Objectives Struma ovarii (SO) often presents as a multilocular-solid adnexal mass with abundant vascularity, easily misdiagnosed as an epithelial malignancy and leading to inappropriate surgical management. This study aimed to develop and validate a preoperative nomogram to differentiate O-RADS US 4/5 struma ovarii (SO) from early-stage high-grade serous carcinoma (HGSC) and to identify characteristic ultrasound signs of SO, enhancing diagnostic accuracy and clinical applicability. Methods This retrospective cohort study enrolled 93 SO lesions from 92 patients and 87 early-stage HGSC lesions from 79 patients at Peking Union Medical College Hospital between January 2017 and December 2025. Lesions were randomly divided into training and validation sets (7:3). Independent predictors were identified using univariate and multivariate logistic regression. An individualized risk prediction nomogram was then developed, along with a dynamic nomogram constructed using the "DynNom" and "shiny" packages in R. Model performance was evaluated using the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis. Results Among SO cases, 65 (70.7%) were asymptomatic, 23 (25.0%) had elevated CA125 (> 35 U/mL). Ascites was present in 7 patients (7.6%). 80 lesions (86.0%) were classified as O-RADS 5, and 25 (26.9%) misdiagnosed as malignant. Most SO were pure lesions with low malignant transformation and no metastasis. 9 premenopausal patients (17.3%) underwent radical surgery, suggesting overtreatment. Multivariate logistic regression identified CA125, heterogeneous cyst fluid, comet-tail artifact, morphological pattern of the solid component, and echogenicity of the solid component as independent preoperative predictors. The clinical-ultrasound nomogram demonstrated excellent predictive performance, with an AUC of 0.971 (95% CI: 0.95–0.99) in the training set and 0.939 (95% CI: 0.88–0.99) in the validation set. Calibration curves indicated strong agreement between predicted and observed probabilities, and decision-curve analysis confirmed its clinical utility. Three typical ultrasound signs of SO—ovary-like sign, palette sign, and Cheerios sign—were summarized, and the interpretation of the “pearl sign” was refined. Conclusion The static and dynamic nomograms and ultrasound signs enable accurate preoperative differentiation of O-RADS US 4/5 SO from HGSC, which provide an innovative and reproducible framework for precise preoperative decision-making.

This case presents the diagnosis and management of a rare ectopic molar pregnancy. A 31-year-old woman developed intermittent vaginal bleeding after presumed induced abortion 6 months ago. Elevated serum level of 𝛽-HCG and multimodal imaging confirmed the diagnosis of parametrial molar pregnancy. The patient underwent laparoscopic surgery combined with chemotherapy and immunotherapy. She has maintained complete remission for 1 year with normal range of serum 𝛽-HCG. This case underscores the characteristic imaging features of ultrasound and magnetic resonance imaging of ectopic molar pregnancy. Familiarity with these specific signs may facilitate accurate preoperative diagnosis of this rare disease.

OBJECTIVE:Clear cell borderline ovarian tumor is a rare subtype of borderline ovarian tumor for which the clinicopathological characteristics, management, and prognosis remain unclear. Herein, we describe the clinical features, treatment options, and prognosis of clear cell borderline ovarian tumors. STUDY DESIGN:This was a retrospective study of nine patients with pathologically confirmed clear cell borderline ovarian tumors treated at Peking Union Medical College Hospital between 2006 and 2023. Data regarding the patients' clinicopathological features, management, and prognosis were analyzed. We also reviewed previously published studies in English of patients with clear cell borderline ovarian tumors who underwent fertility-sparing surgery. RESULTS:The median age at diagnosis was 52 years (range, 35-72) and the median tumor size was 6.5 cm (range, 2.7-13). Seven patients had unilateral tumors and two patients had bilateral tumors. Seven patients underwent radical surgery and two patients underwent fertility-preserving surgery. All patients had stage I disease. Pathological analysis revealed synchronous endometriosis or adenomyosis in five patients. Endometrial hyperplasia with atypia was found in two of the seven patients who underwent hysterectomy. During a median follow-up time of 54 months (range, 14-200), only one patient suffered a recurrence, which was treated successfully with secondary surgery. CONCLUSION:The prognosis of clear cell borderline ovarian tumors is favorable, and fertility-sparing surgery is acceptable for young patients who may desire future pregnancies. Unilateral salpingo-oophorectomy is recommended for patients in whom ovarian cystectomy was the initial surgery.

In clinical practice, borderline seromucinous ovarian tumor (SMBT) is hard to differentiate preoperatively on ultrasound. We presented a case of SMBT. In this case, microvascular imaging, particularly three-dimensional (3D) microvascular imaging of ultrasound showed the regular distribution of vascularity along the axis of the papillary trunk and branches. Microvascular imaging helped improve identify vascularity distribution in the papillary of SMBT and may improve our ability to differentiate SMBTs.

Although many studies have validated the diagnostic performance of Ovarian-Adnexal Reporting and Data Systems ultrasound (O-‎RADS US), most have been observed by experienced sonologists, and relatively few by junior sonologists. The purpose of this study was to compare the diagnostic performance of the O-RADS US and the International Ovarian Tumor Analysis (IOTA) Simple Rules (SRs) in senior and junior sonologists to determine a more suitable assessment model for general clinical use. We prospectively recruited 228 patients diagnosed with adnexal masses (AMs). Two senior sonologists acquired images and evaluated them following the O-RADS US and IOTA guidelines, and two junior sonologists reviewed and analyzed images and evaluated them following the same guidelines. In this research, pathological findings were used as the reference standard. Comparisons of categorical variables were made using the chi-square test, and comparisons of continuous variables were made using the two independent-samples t-test. The diagnostic performance of the models was compared by analyzing the receiver operating characteristic (ROC) curve. The kappa value (κ) was used to compare the interobserver agreement between the senior and junior sonologists and the agreement between each ultrasound method and the reference standard. Of 228 AMs, 176 were benign and 52 malignant. The junior adjusted O-RADS US (> O-RADS 4a represents malignancy) had the highest diagnostic validity, with a sensitivity, specificity, and accuracy of 94.23

Coexistent growing teratoma syndrome (GTS) and gliomatosis peritonei (GP) arising during chemotherapy of ovarian immature teratoma (IMT) is extremely rare and can be misdiagnosed as recurrent or progressive disease. We present a 33-year-old woman diagnosed with GTS with synchronous GP during chemotherapy of IMT. She underwent ovarian cystectomy due to ovarian immature teratoma and chemotherapy were administered. The α-fetoprotein (AFP) concentration decreased from 28.7 ng/mL to normal after the second cycle. Four days after the third cycle of chemotherapy, ultrasound and CT revealed an 8-cm mass with negative tumor markers in the pouch of Douglas. An exploratory laparotomy was conducted, and a smooth round cystic-solid 8-cm mass was noted in the pouch of Douglas. Extensive peritoneal seeding glial nodules were also observed on the surface of the uterus, peritoneum, and omentum. The patient underwent a partial omentectomy, intact resection of the tumor, and resection of most of the glial nodules. Postoperative pathology demonstrated a pure mature cystic teratoma component in the mass, as well as diffuse GP involving the uterine serosa, peritoneum, and omentum; this diagnosis of GTS with synchorous GP should be considered in IMT patients with mass newly identified during chemotherapy while tumor markers are normal after treatment.

Aggressive angiomyxoma (AAM) is a rare tumour that often occurs in soft tissues of the female genital tract. Eight cases of AAM are reported in this article, and the clinical features and ultrasound and magnetic resonance imaging (MRI) results of the eight cases are reviewed and summarized. The main complaints of all the patients were palpable and painless masses in the vulva or scrotum. The lesions were mainly located in the vulva, pelvis, and perineal region, with a large scope of involvement. The sonographic features of AAM were characteristic. On sonography, all of the masses were of irregular shape and showed hypoechogenicity, with a heterogeneous inner echotexture. Intratumoural and peritumoural blood flows were detected by colour Doppler imaging. On real-time ultrasonic imaging, prominent deformation of the lesions was observed by compressing the masses with the probe. Some special imaging features were also revealed, including a laminated or swirled appearance of inner echogenicity, and a finger-like or tongue-like growth pattern. On MRI imaging, the lesions showed intermediate-intensity signals and intermediate to high-intensity signals on TI-weighted and T2-weighted sequences. A rapid and uneven enhancement pattern was demonstrated. After the comparison of sonographic features with MRI and pathological findings, we found the relevance of the ultrasonographic characteristics with MRI and histological features of AAM. Ultrasound can be a valuable imaging method for the preoperative diagnosis, evaluation of scope, and follow-up of AAM.

introduction Lymphedema is a chronic, debilitating disorder characterized by abnormal tissue swelling, adipose deposition, tissue fibrosis, and edema resulting from disruption, blockage, or genetic abnormalities of the lymphatic system.[1] It arises most commonly as a consequence of cancer or the treatments of cancer. Upper extremity lymphedema is commonly associated with the treatment of breast cancer. Lower extremity lymphedema is seen in patients who have been treated for gynecologic malignancy and prostate cancer, as well as melanoma and lymphoma.[2,3] The damage of the lymph circulation results in an overload of lymph fluid that accumulates in the subcutaneous space, causing increased limb weight, decreased limb function, increased infection risk, decreased quality of life, and interference with body appearance.[4]

To evaluate the contrast enhanced perfusion pattern of PTC micro-vascular imaging (MVI) quantitatively, and investigate the correlation between MVI features, CD34 micro-vascular density (MVD), and whole genoe DNA copy number abrrevation(CNA) of the PTCs. Thirty-nine pathological and clinical confirmed sporadic PTCs were evaluated with real-time gray-scale contrast-enhanced micro-vascular imaging under a low mechanical index. The micro-bubble agent was SoneVue. Of the 39 PTCs, 33 were classical PTCs, 6 were PTC with follicular variant (FVPTC). The △ROI ,which is the subtraction of peak echo intensity between the lesion region of interest (ROI) and normal thyroid parenchyma ROI, was used to evaluate the perfusion characteristics of PTC MVI quantitatively. The paraffined specimens were selected for immunohistochemical (IHC) staining for CD34. The correlation between △ROI, CD34 expression level and the whole genome DNA copy number abbrevation(CNA) grouping of the PTCs were evaluated. △ROI was strongly correlated with the CD34 expression(p=0.000), significant differences were detected in the distribution pattern of △ROI value among different CD34 expression levels, no overlapping of the mean △ROI values and the 95% confidence intervals was found among the different CD34 expression levels. The PTC MVI perfusion was therefore classified into 3 patterns, low perfusion, focal perfusion and high perfusion, on the basis of combining △ROI values with the peak ehco pattern in time-intensity curve. The high DNA CNA PTCs presented mainly with high and focal perfusion pattern, the low DNA-CNA PTCs showed a combination of focal and low perfusion, the normal DNA-CNA PTCs mostly demonstrated low perfusion patterns. The mean △ROI values rose with the extent of DNA-CNAs accordingly. Based on the strong correlation of △ROI and CD34 expression, △ROI can be take as an objective indicator for the quantitative evaluation of PTC MVI pattern and intensity. The MVI perfusion intensity of PTC showed a positive correlation with the extent of CNAs, which proves that the PTC angiogenesis is related to the gene level pathogensis.

OBJECTIVE:To investigate the sonographic features of struma ovarii and its corresponding histopathologic findings.METHODS:The sonographic and histopathological features of 72 patients with histopathologically comfirmed struma ovarii who were treated in Peking Union Medical College Hospital from January 2005 to December 2014 were retrospectively reviewed.RESULTS:Of these 72 patients,71 had benign struma ovarii(73 lesions)and one patient had malignant struma ovarii(1 lesion). On ultrasonography,all the 73 benign lesions had distinct margin,45(61.6%)had multilocular cystic or cystic-solid mass,49(67.1%)had irregular shape,and 28(38.4%)had nodular solid protrusions in the cystic areas. On the color Doppler flow imaging,36(49.3%)lesions had blood flow signals. The ultrasonographic features of the malignant struma ovarii lesion were multilocular cystic-solid mass with several nodular solid protrusions in the cysic areas;on the color Doppler flow imaging,blood flow signals were visible within septa and solid areas.CONCLUSIONS:The sonographic features of struma ovarii are diverse. If ultrasonography reveals multilocular cystic or cystic-solid mass with distinct margin and isoechoic or hyperechoic nodular solid protrusions in the cystic areas with visible blood flow signals,the diagnosis of struma ovarii should be considered.

OBJECTIVE:To investigate the clinical value of ultrasonography in predicting massive haemorrhage during Cesarean scar pregnancy.METHODS:The clinical and ultrasonograhic data of 119 Cesarean scar pregnancy patients were retrospective analyzed. According to the amount of bleeding, these patients were divided into two groups:massive hemorrhage group and non-massive hemorrhage group. The potential risk factors of massive hemorrhage were analyzed with Logistic regression analysis.RESULTS:The size and type of lesions, flow grade, and residual muscular thickness were screened as the risk factors of massive haemorrhage by Logistic regression model. When P=0.3 was applied as the cutoff value,the diagnostic accuracy was 90.75%;meanwhile,the sensitivity,specificity,positive predictive value, and negative predictive value were 88.23%, 91.76%, 81.08%, and 95.12%,respectively.CONCLUSION:Ultrasonography can accurately predict the risk of massive hemorrhage during the Cesarean scar pregnancy.

OBJECTIVE:To summarize the ultrasonographic characteristics of ovarian carcinosarcoma (OCS).METHODS:Totally 12 patients with OCS have been detected in our department. All patients underwent surgical resection and the OCSs were confirmed pathologically. Ultrasound examination was performed before operation. Imaging features were analyzed retrospectively for bilaterality, size, and tumor solidity (cystic or solid). Presence of ascites and other evidence of peritoneal seeding, adjacent organ invasion, and surgical staging were also evaluated.RESULTS:Unilateral OCSs were found in 11 patients and bilateral OCSs in one patient one side was missed by ultrasound). Nine OCSs were solid, and 3 were mixed (solid and cystic). The diameter of the largest dimension was less than 10 cm in 4 cases, 10-20 cm in 7 cases, and larger than 20 cm in one case. Other ultrasonographic findings including peritoneal seeding and direct invasion into the adjacent organs were seen in 8 patients. Surgical stages were International Federation of Gynecology and Obstetrics (FIGO) classification c and b in one patient each, c in 9 patients, and in one patient.CONCLUSION:OCSs usually present as large, hypoechoic, solid, and aggressive tumors, combined with frequent peritoneal seeding and adjacent organ invasion.

Objective To investigate the diagnostic value of ultrasonography in fetal body stalk anomaly.Methods In a retrospective analysis the sonographic findings of five fetuses with body stalk anomaly diagnosed in our hospital were reviewed and compared with the pathological findings.Results In the five fetuses with body stalk anomaly.the common uItrasonographic features include a large abdominal/thoracoabdominal wall defect,eventration of multiple visceral organs,severe vertebra and lower limb abnormalities,and a short or absent umbilical cord,mostly associated with a single umbilical artery.All of the cases chose termination of pregnancy,and two of whom underwent autopsy and the results confirmed the prenatal sonographic findings.Conclusions Body stalk anomaly can be diagnosed accurately by prenatal ultrasonography,especially with the finding of abnormal umbilical cord.The first trimester ultrasound screening can help ensure the early and accurate diagnosis of this severe and lethal malformation.