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Small Echogenic Foci in the Ovaries

Correlation With Histologic Findings

Departments of Radiology (D.L.B., M.C.F.), Obstetrics and Gynecology (M.G.M.), and Pathology (W.R.W.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts USA.

Address correspondence and reprint requests to Douglas L. Brown, MD, Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA. E-mail: brown.douglas{at}mayo.edu.

Objective. The purpose of this study was to determine the histologic correlate of small echogenic foci in the ovary and to assess for any association with endometriosis or endosalpingiosis. Methods. Women planning to have a normal ovary surgically removed were scanned preoperatively with transvaginal sonography. If echogenic foci were present in either normal ovary on the preoperative scan, the removed ovary was scanned in a saline bath, and the surface was marked with india ink over an echogenic focus. Histologic sections were then obtained at the marked site. Results. Echogenic foci were detected in 23 ovaries of 16 women. Possible causes were found in 17 of the 23 ovaries: hemosiderin in 6 cases, calcification in 5 cases, hemosiderin and calcification in 2 cases, clusters of inclusion cysts in 2 cases, 1 of which also had hemosiderin, and dense cortical nodules in 2 cases. Histologic findings were benign in all cases except in 1 patient who had primary peritoneal carcinoma unrelated to the echogenic foci. One ovary in another patient had both endosalpingiosis and endometriosis. One other patient had endometriosis involving a fallopian tube but not the ovary. There were no other cases of endometriosis or endosalpingiosis. Conclusions. Small echogenic foci in the ovaries are most frequently due to hemosiderin or calcification. A few small echogenic foci in the ovaries are associated with benign histologic changes and do not appear to be reliable indicators of endosalpingiosis or endometriosis.

Key Words: calcification • hemosiderin • ovary • sonography

Abbreviations: H&E, hematoxylin-eosin

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