8. FNA Cytology
• NEGATIVE FOR
CARCINOMA.
Polymorphic
population of
lymphocytes,
consistent with
lymph node sampling.
• Concordant?
• Recommend surgical
excision
9. Lymph nodes with scattered small
aggregates of macrophages (micro-
granulomas) and calcification (including
psammoma-body type calcifications)
associated with multinucleated giant cells.
21. Grade 2 Invasive Lobular Carcinoma
with LN positive for Metastatic Adenocarcinoma
SURGERY – Mastectomy with LN dissection
22. Invasive Lobular Carcinoma
• 10-15% of all invasive breast ca
• Sensitivity of MG 57-81%
– Mass most common – usually spiculated (44-
65%)
– Distortion 10-34%
– Asymmetry 1-14%
• Much less freq assoc with calcs than IDC
• Sensitivity of US 68-98%
– Spiculated mass
– Shadowing
Lopez et al. Radiographics 2009; 29:165.
23. Invasive Lobular Carcinoma
• Sensitivity of MRI up to 95%
– Changes in clinical management up to 50%
– Changes in surgical management up to 28%
• Kinetics – progressive more typical than
washout
Lopez et al. Radiographics 2009; 29:165.
24. Companion Case
64 yo female
6 months hx of “right breast is swollen; it‟s not the same”.
MG – dense tissues, negative.
Clinical breast exam – negative.
Sent for US by PCP – negative.
Biopsy – DCIS. Surgery – mastectomy.
36. Situs Inversus Totalis
• 3-5% with cardiac abnormalities
• 25% with primary ciliary dyskinesia (PCD)
– Kartagener‟s Syndrome
– Chronic sinus infections; respiratory infections;
infertility
37. Terminology
• Situs solitus – normal anatomy
• Situs inversus – mirror image of normal
• Situs ambiguous – heterotaxy
– Disordered arrangement of organs in chest and
abdomen
– Asplenia – right atrial isomerism
– Polyslenia – left atrial isomerism
38. Esophageal Atresia
• Polyhydramnios
• small / absent stomach if no
fistula
• Often other assoc anomalies
– Imperforate anus
– Duodenal atresia/stenosis
– Vertebral/rib anomalies
– VACTERL spectrum
40. HISTORY
• 40 yo female 8.5 weeks pregant
• S/P D&C for pregnancy implanted at site of
c-section scar
41.
42. • 6 weeks post D&C patient presents with
heavy persistent bleeding
• For Pelvic US
• HCG = 451 mIU/mL
43.
44.
45.
46.
47.
48.
49.
50. D&C complicated by Perforation,
AVM w RPOC at Site of Perforation
• AVM – Acquired or Congenital
• Acquired
– Traumatic – D&C, TAB, uterine surgery
– Less common: Endometrial / Cervical CA, GTD
– Clue on US: numerous tortuous vessels, high velocities
• Tx:
– transcatheter arterial embolization
• Potential to preserve fertility
– UA ligation, hysterectomy
55. HISTORY
• 42 yo female
• Recent immigrant from China
• C/O postcoital and intermenstrual bleeding
• Abnormal GYN exam
• Abnormal biopsy
• Further imaging performed
56.
57.
58.
59.
60.
61.
62.
63. MRI findings - Stage IIB
with PET/CT - Stage IIIB
Cervical Cancer
64. Stage I – Carcinoma Confined to Cervix
<= 4 cm greatest dimension > 4 cm greatest dimension
<= 7 mm wide
A1 < =3mm deep
A2 >3 but < 5mm deep
65. Stage II – Carcinoma Invades Beyond Uterus
But not to Pelvic Wall or Lower 1/3 Vagina
With(A) or without (B)
parametrial invasion
66. Stage III – Carcinoma to Pelvic Wall and/or Lower 1/3 of
Vagina and/or Causes Hydronephrosis or Nonfxing Kidneys
Lower 1/3 Vagina
No pelvic wall
Extends to pelvic wall
and/or renal issues
67. Stage IV – Carcinoma beyond True Pelvis or Involvement
Of Mucosa of Bladder or Rectum (bx proven)
Distant Mets
Spread to adj organs
68. Role of MR Imaging in Tx Stratification
of GYN (Cervical) Cancer
• Cervical Cancer – 2nd most common ca in women
worldwide
– Developing countries; pk 30-40 yrs
• FIGO classification – revised in 2009 from just clinical to
incorporate cross-sectional imaging (CT, MR)
• Staging accuracy of MR 85-96%
– Best test to assess tumor size and location; invasion into
parametria, pelvic side wall, adjacent organs; local nodal enlgment
• PET/CT helpful in staging advanced disease
– Demonstrates unexpected sites beyond pelvis
• Treatment options
– Radical surgery - early stage (IA, IB1, IIA1)
– Primary Chemo and Radiation – bulky IB2 or IIA2, or local
advanced (IIB or greater)
Sala et al. Radiology 2013; 266: 717.
