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 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

Hydropic leiomyoma of the uterus presenting as a giant abdominal mass

We describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. Magnetic resonance imaging (MRI) was performed to further characterise and revealed a myometrial pedunculated tumour. Despite its marked T2-signal heterogeneity and volume, there were no other suspicious findings to suggest a malignant nature; therefore, fertility-sparing myomectomy was performed. Leiomyomas frequently undergo degenerative changes altering their imaging appearances. Leiomyomas with uncommon degenerative changes may be difficult to differentiate from malignant myometrial tumours, based solely on imaging. To the best of our knowledge, a diffuse hydropic degeneration imaging appearance has only been described twice in the literature. We describe the imaging appearance of this rare form of lei

A acurácia do estudo de difusão na avaliação pré-operatória do carcinoma do endométrio

To evaluate the added value of diffusion-weighted imaging (DWI) in the preoperative assessment of myometrial invasion in endometrial cancer, in comparison with T2-weighted imaging (T2WI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).A acurácia do estudo de difusão na avaliação pré-operatória do carcinoma do endométrioinfo:eu-repo/semantics/publishedVersio

Ovarian sertoli-leydig cell tumour with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review

Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alphafetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrineinactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker

Desenvolvimento e implementação de um SGQ numa junta de freguesia

Mestrado em Administração e Gestão PúblicaO presente relatório descreve os primeiros passos para a implementação de um Sistema de Gestão da Qualidade (SGQ) na Junta de Freguesia de São Salvador tendo como referência a norma ISO 9001:2008. O relatório encontra-se dividido em três partes. A primeira parte consiste numa revisão de literatura sobre a temática da qualidade na administração pública, explicando-se a evolução do conceito da qualidade e como o mesmo se pode aplicar ao setor público. Na segunda parte analisa-se a norma ISO 9001:2008 como referencial para a implementação de um SGQ. Por último, na terceira parte é apresentada a vertente prática do relatório, descrevendo-se e discutindo-se os primeiros passos desenvolvidos para a implementação de um SGQ na Junta de Freguesia, com o objetivo de alcançar a sua certificação.This report describes the first steps towards implementing a Quality Management System (QMS) in the Junta de Freguesia de São Salvador with reference to ISO 9001:2008. This report is divided into three parts. The first part consists of a literature review on the topic of quality in public administration, explaining the evolution of the concept of quality and how it can be applied to the public sector. In the second part we analyze the ISO 9001:2008 standard as a reference for the implementation of a QMS. Finally, in the third part is presented the practical part of the report, describing and discussing the first steps developed for the implementation of a QMS on the parish, with the goal of achieving their certification