Fig. 4

High-grade serous adenocarcinoma within an endometrioma in a 48-year-old woman with a known history of endometriosis. Coronal (a), sagittal (b), and axial (c) T2-weighted images show severe uterine adenomyosis (white arrowheads) and deep endometriosis involving the posterior compartment (dotted arrows). There is a mixed cystic right ovarian mass (asterisk) with intermediate signal intensity on T2 images (shading effect) containing a mural nodule (black arrows). Diffusion-weighted imaging (d high b value and e ADC map) shows a restricted diffusion within the mural nodule. Axial fat-suppressed T1-weighted image (f) shows the typical features of ovarian endometrioma. Heterogeneous enhancement of the nodule is displayed on fat-suppressed contrast-enhanced T1 image (g) and subtraction sequence (h)