VIQ - Female Imaging Flashcards
@# 6. Regarding yolk sac tumours of ovary:
A. Are the most common malignant germ cell tumour of the ovary
B. Account for 5% of all ovarian malignancy
C. Carry a poorer prognosis than any other ovarian germ cell tumour
D. Haemorrhagic change is very rare
E. Are slow growing tumours
C. Carry a poorer prognosis than any other ovarian germ cell tumour
Yolk sac tumours are well-enhanced tumours consisting of mixed solid and cystic tissue with some area of haemorrhage.
A ‘bright dot’ sign is recognised; a well-enhanced dilated vessel on the post-contrast image.
Yolk sac tumours have a poor prognosis.
They account for 1% of ovarian malignancies.
They are the second most common malignant germ cell tumour after dysgerminomas.
@# 44. Regarding clear cell tumour of the ovary:
A. Are rarely invasive
B. Represents > 20% of ovarian carcinomas
C. Most patients present at stage 2 disease
D. Frequently occurs as a unilocular cyst with mural nodule
E. Has a poorer survival rate compared with other ovarian cancers
D. Frequently occurs as a unilocular cyst with mural nodule
50% of patients have a 5-year survival rate; it presents in stage I in 75% of cases and accounts for up to 10% of all ovarian cancers.
@# 13) A postmenopausal patient has a hysterectomy and bilateral salpingo-oophorectomy for bilateral ovarian masses. Histological examination confirms bilateral ovarian tumours and reveals concomitant endometrial adenocarcinoma. What is the most likely histological diagnosis of the ovarian lesions?
a. benign serous cystadenoma
b. benign mucinous cystadenoma
c. malignant serous cystadenocarcinoma
d. malignant mucinous cystadenocarcinoma
e. endometrioid tumour
e. endometrioid tumour
Benign serous cystadenoma is bilateral in 20% of cases, benign mucinous cystadenoma in 5%, malignant serous cystadenocarcinoma in 50% and malignant mucinous cystadenocarcinoma in 25%. However, not only are endometrioid ovarian tumours frequently bilateral (30–50%) but they are also often (30%) found with concomitant endometrial adenocarcinoma.
@# 47) A postmenopausal patient is investigated for ascites. Cytology from the ascites reveals cells in keeping with an epithelial ovarian malignancy. Which of the following is the most appropriate staging investigation?
a. CT of the abdomen and pelvis with oral and intravenous contrast
b. CT of the chest, abdomen and pelvis with oral and intravenous contrast
c. MRI of the pelvis
d. 18FDG PET
e. PET/CT
a. CT of the abdomen and pelvis with oral and intravenous contrast
Plain chest radiograph may be added to this as a routine, but chest CT would be requested only with an additional reason to do so. MRI of the ovaries can be helpful in characterizing ovarian masses where ultrasound scan and CA-125 are equivocal. There may be a role for PET/CT in defining disease extent, but cystic tumour deposits, particularly when they may be on or close to bowel or associated with ascites, present a challenge for this technique.
@# 60) MRI is performed for locoregional staging of vaginal cancer. Which of the following descriptions is the most likely appearance on a T2W sequence, given a small primary tumour confined to the vagina?
a. central high signal within the vagina; focal homogeneous, low-signal mass not breaching the surrounding ring of intermediate-signal vaginal wall
b. central high signal within the vagina; focal homogeneous, high-signal mass not breaching the surrounding low-signal vaginal wall
c. central high signal within the vagina; focal homogeneous, intermediate-signal mass breaching the surrounding low-signal vaginal wall
d. central high signal within the vagina; focal homogeneous, intermediate-signal mass not breaching the surrounding low-signal vaginal wall
e. central intermediate signal; focal homogeneous, high-signal mass contained by low-signal vaginal wall
d. central high signal within the vagina; focal homogeneous, intermediate-signal mass not breaching the surrounding low-signal vaginal wall
The vaginal epithelial layer and mucus are bright on T2W images. This is normally surrounded by low-signal (fibromuscular) vaginal wall. Tumours are typically intermediate signal on T2W images. If gadolinium is used, cancers often have early phase enhancement. Large tumours may have central necrosis.
T1 tumours do not breach the low-T2-signal vaginal wall,
whereas T2 tumours do and extend into the paracolpal fat.
T3 tumours reach the pelvic side wall
while T4 tumours extend beyond the true pelvis or involve bladder or rectal mucosa
@# 63) On transvaginal ultrasound scan, an ovary measures 5 X 3 X 2 cm. Regarding the volume of this ovary, which of the following statements is most accurate?
a. it is large for pre- and postmenopausal ovaries
b. it is normal for pre- and postmenopausal ovaries
c. it is normal for a premenopausal ovary but large for a postmenopausal ovary
d. it is normal for a postmenopausal ovary but large for a premenopausal ovary
e. not enough information is given to assess the volume
c. it is normal for a premenopausal ovary but large for a postmenopausal ovary
Normal ovarian volume is less than 18 cm3 before the menopause and less than 8 cm3 after.
The volume can be estimated by multiplying the three diameters and dividing by two.
@# 70) A 17-year-old female with primary amenorrhoea is found on clinical examination to have a hypoplastic upper/middle vagina. MRI shows an absent uterus but normal tubes and ovaries. Which of the following is the most likely diagnosis?
a. uterus didelphys
b. unicornuate uterus
c. Mayer–Rokitansky–Kuster–Hauser syndrome
d. uterine agenesis
e. septate uterus
c. Mayer–Rokitansky–Kuster–Hauser syndrome
The uterus, fallopian tubes and upper vagina arise from the paired paramesonephric (mullerian) ducts. The caudal parts fuse and ultimately form the uterus and upper vagina with resorption of the midline septum. The cranial parts remain unfused and form the fallopian tubes. Congenital uterine abnormalities arise with failure of development or fusion of this duct, or failure of midline resorption following fusion. Mayer–Rokitansky–Ku¨ster–Hauser syndrome describes uterine agenesis accompanied by hypoplastic proximal/middle third of the vagina but normal tubes and ovaries. Forty per cent of patients with the syndrome have pelvic kidneys and other urinary tract anomalies are also associated. They have a normal genotype.
@#e 36 A 30 year old woman with a previous history of pelvic inflammatory disease is undergoing investigations for infertility. With regards to assessment of tubal patency, which of the following statements is correct?
(a) Gadolinium enhanced MRI is the investigation of choice
(b) Normal fallopian tubes are visible on pelvic US
(c) Hysterosalpingography should be performed in the first half of the menstrual cycle
(d) Hysterosalpingo contrast sonography is as good as laparoscopy and dye instillation
(e) Iodine based contrast is used for hysterosalpingo contrast sonography
(c) Hysterosalpingography should be performed in the first half of the menstrual cycle
Laparoscopy and blue dye instillation (with spillage of dye into the peritoneal cavity indicating patency) is the gold standard, but requires a general anaesthetic. MRI and standard pelvic US do not clearly demonstrate the fallopian tubes. HSG provides an accurate indication of tubal patency but employs ionizing radiation. It should therefore be performed in the first half of the menstrual cycle to avoid irradiating a patient with possible early pregnancy. Hysterosalpingo-ContrastSonography uses microbubbles to demonstrate the fallopian tubes and has the advantage of not using ionizing radiation or requiring anaesthesia but is less accurate than the other methods.
@#e QUESTION 45
A transvaginal ultrasound is performed on a 36-year-old woman with dysfunctional uterine bleeding. This demonstrates an enlarged globular uterus with a heterogeneous appearance of the myometrium. The myometrium contains diffuse echogenic nodules, subendometrial echogenic linear striations and 2- to 6-mm subendometrial cysts. Colour Doppler demonstrates a speckled pattern of increased vascularity within the heterogeneous area of myometrium. What is the most likely diagnosis?
A Adenomyosis
B Endometrial polyposis
C Gestational trophoblastic.disease (GTD)
D Stage 1A endometrial cancer
E Uterine fibroid
A Adenomyosis
@#e A 60-year-old nulliparous woman presents with postmenopausal bleeding. On transvaginal ultrasound, her endometrium is 8 mm thick and the endomyometrial junction appeared indistinct. The radiologist suspects invasive endometrial cancer and refers her for an MRI examination. What are the likely findings on MRI?
A On unenhanced Tlw images the endometrial cancer appears of high signal intensity compared to the surrounding myometrium.
B On contrast-enhanced Tlw images, endometrial cancer shows avid enhancement compared with surrounding myometrium.
C On T2w images the normally high signal junctional zone is disrupted.
D Tlw fat-saturated sequences are best used to assess the junctional zone.
E The endometrial cancer demonstrates delayed/little enhancement compared to the normal surrounding myometrium on postcontrast Tlw images
E The endometrial cancer demonstrates delayed/little enhancement compared to the normal surrounding myometrium on postcontrast Tlw images
@#e QUESTION 73
A 64-year-old woman presents with bloating and vague pelvic pain and is referred for a pelvic ultrasound. On transabdominal ultrasound, she is found to have a large right adnexal mass. Which one of the following sonographic findings would indicate that this mass is more likely to be malignant than benign?
A Doppler waveform with a high resistive index (> 0.8)
B Homogeneously hypoechoic mass with posterior acoustic enhancement
C Multiple septations that are approximately 1 mm thick
D Papillary projections
E Size > 4 cm
D Papillary projections
@#e QUESTION 74
A 31-year-old woman has a hysterosalpingogram (HSG) as part of a series of investigations for primary infertility. The HSG shows a single vagina, single cervix but two separate uterine cavities leading to separate uterine horns. What is the most likely diagnosis?
A Arcuate uterus
B Bicornuate uterus
C Didelphus uterus
D Septate uterus
E Bicornis bicollis
B Bicornuate uterus
@#e 28. Which of the following are correct regarding ovarian cancer: (T/F)
(a) It is the commonest gynaecological malignancy.
(b) It is associated with colorectal cancer.
(c) CA-125 is specific for ovarian cancer.
(d) CT only has a pre-operative staging accuracy of 50%.
(e) Doppler ultrasound may help with differentiating benign from malignant disease.
Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Endometrial cancer is the most common gynaecological malignancy. CA-125 is not specific for ovarian cancer, it is increased in benign conditions like fibroids, endometriosis and inflammatory pelvic disease. CT only has a pre-operative staging accuracy of 70% - 90%.
@# 45 During a routine antenatal ultrasound performed at 11 weeks gestation, the nuchal skin thickness is measured at 5 mm. Which of the following is not part of the differential?
(a) Normal variation
(b) Noonan’s syndrome
(c) Zellwegger syndrome
(d) Klippel-Feil syndrome
(e) Fragile X syndrome
(e) Fragile X syndrome
The nuchal skin thickness should measure up to 3 mm at 9-13 weeks, up to 5 mm at 14-19 weeks and up to 6mm at 19-24 weeks. Although rare (<1%) normal variation is observed. Other causes of nuchal skin thickening include Turners and Downs syndromes.
@# 21 A 31 year old is pregnant with her first child. At 16 weeks’ gestation the corrected alphafetoprotein level is noted to be raised. What is a possible cause for this?
a Wrong dates - a normal pregnancy that is less advanced that originally dated
b Greater than average birth weight
C Ectopic pregnancy
d Trisomy 21
e Neural tube defect
21 Answer E: Neural tube defect
An elevated alpha-fetoprotein level is associated with foetal anomalies in 61 %, of which 51 % are neural tube defects. Other causes include a normal pregnancy that is more advanced, twin pregnancy, missed abortion, renal anomalies and anterior abdominal wall defects.
