows left pleural effusion (P) and nodular pleural thickening, consistent with pleural metastases (arrowheads).

 

Figure 6
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  		Fig. 3B —52-year-old woman with stage IV recurrent ovarian carcinoma. CT scan also shows hepatic (black arrow) and splenic (white arrows) metastases.

 

Figure 7
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  		Fig. 4A —52-year-old woman with stage IIIC high-grade papillary serous ovarian carcinoma with thoracic recurrence. Axial CT section of thorax shows 1.5-cm pulmonary nodule (arrow), consistent with pulmonary metastasis.

 

Figure 8
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  		Fig. 4B —52-year-old woman with stage IIIC high-grade papillary serous ovarian carcinoma with thoracic recurrence. Axial CT section through mediastinum shows enlarged subcarinal (white arrow) and left hilar (black arrow) nodes, compatible with metastatic adenopathy.

 

Figure 9
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  		Fig. 5 —48-year-old woman with stage IIIC clear cell carcinoma of the ovary who was receiving chemotherapy after surgery. Dramatic increase of cancer antigen (CA) 125 was seen during her chemotherapy. Axial CT section of chest shows onset of lymphangitic spread in right lung (arrows), and nodularity is noted in thickened interstitium.

 

Figure 10
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  		Fig. 6A —29-year-old woman with endometrioid ovarian carcinoma that was refractory to chemotherapy after left salpingo-oophorectomy. Her cancer antigen (CA) 125 level was rising. Baseline axial CT section shows several ill-defined hypodense hepatic metastases (arrowheads).

 

Figure 11
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  		Fig. 6B —29-year-old woman with endometrioid ovarian carcinoma that was refractory to chemotherapy after left salpingo-oophorectomy. Her cancer antigen (CA) 125 level was rising. Follow-up CT scan shows increase in number and size of hepatic metastases and new splenic metastasis (arrow).

 

Figure 12
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  		Fig. 7A —56-year-old woman with ovarian cancer treated with cytoreductive surgery and cisplatin-based chemotherapy 10 years earlier. Patient presented with jaundice and pruritus. Axial CT sections show dilated common bile duct (curved arrow, A) caused by obstruction by ill-defined hypodense mass (straight arrow) in pancreatic head. Patient underwent exploratory laparotomy and biopsy of mass in pancreatic head. Histology was consistent with poorly differentiated metastatic carcinoma of ovarian origin. Incidentally, she had chronic right hydronephrosis (K) related to congenital ureteropelvic junction obstruction and marked thinning of renal parenchyma.

 

Figure 13
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  		Fig. 7B —56-year-old woman with ovarian cancer treated with cytoreductive surgery and cisplatin-based chemotherapy 10 years earlier. Patient presented with jaundice and pruritus. Axial CT sections show dilated common bile duct (curved arrow, A) caused by obstruction by ill-defined hypodense mass (straight arrow) in pancreatic head. Patient underwent exploratory laparotomy and biopsy of mass in pancreatic head. Histology was consistent with poorly differentiated metastatic carcinoma of ovarian origin. Incidentally, she had chronic right hydronephrosis (K) related to congenital ureteropelvic junction obstruction and marked thinning of renal parenchyma.

 

Figure 14
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  		Fig. 8A —47-year-old woman with recurrent papillary serous ovarian carcinoma who presented with palpable left axillary lymphadenopathy. CT scan of chest shows left axillary node (L).

 

Figure 15
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  		Fig. 8B —47-year-old woman with recurrent papillary serous ovarian carcinoma who presented with palpable left axillary lymphadenopathy. Longitudinal sonogram obtained during fine-needle aspiration biopsy shows enlarged hypoechoic left axillary lymph node and loss of fatty hilum that proved to be metastatic ovarian carcinoma.

 

Figure 16
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  		Fig. 9A —44-year-old woman with recurrent papillary serous ovarian carcinoma who presented with severe lower back pain. High T1 signal anterior to the spine is compatible with prevertebral fat. Lateral lumbar radiograph shows collapsed L3 vertebra.

 

Figure 17
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  		Fig. 9B —44-year-old woman with recurrent papillary serous ovarian carcinoma who presented with severe lower back pain. High T1 signal anterior to the spine is compatible with prevertebral fat. Unenhanced (B) and gadolinium-enhanced (C) sagittal Tl-weighted MR images of lumbar spine show collapsed L3 vertebra with enhancement (arrow) and retropulsion of bone fragment into spinal canal. CT-guided fine-needle aspiration biopsy showed evidence of bone metastasis.

 

Figure 18
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  		Fig. 9C —44-year-old woman with recurrent papillary serous ovarian carcinoma who presented with severe lower back pain. High T1 signal anterior to the spine is compatible with prevertebral fat. Unenhanced (B) and gadolinium-enhanced (C) sagittal Tl-weighted MR images of lumbar spine show collapsed L3 vertebra with enhancement (arrow) and retropulsion of bone fragment into spinal canal. CT-guided fine-needle aspiration biopsy showed evidence of bone metastasis.

 

Figure 19
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  		Fig. 9D —44-year-old woman with recurrent papillary serous ovarian carcinoma who presented with severe lower back pain. T1-weighted sagittal MR image of thoracic spine shows marrow replacement (asterisk) in T2 vertebral body, in keeping with another site of bone metastasis.

 

Figure 20
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  		Fig. 10A —46-year-old woman with recurrent ovarian cancer treated with chemotherapy. Axial CT scan shows soft-tissue nodule (arrow) in subcutaneous fat of anterior abdominal wall. Surgical biopsy specimens confirmed presence of tumor recurrence in peritoneum.

 

Figure 21
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  		Fig. 10B —46-year-old woman with recurrent ovarian cancer treated with chemotherapy. CT scan shows enlarged bilateral superficial (white arrows) and left deep (black arrow) inguinal lymph nodes, consistent with lymph node metastases.

 

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