EURORAD ESR

Case 15273

The Black Garland sign in Ovarian Fibromatosis

Author(s)
Laura Wuyts1, 2, Anja Bernaerts2, François Van Mieghem2, Filip Deckers2, Marc Pouillon2.

1Department of Radiology, Antwerp University Hospital, Edegem, Belgium
2Department of Radiology, GZA Hospitals, Antwerp, Belgium
Oosterveldlaan 24 2610 Wilrijk, Belgium; Email:laura_wuyts@hotmail.com
 
Patient
female, 63 year(s)
 
 
  • Figure 1
    Axial T2 WI

    Axial T2 WI. Sharply delineated nodular hypointense mass lesion (asterisk), located posterior to the right ovary, compatible with an ovarian fibroma. Note also the abnormal aspect of both ovaries (arrows).

     
    Area of Interest: Abdomen; Genital / Reproductive system female; Imaging Technique: MR; Procedure: Localisation; Special Focus: Tissue characterisation;
     
     
  • Figure 2
    The ovarian pathology
     

    Coronal unenhanced T1 WI. Both ovaries can be noted as nodular hypointense lesions, located laterally in the pelvis on both sides (arrows).

     
    Area of Interest: Abdomen; Genital / Reproductive system female; Imaging Technique: MR; Procedure: Localisation; Special Focus: Tissue characterisation;

    Coronal T2 WI. Characteristic appearance of the low signal fibrous cortex (arrows) with entrapped normal follicles (arrowhead), known as the black garland appearance.

     
    Area of Interest: Abdomen; Genital / Reproductive system female; Imaging Technique: MR; Procedure: Localisation; Special Focus: Tissue characterisation;

    Coronal gadolinium-enhanced 3D-gradient echo T1 WI with fat saturation. Only minimal enhancement of the fibrous tissue (arrow) in the periphery of the ovaries can be noted.

     
    Area of Interest: Abdomen; Genital / Reproductive system female; Imaging Technique: MR; Procedure: Localisation; Special Focus: Tissue characterisation;
     
     
  • Figure 3
    Hematoxylin and eosin stain (10x)

    Proliferation of collagen-producing cells in the ovarian stroma, with preservation of a normal cystic follicle (asterisk).

     
    Area of Interest: Abdomen; Genital / Reproductive system female; Imaging Technique: MR; Procedure: Surgery; Special Focus: Tissue characterisation;
     
     
  • Figure 4
    The black garland sign

    The entrapment of the cystic follicles in the fibrous cortex resembles Christmas balls in a garland.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Pathology;
     
     
Axial T2 WI. Sharply delineated nodular hypointense mass lesion (asterisk), located posterior to the right ovary, compatible with an ovarian fibroma. Note also the abnormal aspect of both ovaries (arrows).
 
Coronal unenhanced T1 WI. Both ovaries can be noted as nodular hypointense lesions, located laterally in the pelvis on both sides (arrows).
 
Coronal T2 WI. Characteristic appearance of the low signal fibrous cortex (arrows) with entrapped normal follicles (arrowhead), known as the black garland appearance.
 
Coronal gadolinium-enhanced 3D-gradient echo T1 WI with fat saturation. Only minimal enhancement of the fibrous tissue (arrow) in the periphery of the ovaries can be noted.
 
Proliferation of collagen-producing cells in the ovarian stroma, with preservation of a normal cystic follicle (asterisk).
 
The entrapment of the cystic follicles in the fibrous cortex resembles Christmas balls in a garland.
 
 
 
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