O&G and Breast Flashcards
Uterine fibroids
1. Characteristic MR appearance?
2. Degeneration of fibroid characteristic?
3. Types of degeneration and their imaging appearance?
- Low T1, low T2, variable enhancement
- Involution of blood supply - loss of enhancement
- Hyaline - T2 dark; red (carneous, pregnancy) - T1 bright rim; myxoid - T2 bright
Cervical cancer
1. Key distinction to make on staging?
- Is there parametrial invasion - yes, it’s IIb and you need chemo/rad. No, it’s IIa and you have surgery.
Endometrioma appearance
1. on US?
2. on MR?
3. how to distinguish from haemorrhagic cyst?
- Homogenous, low level internal echoes (snowglobe), increased through transmission
- T1 bright (blood), T2 dark (methaemoglobin), so called “T2 shading”, no loss of signal on fat sat
- Haemorrhagic cyst will resolve in 1-2 cycles
Malignant ovarian neoplasms - top three?
Serous cystadenocarcinoma
Endometroid
Mucinous cystadenocarcinoma
All subtypes of surface endothelial tumour
Miscellaneous ovarian tumours
1. Important fact about struma ovarii?
2. Meig’s syndrome?
- Contain thyroid tissue - patient may be thyrotoxic
- Ascites, pleural effusion, fibroma
3 most important malignant GCTs?
Dysgerminoma
Yolk sac tumour
Embryonal cell ca
On Granulosa cell tumour:
- age of presentation?
- presents with?
- imaging appearance
- usually post-menopausal
- endometrial thickening/PMB due to oestrogen secretion
- solid or cystic, thick septations
On theca cell tumour/thecoma:
- age
- presentation
- imaging
- can present at any age
- precocious puberty, abnormal bleeding, PMB
- solid tumour, T1 and T2 dark
Krukenberg tumours - primary has metastasized to ovary with signet ring cell features - most common primaries?
Stomach
Colorectal
Appendix
HPB
Small bowel
Breast
Lung
Contralateral ovary
Primary cancers that metastasize to ovaries (non-Krukenberg)?
Melanoma
Lymphoma
Leydig-Sertoli cell tumours
- Age?
- Clinical features?
- Tumour marker?
- MRI appearance?
- Teens (premenopausal women)
- Virilisation, excess androgen, infertility
- AFP
- Solid fibrous tumours with areas of cystic change which may include haemorrhage/necrosis - T1/2 dark +/- high signal related to cystic change
Endometrial cancer
- Key staging investigation? Key feature that determines management?
- Cut off for endometrial thickness on US in a post-menopausal woman?
- Are the inguinal nodes regional?
- MR appearance
- MRI with contrast; myometrial invasion (+ LN involvement)
- 5mm
- No
- T1 isointense to endometrium, T2 hyperintense to myometrium, minimal to variable enhancement
Benign breast lesion
- US appearance of fibroadenoma?
- MR appearance of fibroadenoma?
- Mimic of fibroadenoma?
- Oval, circumscribed, homogenous hypoechoic. May have popcorn calcification if patient is postmenopausal
- T2 bright with non-enhancing septa, progressive enhancement Type 1 kinetics
- Phyllodes tumour
Causes of architectural distortion?
Malignancy - ILC, IDC
Post-surgical
Trauma
Radial scar
Fibrocystic change
Fibrosis
Gynae causes of raised AFP?
Yolk sac tumour
Embryonal cell carcinoma
Leydig-Sertoli tumour
Teratoma
How might you distinguish serous from mucinous ovarian tumour on CT/MR?
Calcifications - likely to be serous
High T1 cyst contents - likely to be mucinous
On dermoid cysts:
“mature benign cystic teratoma”
- US features
- MR features
- what is the Rokitansky nodule/dermal plug?
- may be cystic with nodule; hyperechoic with acoustic shadowing from calcs; fluid-fluid level; cyst with fine internal echogenic lines - hair
- fat components follow fat on all sequences; may be low SI from calcification; fluid-fluid levels
- solid protuberance projecting into ovarian dermoid cyst
Most common location for an ectopic pregnancy?
Tube - ampulla
Intradecidual sign
A sign of early IUP - early gestational sac
Double decidual sac sign
A sign of early IUP - two concentric echogenic rings outlining the anechoic gestational sac
At what size should you be able to identify a yolk sac TV? Embryo?
8-10mm (20 on TA) size gestational sac diameter. Embryo - 16-18mm.
If not, suspicious for pregnancy failure
Signs of ectopic pregnancy?
Pseudogestational sac
Tubal ring sign (second most common)
Adnexal mass separate from ovary (most common) - most specific if YS or embryo with heartbeat
Ring of fire - may be seen in corpus luteum
What is diagnostic of pregnancy failure?
No fetal pole when MSD 25mm on TVS
No heartbeat 14 days after seeing GS without YS or 11 days after seeing GS + YS
CRL of 7 or more and no heartbeat
Endometrium thickness in post-menopausal woman?
<5mm
