Tammy T. ChangGillian Lieberman, MD

Radiologic Evaluation of Complex Adnexal Mass

Tammy T. Chang, Harvard Medical School Year IIIGillian Lieberman, MD

August 2001

Tammy T. ChangGillian Lieberman, MD

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AgendaTo discuss:

•Anatomy of Female Pelvis

• Radiologic Modalities Used to Evaluate the Female Pelvis

• Differential Diagnosis of Complex Mass in the Female Pelvis

Tammy T. ChangGillian Lieberman, MD

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Female Pelvic Anatomy

http://www.bartley.com/107/illus1165.html

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Hysterosalpingogram

http://radiology.bidmc.harvard.edu/kinds_of _exams/Xrays/hystero.html

Fallopian Tube

Uterine Cavity

Tammy T. ChangGillian Lieberman, MD

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Ms. L, 31-years-old, presents with

right lower quadrant pain

Our Patient:

Tammy T. ChangGillian Lieberman, MD

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Radiological Modalitiesfor Evaluation of Female PelvisUltrasound

TransabdominalTransvaginal

Magnetic ResonanceImaging

ComputedTomography

Noionizing radiation and

i.v. contrast

Noionizing radiation and

i.v. contrast

Ionizing radiationand i.v. contrast

Initial evaluation Surgical evaluation Staging for ovariancancer

Differentiates cysticfrom solid lesions

Best typifiesNature of lesion

Evaluates sizableovarian masses

Swartz, L.B. and Seiger, D.B. 1992. J Repro Med 37:63-71

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Our Patient’s pelvic ultrasound

Courtesy of Dr. Chad Brecher, M.D. Complex Mass

Tammy T. ChangGillian Lieberman, MD

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Complex Mass

Normal Ovary

Courtesy of Dr. Chad Brecher, M.D.

Our Patient’s complex adnexal mass

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Differential Diagnosis forComplex Adnexal Mass

BenignCystadenomaHemorrhagic cystEndometriomaTeratoma

MalignantOvarian Carcinoma

EpithelialGerm cellStromal

OtherEctopic pregnancyAbscessHematoma

Uterin OriginSubserosal uterin fibroid

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Courtesy of Dr. Chad Brecher, M.D.

AscitesHydroureter

Our Patient: Axial Abdominal CT

Tammy T. ChangGillian Lieberman, MD

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Pelvic Mass

Courtesy of Dr. Chad Brecher, M.D.

Our Patient: Pelvic CT

Tammy T. ChangGillian Lieberman, MD

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Mass

Uterus

BladderCourtesy of Dr. Chad Brecher, M.D.

Our Patient: Coronal CT

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Let’s Review the characteristic appearance of some other adnexal masses

Tammy T. ChangGillian Lieberman, MD

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Patient 2: Ultrasound of Simple Cyst

BIDMC PACS

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Patient 3: T1-weighted MR

Mass

Uterus

Bladder

http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html

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Patient 3: Fat-suppression MR

Endometrioma Teratoma

http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html

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Conclusion

• US and MR - major modalities for evaluating female pelvisCT - role in staging ovarian cancer

• Current imaging are non-specific in distinguishing between benign and malignant complex masses

• Some techniques allow definitive diagnosis of characteristic masses e.g. fat-suppressing MR identifies teratomas from hemorrhagic cysts or endometriomas

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ReferencePublications• Kawamoto, S., Urban, B.A., Fishman, E.K. CT of epithelial ovarian tumors. Radiographics 1999; 19:S85-S102.• Occhipiniti, K.A., Frankel, S.D., Hricak, H. The ovary computed tomography and magnetic resonance imaging. Radiologic Clinics of North America 1993; 31:1115-1132.• Schwartz, L.B and Seifer, D.B. Diagnostic Imaging of Adnexal Masses A Review. J Reproductive Medicine 1992; 37:63-71.• Urban, B.A. and Fishman, E.K. Helical (spiral) CT of the female pelvis. Radiologic Clinics of North America 1995; 33:933-948.• Woodward, P.J. and Gilfeather M. Magnetic resonance imaging of the female pelvis. Seminars in US, CT, and MRI 1998; 19:90-103.

Web Resources• Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febifer, 1918; Bartleby.com, 2000. www.bartleby.com/107/illus1166.html. [9/14/01]• http://brighamrad.harvard.edu/Cases/bwh/hcache/62/full.html• http://radiology.bidmc.harvard.edu/kinds_of _exams/Xrays/hystero.html

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Acknowledgements

Chad Brecher, M.D.Larry BarbarasCara Lyn D’amourPamela Lepkowski

Gillian Lieberman, M.D.