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To analyze symptomatic and asymptomatic patients for assessing
adnexal lesions
Comparison is done with ultrasound and magnetic resonance
imaging and final diagnosis is made with histopathology / FNAC
findings.
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A retrospective study was done involving 6 women of various age
groups who presented with adnexal lesions.
Ultrasound scans were evaluated according to sonographic scoring
systems.
Transverse and sagital T1 weighted magnetic resonance images
were obtained before and after administration of contrast with a fat
saturation technique and T2 weighted images were acquired.
Adnexal lesions were first assessed with each modality and final
diagnosis was made with histopathology / FNAC reports.
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The ovaries are suspended on
either side of the uterus in the
petitoneal cavity. The broad
ligaments, consisting of two
layered folds of peritoneum, run
betweent he uterus and the lateral
pelvic walls.
Other ligamentous connections
between the ovaries. Uterine
tubes,
and
the
surrounding
structures are the mesosalpinx,
the mesovarium, the ovarian
ligament, and the suspensory
ligament of the ovary.
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This diagram shows the
progression of the ovarian
follicle from a primordial
follicle, to a priamary follicle , to
a secondary follicle.
The matures follicle eventually
ruptures to release the oocyte,
and the follicle remnants
become the corpus luteum,
which releases progesterone.
If no fertilization event occurs,
the corpus luteum involutes into
whits fiberous tissue(corpus
albicans), and the next cycle of
ovulation continues.
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Next we will view the appreance of the normal ovary on ultrasound.
A normal follicle in premenopausal women appears as a <20-25mm
simple, anechoic, fluid filled cyst.
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A normal corpus luteum appears as a cystic mass with a thick
crenulated wall and peripheral blood floe, or “ring of fire”
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Here is the characteristic appearance of a postmenopausal ovary,
which is small and homogenous in echotexture.
PATIENTS
NAME
AGE
USG
MRI
HPE/FNAC
PATIENT 1
21
Bilateral dermoid
Features
suggestive of
immature/
malignant
ovarian teratoma
Left :
Immature
teratoma
grade II
Right : Benign
cystic
teratoma
PATIENT 2
30
Right hemorrhagic
cyst / adenomyoma
Right
hemorrhagic cyst
/ adenomyoma
Ovaries
showed
corpus
albicantes and
corpus
follicular cyst
PATIENTS
NAME
AGE
USG
MRI
HPE/FNAC
PATIENT 3
55
Left ovarian simple
cyst
Left ovarian
simple cyst
Benign serous
cystadenoma
PATIENT 4
39
Bilateral complex /
endometriotic cyst
Bilateral endo
metriotic cyst
Features
suggestive of
bilateral
endomeriotic
cyst
PATIENTS
NAME
AGE
USG
MRI
HPE/FNAC
PATIENT 5
14
Left mesenteric /
complex cyst
Left paraovarian
cyst / mesenteric
cyst / left ovarian
cyst
Features
suggestive of
simple cyst of
ovary
PATIENT 6
39
Right complex cyst
Right complex
cyst
Featyres
suggestive of
corpus luteal
cyst
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A 21 year old nulliparous women, was diagnosed with ovarian mass
incidentally on ultrasound a month ago
She complained of weight loss (6 kgs in 3 weeks), fatigue and loss of
appetite.
Her menstrual cycles were uneventful.
She is not a known case of diabetes mellitus / hypertension / epilepsy
/ tuberculosis / thyroid disorders
She is a known case of bronchial asthma for the past 4 years on
irregular treatment.
No history of previous surgeries
No history of malignancy in family
Her Ca125 (Tumour marker) was 115.9 U/ml
USG FINDINGS
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A hyperechogenic solid cystic lesion measuring 3.4 x 3.6 cm seen in
the right adnexa.
A large heterogeneous hyperechogenic lesion with multiple cystic
components measuring 14.3 x 9 cm seen in the pelvis and
periumbilical region, in the midline. Multiple calcified foci noted
within the lesion.
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Both ovaries were not separately visualized.
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Possibility of BILATERAL DERMOID was considered
Both ovaries in relation to the
uterus
Right ovary showing both solid
and cystic components
Abundant vascularity on color doppler
MRI FINDINGS
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A well defined right adnexal mass lesion showing mixed sinal (fat/
soft tissue) with internal solid nodules.
Peripheral curvilinear T2 hypointense signal
calcification.
seen suggesting
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Large mixed signal cystic solid midline abdominopelvic mass with
internal fat signal and multiple T2 hypointense calcification..
Uterus was displaced to the left side by the lesion.
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Features suggestive of bilateral immature / malignant teratoma.
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Arrow marks show bilateral immature /
malignant teratoma.
OPERATIVE FINDINGS
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Cystic mass of size 20 x 15 cm found occupying the mid line upto
the epicgastric region. A few cysts were removed and this mass was
seen arising from the left ovary. And the mass was found to be both
solid and cystic.
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Left ovary was not separately visulaised.
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Right ovary enlarged to 5 x 5 cm and found to be solid.
HPE FINDINGS
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LEFT OVARY : Left ovarian solid and cystic mass shows a neoplasm
composed of islands of cartilage and bone, cystic spaces lined by
stratified squamous respiratory epithelium, fibrous tissue, fatty
tissue and glandular elements adhered to immature neuro
ectodermal tissue and myxoid areas.
Impression : Immature teratoma grade II
RIGHT OVARY : Right ovary shows ovarian stroma enclosing a cystic
lesion lined by stratified squamous epithelium and pilo sebaceous
glands. No evidence of immature elements.
Impression : Benign cystic teratoma.
Islands of cartilage with
respiratory epithelium
Mature and immature glial tissue
Sections shows skin with
pilosebaceous glands
Section shows bone tissue
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The sensitivity to MRI for identifying malignancy was 100 %
Excellent agreement was seen between MRI and the final HPE/FNAC
diagnosis for determining the origin, tissue content and tissue
characteristics of a mass.
Sonography had poor agreement with the final diagnosis for the
origin and tissue content of a mass.
The prime reason for indeterminate sonographic diagnosis was the
inability to exactly determine the origin of the lesion because of
location and mass size and the appearance of purely solid or
complex cystic masses.
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The above study reveals that ultrasound can be used as a screening
technique, while magnetic resonance imaging remains the modality
of choice for diagnosis and assessment of symptomatic and
asymptomatic adnexal lesions.
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