Diffusion Magnetic Resonance Imaging in Differentiation of Ovarian Cystic Lesions

Background: MRI can specifically diagnose some certain pathologic types by providing accurate information on fat, collagen and hemorrhage. Diffusion-weighted magnetic resonance imaging, an emerging non-invasive MRI technique, is of the capability to evaluate the extent of microscopic diffusion which might exist in biologic tissues. Evidence has shown that DWI-MRI and ADC were beneficial in differentiating malignant from benign ovarian lesions and may be helpful to predict suboptimal cytoreduction in ovarian cancer. The aim of this study to assess the role of magnetic resonance imaging with diffusion weighted images in the assessment and differentiation of ovarian cystic lesions. Methods: This prospective study was conducted on 30 female patients who are proved by ultrasound to have ovarian cystic lesions. Selected patients were given butylscopolamine bromide (20mg) administered IV or intramuscularly at the beginning of the examination. Imaging is performed with the patient in the supine position with an empty urinary bladder. A distended urinary bladder is not recommended because it increases phase ghost artifacts and can compress the uterus. Results: As regards diagnosis according to Ultrasound examination, revealed that ovarian cancer and simple cyst were the most frequent (26.7% and 20% respectively), followed by Tubo-ovarian hydrosalpinx and Hemorrhagic cyst (10%) each. Ovarian serous cyst adenoma constituted (6.7%), while pyosalpinx, PCO, hydrosalpinx, and endometrial cyst constitutes (3.3%) each. As regards diagnosis according to MRI examination, Simple cyst and ovarian cancer were the most frequent (13.3%) each, followed by Tubo-ovarian hydrosalpinx and Hemorrhagic cyst (10%) each. Krekenberg tumor, Ovarian dermoid, and Ovarian serous cyst adenoma constituted 6.7% each. As regards the ADC value was significantly lower in the malignant lesions (0.7*103) than benign ones (0.9*103). As regards histopathologic confirmation, 23 cases of the studied women, Ovarian cancer (17.4%), Tubo-ovarian hydrosalpinx (13.0%), and Hemorrhagic cyst (13.0%) were the most common diagnosis. Ovarian dermoid, Krekenberg tumor, and Ovarian serous cyst adenoma constituted 8.7% each. Other less frequent diagnosis included Endometeriotic cyst, Hydrosalpnix, Mucinous cystadenoma, Ovarian serous cyst adenocarcinoma, Ovarian dysgerminoma and Terato-dermoid (4.3%) each. The mean ADC value was significantly lower in the malignant lesions than benign ones. At a cut off ≤0.7, ADC showed a significant good diagnostic value of malignant lesions with sensitivity, Specificity, and an accuracy. Conclusions: DWI to conventional MRI is an important tool. It improves the specificity of MRI and thus increasing radiologist’s confidence in image interpretation which will finally reflect on patients’outcome and prognosis. Cost effective technique (no additional cost to MRI examination), was easily added to MR study protocols.

Prevalence of Adenomyosis in Hysterectomy Specimens Performed at a Tertiary Hospital of Kathmandu, Nepal

Adenomyosis is a common condition, detected in 15-30% of hysterectomy specimens. It is characterized by the presence of endometrial glands and stroma within the myometrium. The data regarding incidence or incidental finding of adenomyosis in hysterectomy specimen is lacking despite this condition being common and bearing serious implications in symptomatology as well as in infertility. Adenomyosis can be incidental finding in hysterectomy done for other gynecologic pathology as well. Hence, this present study has established the prevalence of adenomyosis as well as it’s association with other uterine pathology in routine hysterectomy specimens. This was a cross sectional study conducted at Nepal Medical College and Teaching Hospital (NMCTH), Kathmandu for a duration of one year (March 2019 to February 2020). Total of 154 hysterectomies were included in the study, out of which 37 cases showed adenomyosis. The prevalence of adenomyosis was 24%. The age group for adenomyosis ranged from 36 years to 52 years with the mean age of 44 ± 4.4 years. The most common pathology other than adenomyosis was leiomyoma (19 cases) followed by two cases of endometriotic cyst, two cases of endometrial polyp, one case of high grade squamous intraepithelial lesion (HSIL), one case of hyperplasia of endometrium with atypia, and one case of serous cyst adenoma of ovary. Thus this study showed that the prevalence of adenomyosis was 24% and was seen higher in the age group of 35-50 years. The most frequent co-pathology in these adenomyosis cases was leiomyoma.

Computed tomography features of benign adnexal mass lesions

Background: Adnexal masses originating from gynaecologic and nongynecologic sources may be benign or malignant. The objective of this study was to describe multi-detector computed tomography features of benign adnexal masses for diagnostic accuracy and disease understanding.Methods: Study retrospectively evaluates the multidetector computed tomography features of benign adnexal mass lesions, which were referred for MDCT examination with a primary diagnosis of adnexal masses on clinical or USG. Patients who underwent MDCT and subsequently underwent surgery and proved to benign adnexal mass lesion on histopathological examination were included in this study.Results: Forty five percent benign adnexal mass were in the age group of 36-50 years followed by 32.7% in the age group of 21-35 years. Common presenting symptoms of benign adnexal masses were pain abdomen or pelvic pain (65.5%) followed by mass abdomen (42%) while in one fourth of the patients it was asymptomatic and detected as incidental finding. Pathologic diagnosis of most common benign adnexal mass detected were serous cyst adenoma (54.5%), followed by mature cystic teratoma (18.2%), mucinous cyst adenoma (14.5%) and par ovarian cyst (9.1%). Benign ovarian mass had a characteristic CT appearance of cystic lesion (83.6%), unilocular (65.5%) with regular/well defined and thin wall (83.6%) with occasional septations (21.8%) and papillary projections (14.5%). Ascitis (5.5%) was an uncommon finding of a benign adnexal mass lesion. Computed tomography was most accurate to characterize mature cystic teratoma with a typical cystic lesion having fat deposition and calcifications. Serous cyst adenoma had a CT appearance of thin walled cyst mass with no septations or solid component. Mucinous cyst adenoma ovary had a characteristic multilocular cystic lesion with different fluid attenuation and thin septations. Endometrioma had a variable CT appearance with uni or multilocular cystic lesion and hyperdense lesion with focal calcifications.Conclusions: Multi detector computed tomography may provide accurate and valuable diagnostic information about benign nature of an adnexal mass lesion.

A Postmenopausal Woman with Giant Ovarian Serous Cyst Adenoma: A Case Report with Brief Literature Review

Giant (>10 cm) ovarian cyst is a rare finding. In the literature, a few cases of giant ovarian cysts have been mentioned sporadically, especially in elderly patients. We report a 57-year-old postmenopausal woman with a giant left ovarian cyst measuring 43 × 15 × 9 cm. She was referred to us from the local health center in view of palpable pelvic mass for six-month period. Considering the age and menopausal state, we performed a total abdominal hysterectomy and bilateral salpingo-oophorectomy with excision of the giant left ovarian cyst intact and successfully without any significant complication. On histopathological examination, the cyst was confirmed as benign serous cystadenoma of the ovary. During the management of these high-risk cases of multidisciplinary approach, intraoperative and postoperative strict vigilance is necessary to avoid unwanted complications.

Study of histomorphological pattern of ovarian neoplastic and non-neoplastic lesions

Background: The ovary is a striking exception to the Virchow’s dictum that organs that are frequently the site of primary cancer are rarely involved in secondary malignancy, and vice versa. Both primary and secondary carcinomas of the ovary are relatively frequent and show an astounding variety of pathologic patterns. The objectives were to study the histomorphological diversity of various neoplasms and non neoplastic lesions of ovary. To provide a specific diagnosis based upon the histomorphological study which is of paramount clinical significance in further management of the patient.Methods: The present study is based on histomorphological evaluation of 100 cases of ovarian neoplastic and non neoplastic lesions received at the department of Pathology, tertiary care hospital from June 2008 to Aug 2010.Results: A wide variation of age was noted. Among neoplastic lesions, majority of the cases were seen in age group of 20-39 years i.e., 50.6%. Non neoplastic lesion occurred in all age group, but majority of the incidences were seen in the age group of 20 to 40 years of age, accounting for 60% of total occurrence. the commonest ovarian tumor was serous cyst adenoma constituting 54.1% (46 cases) of all ovarian neoplasm. Mucinous cyst adenoma was the second most common tumor. There were 72 cases (85%) of benign, 2 cases (2%) of borderline and 11 cases (13%) of malignant tumors in the present study.Conclusions: The diversity of neoplasms makes it mandatory to classify the tumors accurately by histopathological features following universally accepted classification.

Occurrence and Histopathological Patterns of Ovarian Tumours in a Tertiary Hospital

Background: Ovarian tumours are common problem in gynaecology and have varied clinical presentation and histopathological appearances. Objectives: This study was undertaken to find out the occurrence and different histopathological types of the tumours originating from the ovaries. Methods: A retrospective study was carried out in the Department of Obstetrics and Gynaecology and Department of Pathology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, between May 2010 and December 2014. Five hundred forty seven (547) cases of ovarian tumours were studied in respect to their histopathological appearance. Results: Out of total gynaecological admission of 5633 patients during the study period, 613 patients admitted with a clinical diagnosis of ovarian tumours: so, the occurrence was 10.9%. Out of 613 patients 547 did histopathology in the department of pathology of our institution. Of the 547 cases, majority were benign (n=379, 69.3%); followed by malignant (n=38, 7%); borderline (n=4, 0.7%); and others (n=126, 23%). Most commonly occurring benign ovarian tumours were serous cystadenoma (115; 30.3%); mature cystic teratoma (76; 20.1%) and mucinous cyst adenoma (66;17.4%). Common malignant tumours were serous cyst adenocarcinoma (21; 55.3%); mucinous cystadenocarcinoma (5; 13.2%) and dysgerminoma(4; 10.5%). Conclusion: Nine out of ten ovarian tumours were nonmalignant. Epithelial tumours were most common among both benign and malignant ovarian tumours. Overall, most common was serous cyst adenoma in benign group and serous cyst adenocarcinoma in malignant group. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(1): 5-9

Misdiagnosis of a Giant Uterine Leiomyosarcoma: Clinic and Image Challenges

A 41-year-old woman (G3P2L2Ab1) was referred to gynecology clinic with chief complaints of abdominal distension and localized abdominal wall pruritus for three months. She was misdiagnosed with gastrointestinal disorder and ultimately had undergone imaging. Ultrasonography and computed tomography (CT) scan disclosed a huge solid-cystic mass originating from the ovary. On clinical examination the patient had no pain or tenderness and no gynecologic complaints. Laboratory tests showed normal tumor markers and hemoglobin at 8 g/dl. Laparotomy was carried out as diagnosis of ovarian serous cyst adenoma, but a huge tumor with attachment to uterus and ovaries and extension to pelvic floor, peripheral tissues of ureter, and upper abdomen was found. Hysterectomy with bilateral salpingooophorectomy was done. Pathology report demonstrated uterine leiomyosarcoma measuring 40 centimeters and weighing 10 kilograms. In conclusion, as pelvic masses even in a large size may present unspecific symptoms misdiagnosis may occur which lead to overgrowth, local invasion, or other complications. So, it is rather to suggest ultrasonography in patients with persistent abdominal or pelvic symptoms and if needed, more exact diagnostic modalities like magnetic resonance imaging (MRI) could be offered to avoid misdiagnosis and mismanagement.

An analytical study of 50 women presenting with an adnexal mass

Background: The aim of this study was to detect and determine the origin of adnexal mass and to narrow down the diagnosis. Also, to determine the reliability of the bimanual pelvic examination in diagnosing adnexal mass and to determine clinical, radiological and histopathological co-relation of adnexal mass. Adnexal mass lesions are fairly common among women (with a prevalence of 0.17% to 5.9% in asymptomatic women and 7.1% to 12% in symptomatic women) of all age group but very common among reproductive age. Differential diagnosis of adnexal mass is difficult and complex. Recognition of the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal.Methods: Prospective, observational study of 50 patients with suspected various adnexal masses were conducted for a period of 1.5yr i.e. from November 2014 to May 2016. All patients underwent pelvic and ultrasonography examination. All patients later underwent surgery. Results were correlated later.Results: The patient ages ranged from 19 to 58 with a mean age of 31.5. Most common site of origin of adnexal masses is the Ovary (Rt. 38% and Lt. 34%) Most common adnexal masses on histopathological diagnosis are mucinous cyst adenoma (20%), Benign and mature cystic teratoma (16% and 6%) and serous cyst adenoma (10%). About 92% patients with adnexal mass presents with abdominal pain as a chief complaint.Conclusions: Although bimanual palpation of the adnexal masses may not allow a very specific diagnosis, clinically useful information can usually be obtained and hence it is particularly useful as a first step in assessment of adnexal masses and as an adjunct to morphological assessment of ovarian lesions. Ultrasonography is an important noninvasive investigation and is helpful in diagnosing most of these cases, but the histopathological examination of specimen obtained from laparotomy of adnexal mass is the gold standard for confirming the diagnosis.