From the Guidelines
Ovarian calcification is primarily caused by dermoid cysts, endometriosis, and previous ovarian inflammation or infection, with the most recent evidence suggesting that dermoid cysts are a common cause of ovarian calcification due to the presence of bone and teeth within the cysts 1. The etiology of ovarian calcification is multifactorial, involving various underlying conditions that can lead to calcium deposition in the ovaries. Some of the common causes include:
- Dermoid cysts (mature teratomas), which contain various tissue types including bone and teeth that appear as calcifications on imaging
- Endometriosis, where endometrial tissue implants on the ovaries and undergoes hemorrhage and subsequent calcification
- Previous ovarian inflammation or infection, such as pelvic inflammatory disease, which can lead to dystrophic calcification during the healing process
- Polycystic ovary syndrome (PCOS), where calcification may develop in theca lutein cysts
- Ovarian neoplasms, both benign and malignant, which may contain calcified components
- Post-surgical changes following procedures like partial oophorectomy or cyst removal The calcification process typically involves calcium deposition in damaged tissue as part of the body's healing response, particularly in areas of previous inflammation, necrosis, or hemorrhage. According to the most recent study 1, the best imaging modality for diagnosing ovarian calcification is transvaginal ultrasound (TVUS), which has a high sensitivity and specificity for detecting ovarian pathology. In terms of diagnosis, TVUS is the most useful imaging modality for initial assessment of ovarian calcification, with a sensitivity of 83.3% for ovarian torsion and 84% for endometriotic cyst 1. It is essential to note that ovarian calcifications are often incidental findings on imaging studies and may not require treatment unless associated with symptoms or underlying pathology.
From the Research
Etiology of Ovarian Calcification
The etiology of ovarian calcification is not directly addressed in the provided studies. However, some studies discuss the characteristics and diagnosis of ovarian dermoid cysts, which can contain calcifications.
- Ovarian dermoid cysts, also known as mature cystic teratomas (MCTs), are formed by tissues derived from three germ layers and can contain sebaceous materials, hair, and other ectodermally-derived structures, including bone and teeth 2, 3.
- The origin of MCTs is widely considered to be the germ cell origin, which completes meiosis I 2.
- Dermoid cysts can present with calcifications, which can be visualized using ultrasound techniques, such as HDLive ultrasound 4.
- The diagnosis of ovarian dermoid cysts can be made using ultrasound and confirmed by histopathology post-operatively 2, 5.
Diagnosis and Characteristics
The diagnosis of ovarian dermoid cysts is typically made using ultrasound, which can visualize the characteristic features of these tumors, including:
- A cystic, unilocular lesion with a densely echogenic tubercle (Rokitansky nodule) 4
- A diffuse or partially echogenic mass usually demonstrating sound attenuation 4
- Fluid-fluid/fat-fluid levels 4
- Dermoid mesh with hyperechogenic calcifications indicating the presence of bone, teeth, or other ectodermally-derived structure 4
- Multiple mobile spherical structures (fat globules) 4
Management and Prognosis
The management of ovarian dermoid cysts depends on the risk of malignancy, the age of the patient, and the patient's fertility reserve requirement 2.