Ovary
Other nonneoplastic
Calcification
Topic Completed: 1 August 2016
Minor changes: 15 October 2020
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PubMed Search: Calcification [title] ovary
Table of Contents
Definition / general | Pathophysiology | Clinical features | Diagnosis | Radiology description | Radiology images | Prognostic factors | Case reports | Differential diagnosisCite this page: Busca A, Parra-Herran C. Calcification. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumorcalcification.html. Accessed April 15th, 2021.
Definition / general
- Ovarian calcifications are commonly found in the context of a mass (mature teratoma, mucinous cystadenoma, serous neoplasia) but also in grossly normal ovaries (mostly within corpora albicantia)
- Often identified by radiologists on ultrasound or other pelvic imaging modalities
- By itself, ovarian calcification is not an indication for biopsy or oophorectomy; pathologic evaluation of calcifications is usually seen in the setting of a mass or in prophylactic oophorectomies
- Calcifications are divided into psammomatous (psammoma bodies) and nonpsammomatous
- Identifying psammomatous calcifications is important; their presence in an otherwise normal ovarian specimen should raise the possibility of an underlying serous neoplasm and prompt additional sampling and correlation with intraoperative findings
Pathophysiology
- Ovarian calcifications are considered dystrophic (associated with cellular degeneration)
- Impaired metabolism elevates the pH and induces intracellular precipitation of calcium salts within epithelial cells or hystiocytes
- Large extracellular calcifications result from fused calcific bodies which have been extruded from calcified cells (Cancer 1977;39:2451)
Clinical features
- Asymptomatic, usually identified by ultrasound in otherwise normal ovaries
Diagnosis
- Most ovarian calcifications are composed of calcium phosphate, which stains as intensely / darkly eosinophilic in routine H&E preparations and are nonpolarizable
- Psammomatous calcifications: round with concentric laminations (onion-like appearance)
- Nonpsammomatous: irregular shape, dense, nonlaminated
- Nonpsammomatous calcifications and psammomatous calcifications within a serous neoplasm do not need to be reported
- Psammomatous calcifications in the absence of a serous neoplasm should prompt additional sampling and correlation with previous history and intraoperative findings; their presence should be mentioned in the report if a serous tumor cannot be identified
Radiology description
- Curvilinear or punctate echogenic foci, usually between 1 - 3 mm (Radiology 1996;198:415)
- Calcifications in dermoid cyst (LearningRadiology)
Radiology images
Images hosted on other servers:
Dermoid cyst
Prognostic factors
- In a study of 17 otherwise normal ovaries, presence of calcifications by ultrasound was associated with benign neoplasms in 24% of cases (Radiology 1996;198:415)
- In a study of 28 patients, the presence of large ovarian calcifications (> 5 mm) identified by imaging in otherwise normal ovaries remained stable and was not associated with ovarian neoplasms (Ultrasound Obstet Gynecol 2007;29:438)
Case reports
- Calcification in a corpus albicans in a case of unresorbed corpora albicantia simulating a solid ovarian mass in the contralateral ovary (J Ultrasound Med 2004;23:1523)
- Ovarian ossification associated with endometriosis (Clin Exp Obstet Gynecol 2007;34:113)
Differential diagnosis
- Calcifications are detected by CT in 34.1％ and by histology in 56.8％ of mucinous cystic tumors; calcifications are found in two locations, intramural and intra-cystic (J Nippon Med Sch 2005;72:29)
- Calcifications may be associated with neoplastic disease, either benign (teratoma, mucinous cystadenoma) or malignant (serous carcinoma)
- Cystic teratoma: 56% show evidence of calcification (Radiology 1989;171:697)
- Serous carcinomas: calcifications are both stromal and epithelial, with the stromal component predominating (Mod Pathol 2003;16:219)
