Radiology: Recognising Tumours of the Female GU Tract

Question 1

Name the types of benign ovarian pathology [6]

Answer 1

1. ovarian follicle
2. ovarian torsion
3. polycystic ovarian syndrome
4. endometriomas
5. haemorrhagic cysts
6. dermoid cysts

Question 2

Ovarian Follicle

1. Presentation [1]
2. Features on ultrasound [1]

Answer 2

1. asymptomatic
2. can look like a cyst on ultrasound

Question 3

Haemorrhagic Cyst

1. Definition? [1]
2. Presentation? [2]
3. Features on ultrasound? [2]
4. When does follow-up occur? [1]

Answer 3

1. haemorrhage into the dominant follicle/functional cyst
2. presentation:
   
   • can be asymptomatic or
   • can present with pain
3. features on ultrasound:
   
   • variable
   • cyst with haemorrhagic debris
4. follow-up after 6 weeks

Question 4

Endometrioma (The Chocolate Cyst)

1. Features on ultrasound [2]
2. Features on MRI [1]

Answer 4

1. features on ultrasound:
   
   • variable
   • cyst with haemorrhagic debris
2. features on MRI:
   
   • shows evidence of haemorrhage

Question 5

Dermoid Cysts

1. Who gets it? [1]
2. What is it? [1]
3. Features on x-ray [2]
4. Features on ultrasound [2]
5. Features on CT [4]

Answer 5

1. young women (usually incidental finding)
2. benign neoplasm containing elements from mutiple germ cell layers
3. features on x-ray:
   
   • calcification
   • possibly teeth
4. features on ultrasound:
   
   • heterogenous mass
   • solid nodule
5. features on CT:
   
   • fat
   • fluid
   • calcification
   • soft tissue

Question 6

Polycystic Ovarian Syndrome

1. Definition? [2]
2. Features on ultrasound [1]

Answer 6

1. chronic anvolution syndrome associated with androgen excess that occurs due to clinical and/or biochemical hyperandrogenism
2. multiple immature follicles seen on ultrasound

Question 7

Ovarian Torsion

1. Definition/cause? [1]
2. Who gets it? [1]
3. Presentation [4]
4. Features on ultrasound [3]

Answer 7

1. ovary twists on its vascular pedicle
2. young women
3. presentation:
   
   • abdominal pain
   • pelvic pain
   • nausea
   • vomiting
4. features on ultrasound:
   
   • enlarged ovary
   • free fluid in pelvis
   • absent vascularity in ovary

Question 8

Ovarian Cancer

1. Signs & symptoms [5]
2. How do you calculate the risk of malignancy index (RMI) and what score is concerning for malignancy? [2]
3. Features of malignancy on ultrasound [4]

Answer 8

1. signs & symptoms:
   
   • abdominal distension
   • pelvic or abdominal pain
   • feeling full & loss of appetite
   • increasing urinary urgency or frequency
   • irritiable bowel disease
2. how do you calculate the risk of malignancy index (RMI) and what score is concerning for malignancy?
   
   • RMI = ultrasound score x menopausal score x CA 125
   • RMI > 200 is a concern for malignancy
3. features of malignancy on ultrasound:
   
   • irregular solid or multi-loculated cystic mass
   • bilateral ovarian lesions
   • solid components on cystic wall
   • free fluid in pelvis (ascites/peritoneal nodules)

Question 9

Types of Ovarian Carcinoma

1. Types of epithelial ovarian carcinoma? [6]
2. Types of non-epithelial ovarian carcinoma? [3]

Answer 9

1. epithelial ovarian carcinoma:
   
   • serous
   • mucinous
   • clear cell
   • endometroid
   • Brenner’s
   • squamous
2. non-epithelial ovarian carcinoma:
   
   • germ cell (dysgerminoma/teratomas)
   • sex cord (granulosa cell/sertoli/leydig/thecoma/fibroma)
   • metastatic

Question 10

Serous Ovarian Carcinoma

1. Benign features seen on imaging? [1]
2. Malignant features seen on imaging? [6]
3. Malignant serous ovarian carcinoma is more common in younger/older women (pick one) [1]

Answer 10

1. benign features:
   
   • large cystic mass
2. malignant features:
   
   • thick septations
   • solid components
   • ascites
   • peritoneal metastases
   • lymphodenopathy
   • distant metastases
3. more common in older women

Question 11

What are the 2 causes of bilateral ovarian mass? [2]

Answer 11

1. primary ovarian malignancy metastases
2. metastases from other sources

Question 12

Describe how ovarian cancer is staged from Stage I to Stage IV [4]

Answer 12

Question 13

What are the 3 types of uterine pathology? [3]

Answer 13

1. endometrial cancer
2. adenomyosis
3. fibroids

Question 14

Fibroids

1. Who gets it? [1]
2. Presentation [3]
3. Features on ultrasound [1]
4. Features on CT [1]

Answer 14

1. premenopausal women (usually found incidentally)
2. presentation:
   
   • pain
   • infertility
   • menorrhagia
3. hypoechoic (dark) mass on ultrasound
4. bulky/lobulated uterus on CT scan

Question 15

Adenomyosis

1. Definition/Cause? [1]
2. Presentation [5]
3. Features on imaging [1]

Answer 15

1. endometrial tissue migrating into the myometrium
2. presentation:
   
   • asymptomatic or…
   • dysmenorrhoea
   • menorrhagia
   • dyspareunia
   • chronic pelvic pain
3. thickening of junctional zone seen on imaging

Question 16

Endometrial Cancer

1. Who gets it? [1]
2. Presentation [1]
3. Features on transvaginal ultrasound [1]
4. Features on MRI [1]
5. Features on CT [1]

Answer 16

1. post-menopausal women
2. vaginal bleeding
3. endometrial thickening (>5mm) on transvaginal ultrasound
4. local invasion on MRI
5. distant metastases on CT

Question 17

Cervical Cancer

1. Who gets it? [1]
2. Presentation? [3]
3. What is the parametrium? [1]
4. What defines stage 2b and above in cervical cancer and how does this affect treatment given? [3]

Answer 17

1. women under 35yrs, mostly associated with HPV virus
2. presentation:
   
   • vaginal bleeding
   • vaginal discharge or
   • picked up with abnormal cervical screening test
3. parametrium = fibrous band that separates the cervix from the bladder
4. stage 2b and above in cervical cancer = parametrial invasion
   
   • if not invaded → surgery
   • if invaded → chemotherapy/radiotherapy

Question 18

Vaginal Cancer

1. Presentation? [3]
2. What conditions is it often associated with? [2]

Answer 18

1. presentation:
   
   • bleeding
   • lump
   • itch
   • all of which will not go away
2. often associated with:
   
   • cervical cancer metastasis
   • HPV virus