From the Guidelines
The recommended management for a 36-year-old female with an ovarian calcification that has increased in size from 7 mm to 9 mm on ultrasound is surgical evaluation, likely through laparoscopy, as the growth of the calcification raises concern for potential malignant transformation, as suggested by the O-RADS US risk stratification and management system 1, 2, 3.
Key Considerations
- The patient should be referred to a gynecologist or gynecologic oncologist for further assessment and probable surgical intervention.
- Prior to surgery, additional imaging such as transvaginal ultrasound with Doppler flow studies or pelvic MRI may be ordered to better characterize the lesion.
- Blood tests including CA-125, HE4, and other ovarian tumor markers should be obtained to assess the risk of malignancy.
Surgical Approach
- During surgery, the physician would likely perform an ovarian cystectomy or oophorectomy depending on intraoperative findings, with specimens sent for frozen section and permanent pathology.
- The patient's reproductive desires should be discussed preoperatively as this may influence the surgical approach, particularly regarding fertility preservation options if appropriate.
Rationale
- The O-RADS US risk stratification and management system provides a framework for managing adnexal lesions, including those with calcifications 1.
- The growth of the calcification in this patient raises concern for potential malignant transformation, and surgical evaluation is necessary to rule out malignancy 2.
- The use of additional imaging and blood tests can help characterize the lesion and assess the risk of malignancy, guiding the surgical approach 3.
From the Research
Ovarian Calcification Management
The recommended management for a 36-year-old female with an ovarian calcification that has increased in size from 7 mm to 9 mm on ultrasound is not clearly defined, but several studies provide insight into the approach:
- A study published in 1996 4 suggests that focal calcifications in otherwise ultrasonographically normal ovaries may not be clinically important in most cases (76%), but in some cases (24%), the calcification may be the initial or only manifestation of a neoplasm, which is usually benign.
- Another study from 2008 5 describes a case of extensive pelvic calcification associated with ovarian serous cystadenofibroma, highlighting the importance of interpreting calcification in the female genital tract with caution.
- The use of FDG PET/CT in evaluating treatment response in cases of calcified ovarian metastases is also noted 6, as it can demonstrate the metabolic activity of calcified lesions and reveal metastases in unexpected sites.
- A 2018 study 7 discusses the clinical significance of calcification in gynecologic tumor microenvironments, including its association with tumor progression and prognosis in ovarian cancer.
Diagnostic Approaches
Diagnostic approaches may include:
- Ultrasound follow-up to monitor the size and configuration of the calcification
- Consideration of FDG PET/CT for evaluating metabolic activity in cases of calcified lesions
- Measurement of serum CA 125 levels, which may be elevated in cases of ovarian cancer progression 8
- Gynecological and general physical examination to detect progression of disease
Considerations
It is essential to consider the following:
- The natural history and clinical importance of ovarian calcifications
- The potential for calcification to be associated with neoplastic or non-neoplastic conditions
- The role of imaging modalities, such as ultrasound and FDG PET/CT, in evaluating and monitoring ovarian calcifications
- The potential benefits and limitations of serum CA 125 measurement in diagnosing progression of ovarian cancer 8