Calcified Liver Masses
Ovarian Neoplasms

Calcified Liver Masses - Causes

• Inflammatory hepatic lesions
  
  
• Most common cause of calcified hepatic lesions
• Inflammatory conditions

• For example, granulomatous diseases (tuberculosis).

• Calcification involves entire lesion
• Appears as a dense mass
• May produce artifacts on CT scans
• Echinococcus cysts have curvilinear or ring calcification
• Central water density in cyst

• Benign neoplasms
  
  
• Hemangiomas, especially large ones, may contain large, coarse calcifications; may be seen at CT  in 20% of cases or radiography in 10%

• Malignant liver neoplasms
  
  
•  Hepatocellular adenoma
• Calcifications may be solitary or multiple
• Usually located eccentrically within complex heterogeneous mass.
• Fibrolamellar carcinoma
• Calcifications reported in 15%-25% of cases at CT
• Occurs in many patterns
• Intrahepatic cholangiocarcinoma
• Calcifications are typically accompanied by a desmoplastic reaction
• Visible at CT in about 18% of cases.
• Calcified hepatic metastases
• Most frequently associated with mucin-producing neoplasms such as colon, or less likely ovarian, carcinoma

Ovarian Carcinoma Metastases. Calcified liver and peritoneal metastases from ovarian carcinoma are seen in the liver and along peritoneal surfaces (white arrows).

Ovarian Neoplasms

• Tumors of Surface Epithelium form 90% of ovarian tumors
  
  
• Mucinous Tumors

-         Incidence – 30% of ovarian neoplasms

§         Mucinous cyst adenoma

·        Commonest tumor

·        Age group: 30-50 yrs

·        Bilateral in 10%

§         Mucinous cystadenocarcinoma

·        Age group: 40-60 yrs

·        Bilateral in 10 %

-         Features

§         Large multilocular pedunculated cyst

§         Rare complication  may occur with involvement of the peritoneum

·        Pseudomyxoma peritonei (jelly belly)

§         May produce coarse calcifications in primary or metastases

• Serous Tumors

-         Incidence  –  50% of ovarian neoplasms

§         Serous cystadenoma:

·        Age group: 20 – 30 yrs

·        Bilateral in 15%

·        Malignant transformation in 20 – 30 %

§         Serous cystadenocarcinoma:

·        Age group: 40 – 60 yrs

·        Bilateral in 30%

·        5 year survival rate: 30 – 50 %

-         Features:

§         Contain fibrous walled cysts with papillary excrescences

§         Locules contain straw-colored fluid

§         Psammoma bodies=concentric calcification in papillary process

·        Usually fine sand-like calcification frequently difficult to see on plain radiographs

• Endometrial tumors

-         Incidence  –  20% of ovarian tumors

-         Morphology:

§       Tumors containing solid and cystic areas

§        Filled with hemorrhagic fluid

§        Lined by glandular epithelium

• Clear Cell (mesonephroid tumor)

-         Incidence: uncommon

-         Age group: 50 – 60 yrs

-         Morphology:

§         Unilocular cysts with small cystic spaces

• Brenner tumor:

§       Incidence: 1- 2%

§       Occur commonly in perimenopausal women

• Germ Cell Tumors

-       Origin : cells derived form oocytes

-       Incidence: 15- 20% of all ovarian tumors, 5% malignant

§         Age: young age

• Dysgerminoma

-         Incidence : very common

§         Age : 20 – 20 yrs

-         Bilateral : 10 – 15 %

-         Macroscopic features :

§         Solid tumors, elastic rubbery consistency having smooth, firm capsule

• Teratoma

-         Derived from cells of all three germ layers

-         Types:

§       Mature or benign type (e.g. Dermoid cysts)

§       Immature or malignant type (e.g. Solid Teratoma)

§       Monodermal or highly specialized (e.g. Struma ovarii)

• Choriocarcinoma and Embryonal Cell Carcinoma

-        Choriocarcinoma mostly of placental origin occurs in prepubertal girls. Highly malignant

§       Contains syncytiotrophoblasts and cytotrophoblasts

§       Secretes large quantities of the tumor marker - HCG

-         Embryonal cell carcinoma

§         Incidence : rare

-         Highly malignant

• Ovarian Fibroma:

-         Meig’s syndrome

§         Ascites

§         Right sided effusion

• Krukenberg tumor

-        Primary : 15% - small & large bowel , 20% - stomach, 6% - breast

-        Bilateral smooth surface

-        Histologically cellular or myxomatous stroma with scattered large signet ring cells

· Routes of Peritoneal Spread

o       Right subphrenic space

o       The greater omentum

o       The Pouch of Douglas