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270 www.jcat.org J Comput Assist Tomogr Volume 39, Number 2, March/April 2015
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FIGURE 1. A 53-year-old woman with postmenopausal vaginal bleeding for 8 months and elevated CA-125 level (61 [<35]U/mL). Axial
fat-saturated T1WI (A) and T2WI (B) show an adnexal cystic-solid mass with isointensity on T1WI, slight hyperintensity on T2WI, and a
serpentine shape on sagittal T2WI (C). The solid component (arrow) of tumor is markedly enhanced compared with the myometrium
(arrowhead) (D).
reported by previous studies, possibly owing to improved medical the fimbria have a worse prognosis, due to the easy occlusion of
conditions and state-of-the-art imaging tools. the fimbrial end and extension to the ovary.10,11 In our series,
The most frequent origination of PFTC is the ampulla, 11 (41%) of the 27 tumors derived from the ampulla, 7 tumors
followed by the fimbria. Patients with PFTC originating from (26%) derived from the fimbria, and the remaining 9 (33%)
extensively involved the fallopian tube, of which the origin was
TABLE 2. MR Imaging Features of 23 Patients With PFTC difficult to identify. Ten tumors extended to the ovaries. Compared
with the reported size of EOC, which ranges from 90 to
MR Imaging Features Patients/Tumors, n % 118 mm,1214 the size of PFTC in our series was significantly
smaller.
Shape Serous carcinoma is the most common pathologic type,
Fusiform/sausagelike/serpentine 19 70 accounting for approximately 45% to 90%, followed by endo-
Nodular/irregular 8 30 metrial carcinoma, undifferentiated carcinoma, and clear cell
Architecture carcinoma.3 In our series, all 27 tumors were high-grade serous
Solid 20 74 carcinoma. At the early stage, PFTC is confined to the tube with
Cystic-solid 7 26 a nodular, papillary, infiltrative, or massive growth pattern. The
SI of solid component fallopian tube is distended to a fusiform, sausage, or serpentine
Hypointense/isointense on T1WI 27 100 shape, which is the characteristic imaging feature for the detection
and differentiation of PFTC from other pelvic masses. Serous
Isointense/slight hyperintense on T2WI 27 100
fluid secreted by the tumor accumulates and distends the tube
Obvious hyperintense on DWI 27 100 resulting in hydrosalpinx, or it may result in a mixed cystic-solid
Obvious hypointense on ADC maps 27 100 configuration. Fluid may decompress through the uterus or
SI of cystic component fimbria resulting in intrauterine fluid collection or ascites. There-
Hypointense on T1WI 6 86 fore, hydrosalpinx is an indirect characteristic imaging feature. In
Hyperintense on T1WI 1 14 our series, 22 (81%) of the 27 tumors had a characteristic imaging
Obvious hyperintense on T2WI 7 100 finding: a fusiform, sausage, or serpentine mass in 19 tumors and
Enhancement of solid components a nodular or irregular mass with an associated hydrosalpinx in 3
Mild 8 30 tumors. After administration of contrast medium, 78% of the
Moderate 13 48 masses were mildly-to-moderately enhanced, whereas most EOCs
were markedly enhanced in previous studies.15,16
Marked 6 22
Some DW imaging studies of EOC have been reported
Hydrosalpinx 14 52 recently1720; however, no DW imaging report concerning PFTC
Intrauterine fluid collection 7 30 has been published. The value of DW imaging for pelvic tumors
Ascites 5 22 lies in the following aspects: (1) identifying small lesions by pro-
SI indicates signal intensity. viding a high contrast-to-noise ratio, (2) sensitivity in identifying
the depth of invasion, (3) assessment of the differentiation of tumors,
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FIGURE 2. A 63-year-old woman with postmenopausal vaginal watery discharge for 4 months. Axial fat-saturated T1WI (A) and T2WI
(B) show a sausagelike, solid, isointense mass (arrow) at the left side of the uterus (arrow head). The mass demonstrates mild enhancement
on contrast-enhanced T1WI (C), obvious hyperintensity on DW image (b = 800 s/mm2) (D), and obvious hypointensity on ADC maps (E).
The ADC value is 0.688 103 mm2/s.
and (4) monitoring treatment response.17 In our series, the solid The PFTC shares a similar appearance with granulosa cell tumors
component of PFTC demonstrated obvious high signal intensity and fibrothecomas, which often have estrogen-related symptoms
on DW images and very low signal intensity on ADC maps. or demonstrate low signal intensity on T2WI because of the
The mean (SD) ADC value was 0.79 (0.22) 103 mm2, which fibrotic component.21 The PFTC may be misinterpreted as uterine
was much smaller than those of ovarian malignancies reported in leiomyoma when it is adjacent to the uterus. However, leiomyoma
the literatures, in which ADC values ranged from 1.03 (0.19) typically shows characteristic low signal intensity on T2WI and
103 to 2.006 (0.53) 103 mm2/s.1820 marked enhancement. The PFTC may present as tubo-ovarian
Further study will be necessary to confirm the difference by abscess and should be considered in the differential diagnosis of
comparing PFTC with EOC using the same DW imaging para- acute pelvic peritonitis such as a tubo-ovarian abscess.22,23 Our
meters. In addition, on conventional MR imaging, PFTC is often series had 1 patient with PFTC and associated tubo-ovarian
surrounded and obscured by the bowel, which demonstrates varia- abscess, which had not been reported radiologically. Only the
ble signal intensity. The DW imaging, however, can be helpful for tubo-ovarian abscess was diagnosed preoperatively. Whether
identifying PFTC, with an obvious high signal on DW images and tubal inflammation induces PFTC or the reverse has not yet been
a low signal on ADC maps. In our series, 3 tumors, which were determined. Both PFTC and tubo-ovarian abscess appear with
difficult to differentiate from the surrounding bowel on conven- high signal intensity on T2WI and DW images and low signal
tional MR images, were clearly demonstrated on DW images. intensity on ADC maps. However, PFTC can be enhanced
Distinguishing between PFTC and EOC is often difficult.4 compared with nonenhanced abscess cavity. The combination of
In our series, the misdiagnosis rate of PFTC was as high as 48% conventional preenhanced and postenhanced MR images and
(13/27), in which 10 cases were diagnosed as EOC. The EOC DW images is crucial for the accurate preoperative diagnosis.
typically manifests as a large multilocular cystic mass with a In conclusion, MR imaging characteristics of PFTC are the
variable amount of solid component, which is usually markedly fusiform, sausage- or serpentine-shaped, solid or mixed cystic-
enhanced. In addition, rare hydrosalpinx, intrauterine fluid col- solid, and mild-to-moderate enhanced mass, with hydrosalpinx
lection, and vaginal watery discharge or bleeding may be found. or intrauterine fluid collection. In addition, PFTC has an obvious
2015 Wolters Kluwer Health, Inc. All rights reserved. www.jcat.org 273
FIGURE 3. A 54-year-old woman with abdominal pain, elevated CA-125 level (94.6 [<35]U/ml), and white blood cell count
(81.81% [43%76%]). Axial fat-saturated T1WI (A) and T2WI (B) show a sausage-shaped solid mass (black arrow) with isointensity
and slight hyperintensity, respectively, in the left adnexal area. The mass demonstrates slight enhancement at the center and marked
enhancement at the periphery on contrast-enhanced T1WI (C). At the upper section, an associated tubo-ovarian abscess with avidly
enhanced and thickened wall (white arrow) is seen (D). The tumor demonstrates obvious hyperintensity on DW image (b = 800 s/mm2)
(E) and obvious hypointensity on ADC maps (F). The ADC value is 0.748 103 mm2/s. Microscopically, neutrophils are numerous in stroma
(black arrowhead), and clusters of poorly differentiated serous tumor cells appear as a glandlike solid structure (white arrowhead)
(G, hematoxylin & eosin 100). Figure 3 can be viewed online in color at www.jcat.org.
high signal intensity on DW images and a low signal intensity and 4. Kawakami S, Togashi K, Kimura I, et al. Primary malignant tumor of the
low ADC value on ADC maps. fallopian tube: appearance at CT and MR imaging. Radiology. 1993;186:
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5. Slanetz PJ, Whitman GJ, Halpern EF, et al. Imaging of fallopian tube
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