Miscellaneous

Question 1

Carney Triad

Answer 1

• extra-adrenal paraganglioma (e.g. spinal paraganglioma)
• gastric gastrointestinal stromal tumors (GIST)
• pulmonary chondroma

Question 2

Markers in ovarian tumours

Answer 2

CA-125 - elevated in most malignancies
AFP - elevated in immature teratomas and yolk sac tumours
B-hcg - dysgerminomas

Question 3

Risk factors ovarian cancer

Answer 3

Nulliparity
Early menopause
FHx: 24% cases of epithelial cancers (BRCA1/2, Lynch syndrome)
Smoking
Previous breast, endometrial or colon Ca

OCPs protective**

Question 4

Imaging appearances in paraduodenal hernias

Answer 4

Left sided (fossa of Landzert)- sac of small bowel loops in the LUQ, with the IMV anterior and medial to the sac

Right sided (fossa of Waldeyer) - located inferior to the 3rd portion of duodenum, jejunal loops displaced to left side of abdomen, posterolateral to the SMA/SMV

Question 5

Imaging appearances in transmesenteric hernias

Answer 5

Clustering of small bowel loops, mesenteric vessel abnormalities (stretched, engorged)

Question 6

Imaging findings sclerosing mesenteritis and ddx

Answer 6

Spectrum - Mesenteric lipodystrophy –> panniculitis –> retractile/sclerosing mesenteritis
Appearance variable from stranding to spiculated, calcified mass
DDx: carcinoid, lymphoma, metastatic nodal disease

Question 7

DDx for solid mesenteric mass

Answer 7

1) GIST and mets from GIST
2) Desmoid tumour
3) Liposarcoma and leiomyosarcoma
4) Lymphoma (usually multiple)
5) Mets from other tumours (usually multiple)
6) Carcinoid

Question 8

Locations of these rare hernias:

• spigelian
• obturator
• lumbar

Answer 8

Spigelian: Lat abdo wall, along linea semilunaris line, between the lateral rectus muscle and the external internal/transversalis fascia

Obturator: Lower pelvis, between external obturator and pectineus muscles, can compress nerve and cause medial thigh pain

Lumbar: Posterior abdo hernia; superior (more common) and inferior subtypes)

• Superior triangle bounded by 12th rib, quadratus lumborum and internal oblique muscle (Grenfelt-Lesshaft)
• Inferior triangle bounded by iliac crest, latissimus dorsi and external oblique (Petit)

Question 9

Distinguishing features of peri-urethral /vaginal cysts

Answer 9

• Skene - peri-urethral near external meatus, BELOW pubic symphysis
• Gardner duct cyst - anterolateral wall of vagina, ABOVE inferior aspect of pubic symphysis
• Bartholin gland cyst - posterolateral wall of vagina, BELOW
• Diverticulum - “dysuria, dribbling, dyspareunia”. posterior mid urethra at level of symphysis
• Leiomyoma - looks same as in uterus

Question 10

Which urethral/vaginal cysts are associated with other mullerian duct abnormalities?

Answer 10

Gardner - remnant Wolfian/mesonephric ducts

May have renal agenesis, hypoplasia, or ectopic ureteral insertion

Question 11

Cervical cancer staging

Answer 11

FIGO staging
1 – confined to cervix (1A < 5 mm depth, 1B > 5 mm)
2 – extends to uterus but does not involve lower third of vagina
A – upper 2/3, no parametrial invasion
B – with parametrial involvement
3 – involves lower 3rd of vagina, OR extends to pelvic wall, OR causes hydro, OR involves pelvic or para-aortic nodes
4 – spread to adjacent organs (bladder or rectal mucosa) or distant organs

Question 12

Most common mullerian duct abnormality

Answer 12

Septate

Strong association with repeated miscarriages (esp in mid 2nd trimester)

Question 13

What percentage of teratomas are malignant?

Answer 13

1-2% (squamous cell)