239 research outputs found
Do hereditary syndrome-related gynecologic cancers have any specific features?
Hereditary syndromes are responsible for 10 % of
gynaecologic cancers, among which hereditary breastovarian
cancer and hereditary non-polyposis colon cancer
syndromes, known as HBOC and Lynch syndromes respectively,
present the highest relative risk. The latter predisposes
to endometrial cancer and both contribute to
ovarian cancer. Cowden syndrome-related endometrial cancer
and the increased risk of ovarian, uterine and cervical
cancers associated with Peutz-Jeghers syndrome, are also
demonstrated, while Li-Fraumeni syndrome patients are
prone to develop ovarian and endometrial cancers. Despite
these syndromes’ susceptibility to gynaecologic cancers
being consensual, it is still not clear whether these tumours
have any epidemiologic, clinical, pathologic or imaging
specific features that could allow any of the intervening
physicians to raise suspicion of a hereditary syndrome
in patients without known genetic risk. Moreover,
controversy exists regarding both screening and surveillance
schemes. Our literature review provides an updated
perspective on the evidence-based specific features of tumours
related to each of these syndromes as well as on
the most accepted screening and surveillance guidelines. In
addition, some illustrative cases are presented
Pre-treatment magnetic resonance stratification of endometrial carcinoma – the role of dynamic contrast-enhanced and diffusion-weighted imaging
O carcinoma do endométrio apresenta uma
taxa de incidência em Portugal de cerca de
7.2%, sendo a 5ª neoplasia mais comum na
mulher. Apesar de apresentar uma prevalência
relativamente elevada, o seu prognóstico global
é favorável, uma vez que 75% dos casos são
diagnosticados em estádio precoce.
O estudo por ressonância magnética é geralmente
efectuado após a realização de uma ecografia para
avaliação de uma hemorragia uterina anormal e
após o diagnóstico histológico por histeroscopia
ou ressecção. Contudo, a ressonância magnética
pode apresentar um papel determinante no
diagnóstico em casos de impossibilidade de
biópsia e nos quais a biópsia é inconclusiva.
Além do mais, apesar de esta técnica não ser
contemplada na classificação para o estadiamento
do carcinoma do endométrio da International
Federation of Gynecology and Obstetrics de
2009, apresenta uma função fundamental no
estadiamento pré-operatório destas doentes,
sendo crucial para definir a abordagem cirúrgica
e terapêutica.
No presente artigo, as autoras descrevem o estado
da arte da ressonância magnética funcional no
diagnóstico e no estadiamento do carcinoma do
endométrio, chamando a atenção para o papel do
estudo dinâmico após administração de contraste
endovenoso e do estudo ponderado em difusão
nestes cenários através da revisão da literatura
mais recente sobre este tópico.Endometrial cancer incidence rate in Portugal is
approximately of 7.2%, being the 5th most common
malignancy in females worldwide. Despite
its relatively high prevalence, the overall prognosis
is generally good since 75% of endometrial
cancer is diagnosed at an early stage.
Magnetic resonance imaging is usually performed
after an ultrasound study for the workup of an
abnormal uterine bleeding and after the histologic
diagnose of endometrial cancer by hysteroscopy
or resection. However, it may play a role
in the diagnosis of endometrial carcinoma when
histology is inconclusive or when biopsy cannot
be performed. Moreover, although it is not considered
in the International Federation of Gynaecology
and Obstetrics 2009 staging classification,
it has a crucial role in pre-operative staging, being
an essential tool for tailoring the surgical and therapeutic
approach.
The authors describe the state-of-the-art of
functional magnetic resonance imaging in the
diagnosis and staging of endometrial carcinoma,
drawing attention to the role of dynamic contrast-enhanced
and diffusion-weighted imaging in
these settings and revising the current literature
on this topic
Pitfalls in gynaecologic imaging
Para o diagnóstico radiológico das patologias
ginecológicas é essencial conhecer e compreender
as indicações dos vários exames disponíveis e,
para cada achado radiológico, integrar a idade,
o contexto clínico e a história pregressa da
doente. A Ressonância Magnética (RM) tem hoje
um papel crucial no diagnóstico das doenças
ginecológicas. Contudo, para maximizar o
potencial desta técnica é imprescindível adequar
o protocolo utilizado a cada caso e a cada doente
e ter em conta algumas regras imprescindíveis
à interpretação dos exames, que descreveremos
neste artigo.
A RM ginecológica é principalmente útil no
estadiamento do carcinoma do colo do útero
e do endométrio, podendo por vezes ser
também útil na sua detecção, na avaliação da
resposta ao tratamento, detecção da recidiva ou
complicações e na avaliação de lesões anexiais
de natureza indeterminada na ecografia. Nas
doenças benignas é frequentemente usada na
avaliação pré-terapêutica de leiomiomas uterinos,
bem como na adenomiose e na endometriose.
Em muitas destas situações há potenciais erros
e pitfalls, para os quais o médico radiologista
deve estar alerta, de forma a minimizar eventuais
falhas diagnósticas ou erros de estadiamento.In gynaecologic imaging it is crucial to choose
the most appropriate imaging method for each
situation, as well as combining imaging findings
with the age, clinical picture and previous clinical
history of the patients. Magnetic resonance
imaging (MRI) is currently indispensable in the
diagnosis of gynaecological diseases. However,
to take advantage of this technique, the use
of adequate protocols is mandatory, specially
designed for each patient and each clinical
problem. On the other hand, the radiologist
should bear in mind some critical rules and
interpretation pearls, that we aim to describe in
this paper.
Gynaecologic MRI has a role to play in
cervical and endometrial cancer staging, and
sometimes also in tumour detection, in response
evaluation after treatment and detection of
recurrence and complications, and in the
evaluation of indeterminate adnexal masses on
ultrasonography. In benign disease, it is mainly
used in the pre-therapeutic evaluation of uterine
leiomyomas, as well as in adenomyosis and
endometriosis. In each situation the radiologist
has to be aware of potential pitfalls, to avoid
diagnostic and staging errors
Urachal carcinoma: imaging findings
Urachal carcinoma is a rare neoplasm, which accounts for only 0.5–2% of bladder malignancies, and arises
from a remnant of the fetal genitourinary tract. A 46-year-old woman presented with a history of pelvic
pain and frequent daytime urination. Ultrasound (US), computed tomography (CT), and magnetic resonance
(MR) demonstrated a supravesical heterogeneous mass with calcifications. The patient underwent a
partial cystectomy with en-bloc resection of the mass and histopathological examination revealed the
diagnosis of urachal adenocarcinoma. Urachal carcinomas are usually associated with poor prognosis
and early diagnosis is fundamental. CT and MR are useful to correctly diagnose and preoperatively staging
Post-Menopausal Metrorrhagia – An Ovarian Thecoma Presentation
Os tecomas são tumores raros do ovário, do grupo dos tumores dos cordões sexuais, de natureza sólida e frequentemente unilaterais.Têm maior incidência no período pós-menopausa e normalmente são silenciosos.Quando sintomáticos traduzem-se por dor pélvica e metrorragia (condicionada pela habitual natureza produtora de estrogénios do tumor). Podem ser concomitantes a síndrome de Meigs e/ou de Golin-Goltz e associarem-se a transformação benigna ou maligna do endométrio. Embora a ecografia possa ser inespecífica neste contexto, uma avaliação multiparamétrica abrangente em ressonância magnética, incluindo por estudo dinâmico e com ponderação em difusão, permite frequentemente orientar de modo favorável a marcha diagnóstica.Apresentamos um caso raro de tecoma do ovário, com espessamento associado do endométrio, avaliado por ecografia ginecológica por vias supra-púbica e transvaginal bem como tomografia computorizada e ressonância magnética, confirmado cirurgicamente. Tratou-se de uma examinada caucasiana de 61 anos de idade, apresentando-se com metrorragia pósmenopáusica, sem outros sintomas nem contexto familiar relevante. Procedeu-se, a este propósito, a uma revisão da literatura focada no diagnóstico multimodal diferencial, apresentação clínica, tratamento e prognóstico destes tumores
Pitfalls in imaging of female pelvic masses
Purpose of Review The purpose of this review is to highlight
potential magnetic resonance (MR) imaging pitfalls
that may mask and simulate ovarian cancer.
Recent Findings MR imaging is the standard method for
evaluating female pelvic masses of indeterminate origin,
especially sonographically indeterminate adnexal masses.
To define the correct origin and nature of a pelvic mass has an
enormous clinical impact, namely in females of child-bearing
age. This is particularly true in adnexal lesions. Ovarian
cancer usually requires a cytoreductive surgery in a specialized
oncological centre. In contrast, a benign ovarian lesion
may be treated by simple resection in a general hospital.
To help preventing diagnostic errors and in order to guide
appropriate therapeutic management, radiologists should
be aware of potential MR pitfalls that may mask and
simulate ovarian cancer.
Summary The first section of this article will describe the
MR imaging protocol that authors perform in their oncological
centre, highlighting how imaging techniques can be
optimized in order to reduce pitfalls in the characterization
of an indeterminate pelvic mass. In the next section, authors will revise the main anatomic
and organ-specific signs that may allow the radiologist to
determine the ovarian origin of a pelvic mass.
Finally, benign gynaecological masses that may simulate
ovarian cancer in a non-emergency setting will be discussed,
with emphasis on features that may provide
important clues to their diagnosis.info:eu-repo/semantics/publishedVersio
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