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Ginekologia Polska 2022Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the "gold standard" among gynecological imaging methods. They are important diagnostic...
Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the "gold standard" among gynecological imaging methods. They are important diagnostic tools used to determine the site of origin of a pelvic mass and to characterize the adnexal lesions. This paper summarizes the diagnostic performance of ultrasound, computed tomography, and magnetic resonance imaging in various gynecological diseases and tumours diagnostics.
Topics: Female; Humans; Gynecology; Tomography, X-Ray Computed; Ultrasonography; Magnetic Resonance Imaging; Genital Diseases, Female
PubMed: 35072254
DOI: 10.5603/GP.a2021.0209 -
Chinese Clinical Oncology Oct 2020Early detection and characterization of ovarian lesions is of utmost importance for adequate management. Ovarian cancer accounts for 3.3% of all cancers in women... (Review)
Review
Early detection and characterization of ovarian lesions is of utmost importance for adequate management. Ovarian cancer accounts for 3.3% of all cancers in women worldwide but has only a 5% of female cancer deaths because of low survival rates. The majority of ovarian lesions are benign and have spontaneous resolution. The adequate discrimination between benign and malignant lesions is the most important starting point for a correct and optimal management. Ultrasound is the method of choice up until now for adequate assessment of adnexal abnormalities, no other method has proven superior. Along time, there has been many classification systems that aim standardization of adnexal masses The Gynecology Imaging Reporting and Data System (GI-RADS), published in 2019. The International Ovarian Tumor Analysis (IOTA) group standardized in 2013 the approach of adnexal pathology descriptions by ultrasound with the limitation of needing pathologic reports for complete assessment. The Ovarian Adnexal Reporting and Data System (O-RADS) is a lexicon designed in 2018 to standardize definitions of characteristics by ultrasound. This system offers an interpretation method to decrease ambiguity and recommends management guides according to its classification.
Topics: Adnexal Diseases; Diagnostic Imaging; Female; Humans
PubMed: 33161725
DOI: 10.21037/cco-20-37 -
IDCases 2019Syphilitic gumma involving the penis is a rare manifestation of tertiary syphilis. Only seventeen cases have been reported in the literature. It can mimic other...
Syphilitic gumma involving the penis is a rare manifestation of tertiary syphilis. Only seventeen cases have been reported in the literature. It can mimic other diagnoses such as penile carcinoma. We report a case of a 56 year old male that had been sexually abstinent for over 10 years and presenting with a 4 cm painful penile lesion with clinically palpable bilateral inguinal nodes with no prior history of sexually transmitted diseases (STDs). A positron emission tomography-computed tomography scan identified the penile mass as being hypermetabolic and suspicious for penile carcinoma. Several inguinal and pelvic lymph nodes were also found to be suspicious for penile carcinoma. A penile biopsy was proposed and declined by the patient as he opted for a partial penectomy. The surgery was performed for diagnostic and palliative purposes. Histopathological studies revealed the presence of polymorphous, granulomatous, epitheloid inflammatory infiltrate with giant cells. Additional microbiologic testing confirmed the diagnosis of tertiary syphilis, presenting as gummatous syphillis associated with neurosyphilis. The patient was treated with intravenous penicillin and had adequate clinical clinical and serologic 12 months following treatment. Gummatous syphillis is a rare entity, but should be considered in the differential diagnosis of a penile lesion. To rule out this possibility, a biopsy should always be performed prior to invasive penis surgery.
PubMed: 31406680
DOI: 10.1016/j.idcr.2019.e00589 -
Scientific Reports Mar 2022This study aimed to evaluate the incidence, clinical diagnosis, surgical treatment, and histopathological findings of adnexal masses in children and adolescents. This...
This study aimed to evaluate the incidence, clinical diagnosis, surgical treatment, and histopathological findings of adnexal masses in children and adolescents. This retrospective study included patients aged < 20 years who were diagnosed with adnexal masses between January 2005 and December 2018 at the Konkuk University Medical Center. Adnexal masses were diagnosed in 406 patients. The mean age of patients was 17.3 years at the time of diagnosis. The primary presenting symptoms and signs were abdominal pain (81.4%), mass per abdomen (13.7%), dysmenorrhea (3.4%), incidental finding (2%), and abdominal distention (0.5%). In total, 204 patients underwent surgery for adnexal masses, and 202 patients were observed without surgery. Histopathological examination revealed 110 benign neoplasms, 72 non-neoplastic lesions, 3 ectopic pregnancies, 3 tubo-ovarian abscesses, 7 borderline malignant tumors, and 9 non-epithelial ovarian malignant tumors. Abdominal pain was the most common reason for hospital visits and surgery in adolescents and young women with adnexal masses. The ultrasonographic diagnosis was consistent with the histopathological diagnosis. In recent years, the use of minimally invasive surgery such as laparoscopy and robotic, has increased in young patients with adnexal masses.
Topics: Abdominal Pain; Adnexal Diseases; Adolescent; Child; Female; Humans; Ovarian Neoplasms; Pregnancy; Retrospective Studies; Treatment Outcome
PubMed: 35273292
DOI: 10.1038/s41598-022-08015-4 -
Tomography (Ann Arbor, Mich.) Jan 2022The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt... (Review)
Review
The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis and unnecessary surgery. This article details the female pelvic anatomy and highlights relevant imaging features that mimic extra-ovarian tumors, to help the radiologists accurately build a differential diagnosis of a lesion occupying the adnexa.
Topics: Adnexa Uteri; Diagnosis, Differential; Diagnostic Imaging; Female; Humans; Ovarian Neoplasms; Pelvis
PubMed: 35076619
DOI: 10.3390/tomography8010009 -
Diagnostic and Interventional Imaging Oct 2019Adnexal lesions are routinely encountered in general practice. Ultrasound is the first line of investigation in determining the benign or malignant potential of an... (Review)
Review
Adnexal lesions are routinely encountered in general practice. Ultrasound is the first line of investigation in determining the benign or malignant potential of an adnexal lesion. In the cases of classic simple cysts, hemorrhagic cysts, endometriomas, dermoids and obviously malignant lesions, ultrasound may be sufficient for management recommendations. In cases where there is an isolated adnexal lesion, without peritoneal disease or serum CA-125 elevation, and in lesions considered indeterminate on ultrasound, MR imaging with incorporation of the ADNEx MR score can increase the specificity for the diagnosis of benignity or malignancy. This article will review the imaging evaluation of adnexal lesions and how to incorporate the ADNEx MR score to help guide clinical management.
Topics: Adnexa Uteri; Adnexal Diseases; CA-125 Antigen; Contrast Media; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Ultrasonography
PubMed: 30177450
DOI: 10.1016/j.diii.2018.06.003 -
Diagnostics (Basel, Switzerland) Oct 2023Tubo-ovarian cancer is the most lethal gynaecological cancer. More than 75% of patients are diagnosed at an advanced stage, which is associated with poorer overall... (Review)
Review
Tubo-ovarian cancer is the most lethal gynaecological cancer. More than 75% of patients are diagnosed at an advanced stage, which is associated with poorer overall survival. Symptoms at presentation are vague and non-specific, contributing to late diagnosis. Multimodal risk models have improved the diagnostic accuracy of adnexal mass assessment based on patient risk factors, coupled with findings on imaging and serum-based biomarker tests. Newly developed ultrasonographic assessment algorithms have standardised documentation and enable stratification of care between local hospitals and cancer centres. So far, no screening test has proven to reduce ovarian cancer mortality in the general population. This review is an update on the evidence behind ovarian cancer diagnostic strategies.
PubMed: 37958227
DOI: 10.3390/diagnostics13213331 -
Endocrinology, Diabetes & Metabolism... Mar 2021Struma ovarii is a teratoma of the ovaries predominantly composed of thyroid tissue. Hyperthyroidism associated with struma ovarii is rare, occurring in approximately 8%...
SUMMARY
Struma ovarii is a teratoma of the ovaries predominantly composed of thyroid tissue. Hyperthyroidism associated with struma ovarii is rare, occurring in approximately 8% of cases. Due to the rarity of struma ovarii, available data are limited to case reports and small case series.We report on a 61-year-old female patient with known Hashimoto's thyroiditis on levothyroxine replacement therapy for years with transition to clinical and biochemical hyperthyroidism despite antithyroid medication with carbimazole (10 mg/day), new diagnosis of urothelial carcinoma and an adnexal mass suspicious of ovarian cancer. The patient underwent resection of the adnexal mass and histopathology revealed a mature teratoma predominantly composed of thyroid tissue showing high levels of sodium iodide symporter protein expression. Following struma ovarii resection and disappearance of autonomous production of thyroid hormones, the patient developed hypothyroidism with severely decreased thyroid hormone levels fT4 and fT3 (fT4 0.4 ng/dL, reference interval 0.9-1.7 and fT3 < 1.0 pg/mL, reference interval 2.0-4.4). This has previously been masked by continued thyroid-stimulating hormone suppression due to long-term hyperthyroidism pre-surgery indicating secondary hypothyroidism, in addition to primary hypothyroidism based on the known co-existing chronic lymphocytic thyroiditis of the orthotopic thyroid gland. Levothyroxine administration was started immediately restoring euthyroidism.This case illustrates possible diagnostic pitfalls in a patient with two concurrent causes of abnormal thyroid function.
LEARNING POINTS
Struma ovarii is an ovarian tumor containing either entirely or predominantly thyroid tissue and accounts for approximately 5% of all ovarian teratomas. In rare cases, both benign and malignant struma ovarii can secrete thyroid hormones, causing clinical and biochemical features of hyperthyroidism. Biochemical features of patients with struma ovarii and hyperthyroidism are similar to those of patients with primary hyperthyroidism. In such cases, thyroid scintigraphy should reveal low or absent radioiodine uptake in the thyroid gland, but the presence of radioiodine uptake in the pelvis in a whole body radioiodine scintigraphy. We give advice on possible diagnostic pitfalls in a case with two simultaneous causes of abnormal thyroid function due to the co-existence of struma ovarii.
PubMed: 33682680
DOI: 10.1530/EDM-20-0142 -
Diagnostics (Basel, Switzerland) Feb 2022Non-Gestational Ovarian Choriocarcinoma (NGOC) is an extremely rare ovarian tumor, with an incidence of less than 0.6% of malignant ovarian germ cell tumors. Its close... (Review)
Review
Non-Gestational Ovarian Choriocarcinoma (NGOC) is an extremely rare ovarian tumor, with an incidence of less than 0.6% of malignant ovarian germ cell tumors. Its close pathologic resemblance to Gestational Ovarian Choriocarcinoma (GOC), however, requires special attention as the treatments differ greatly. NGOC typically affects patients in late adolescence or early reproductive years. As a result, NGOCs are often misdiagnosed as ectopic pregnancies due to their common presentation of bleeding, abdominal pain, adnexal mass, and positive serum beta-HCG. On pathologic examination, the tumor is indistinguishable from GOC, and only after review of tissue for paternal genetic components can the diagnosis of NGOC be made. Imaging studies often show highly vascular lesions with further investigation with computer topography (CT) sometimes showing metastatic lesions in the lungs, pelvis, vagina, and liver. These lesions are often hemorrhagic and can lead to catastrophic bleeding. Treatment is vastly different from GOC; NGOC requires treatment with both surgical resection and chemotherapy, with Bleomycin, Etoposide, and Cisplatin (BEP) being the most used regimen. With correct diagnosis and treatment, patients can often receive fertility sparing treatment with long term survival.
PubMed: 35328112
DOI: 10.3390/diagnostics12030560 -
Turk Patoloji Dergisi 2021Immunoglobulin G4-related disease is characterized by dense fibrosis, obliterative phlebitis, and lymphoplasmacytic infiltration that contains abundant IgG4 positive...
Immunoglobulin G4-related disease is characterized by dense fibrosis, obliterative phlebitis, and lymphoplasmacytic infiltration that contains abundant IgG4 positive plasma cells. It causes tumefactive lesions in the involved organs and is most commonly seen in the salivary glands, pancreas, and retroperitoneum. Ovarian involvement has been reported in only two cases. In our case, a 58-year-old female patient presented with abdominal distention and pain. Pelvic computed tomography revealed a soft tissue lesion compatible with the omental cake, several intraabdominal implants, and bilateral adnexal fullness. A laparotomy was performed under suspicion of peritoneal carcinomatosis secondary to bilateral adnexal mass. In the histopathologic examination, abundant lymphoplasmacytic infiltration and dense fibrosis were observed in both ovaries and the peritoneum. In the areas of greatest density, the density of IgG4-positive plasma cells was found to range from 40 to 50 per high-power field. The patient was accepted as suffering from probable IgG4-related disease because of the bilateral involvement of the ovaries and the histopathological findings. In conclusion, we present this case to draw attention to the fact that IgG4-related disease can also be seen in the ovary.
Topics: Diagnosis, Differential; Female; Fibrosis; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Middle Aged; Ovarian Diseases; Ovarian Neoplasms; Ovary; Plasma Cells
PubMed: 32779156
DOI: 10.5146/tjpath.2020.01500