Ultrasonography was shown to be beneficial in identifying the characteristics of pure ovarian clear cell carcinoma, according to a study published in Ultrasound: Obstetrics and Gynecology.

A team of international researchers led by Federica Pozzati, MD, conducted a retrospective multicenter study using the International Ovarian Tumor Analysis (IOTA) database in order to determine the characteristics of pure ovarian clear cell carcinoma. Patients included in the study had a histologic diagnosis of pure ovarian clear cell carcinoma and underwent ultrasonography between 1999 and 2016. These examinations were performed using equipment with vaginal probes, the frequency of which varied between 5.0 and 9.0 MHz; abdominal probes with a frequency between 3.5 and 5.0 MHz were also used. Adnexal masses with the most complex morphology were included in the study.

A total of 105 women were identified in the IOTA database; an additional 47 patients diagnosed with pure ovarian clear cell carcinoma with ultrasound reports were identified from the departments of gynecological oncology at each respective center. Median age at diagnosis 53.5 years; 42.8% of patients were premenopausal. Median serum CA125 level was 79.0 U/mL, and the majority of tumors were classified as FIGO stage I (60.5%). Most tumors (84.2%) presented unilaterally, and the largest median diameter was 117 mm.

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No substantial tumor differences were found in patients either within or outside of the IOTA database. All clear cell carcinomas contained solid components; the largest median diameter of the largest solid component measured 69 mm. A total of 53 (34.9%) of the 152 tumors were described as unilocular-solid tumors, 63 (41.4%) were described as multilocular-solid tumors, and 36 (23.7%) were described as solid tumors.

Benign lesions were identified on ultrasound in 7 of 152 (4.6%) cases; borderline ovarian tumor and malignant tumor were identified in 28/152 (18.4%) and 117/152 (77.0%) cases, respectively. With the exception of the type of echogenicity of the cyst fluid, there were no differences between the groups of patients. High-quality ultrasound images were obtained for 77 of 152 (50.6%) clear cell carcinomas.

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“Our clinical findings agree with those of others … that noted that clear cell carcinoma presents more often in early stage, in patients that are younger and more often in premenopausal women than high grade serous ovarian carcinomas, the researchers concluded.  “It remains to be shown in prospective studies if different types of ovarian malignancy, including epithelial ovarian cancer, i.e. serous, mucinous, endometrioid, clear cell and undifferentiated cancers, can be distinguished on the basis of clinical information and the ultrasound appearance of the tumors.”


Pozzati F, Moro F, Pasciuto T, et al. Imaging in gynecological disease: clinical and ultrasound characteristics of ovarian clear cell carcinoma [published online July 5, 2018]. Ultrasound Obstet Gynecol. doi: 10.1002/uog.19171