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Background
Ovarian cancer, which has one of the highest mortality rates across all gynecologic malignancies, presents both diagnostic and clinical challenges for physicians. It is often not diagnosed until late stages of disease, presents with vague symptoms that mimic other gynecological and gastrointestinal diseases, and treatment may require consideration of future fertility and sexual health. Epithelial ovarian cancers are the most common subtype, comprising nearly 90% of all ovarian cancers. Non-epithelial ovarian cancers are much rarer than neoplasms of epithelial origin and include Brenner tumors and struma ovarii. Paradoxically, rare ovarian cancers make up nearly half of gynecological oncology cases. Magnetic resonance imaging (MRI) provides high-resolution characterization of ovarian tumors, elucidating certain distinctive features. If caught early and treated appropriately, a substantial number of ovarian cancers are curable. The average 5-year survival rate of ovarian cancer in the United States is currently 47%, but has potential to increase based on improved detection and refined treatment approaches. The goal of this educational exhibit on MRI features of several rare ovarian cancers is to encourage their inclusion on more differential diagnoses, enable early diagnosis and treatment, and increase treatment success and cancer survival rates.

Educational Goals / Teaching Points
By the end of this exhibit, the participant should be able to learn the epidemiology and pathophysiology of rare ovarian malignancies, including but not limited to Brenner tumor, Krukenberg tumor, granulosa cell tumor, and struma ovarii, and identify the relevant MRI findings of each disease.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The disease entities that will be covered in this case-based exhibit are (organized by cell of origin): epithelial tumors (mucinous tumors, including Krukenberg tumor, brenner tumor, clear cell carcinoma), sex cord-stromal tumors (sertoli-Leydig tumor, granulosa cell tumor), germ cell tumors (yolk sac tumor, immature teratoma, struma ovarii). The discussion for each ovarian malignancy will include a brief summary of the epidemiology, overall pathophysiology, and treatment. Representative MR images will be included in the presentation to illustrate key features of each ovarian malignancy.

Conclusion
Rare ovarian malignancies are a common occurrence in gynecological oncology, comprising approximately 50% of cases. Radiologists must be aware of the pathophysiology and imaging findings of these entitiesto guide more accurate patient assessment and treatment planning.