Urology gynecology correlative imaging of gynecological diseases t lamJFIM
This document discusses the use of correlative imaging techniques for gynecological diseases. It provides examples of using structural imaging like MRI and CT to detail anatomy and lesion characteristics. It also explores tissue characterization to differentiate tissues and tumors. Cancer staging is discussed, highlighting how imaging can accurately assess tumor extent and involvement of surrounding structures. Functional imaging techniques like PET/CT are also summarized for evaluating tumor response to treatment and detecting metastases in ovarian and other gynecological cancers.
Prostate cancer is the most common cancer among men. It develops in the prostate gland. Some key risk factors include age, family history, and ethnicity. Staging of prostate cancer involves determining the extent of spread using the TNM system. Treatment options depend on staging and include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Common side effects of treatment include erectile dysfunction, urinary incontinence, and loss of sexual desire. Nursing care focuses on managing side effects, preventing infections, maintaining skin integrity, and providing psychosocial support.
This document provides information about bladder cancer including its definition, types, risk factors, signs and symptoms, staging, diagnostic tests, and treatment options. It defines bladder cancer as uncontrolled growth of cells in the bladder and lists the main types as urothelial carcinoma, squamous cell carcinoma, and flat carcinoma. Risk factors include smoking, chemicals, and chronic infections. Signs may include blood in urine, urinary changes, bone pain, and weight loss. Staging uses TNM criteria and treatments include surgery, chemotherapy, radiation, immunotherapy, and managing side effects.
Uterine or endometrial cancer is the most common gynecological malignancy, with a lifetime risk of 2.6%. It typically affects post-menopausal women around age 61. Most cases are diagnosed at an early stage. Treatment involves surgery such as a hysterectomy along with removal of ovaries and lymph nodes, with additional radiation therapy recommended for high-risk features like deep invasion or spread. Later stage cancers may have spread to lymph nodes, requiring radiation to additional areas. Prognosis depends on stage and grade, with 5-year survival rates ranging from over 90% for early stage to under 20% for late stage. Radiation is commonly delivered through vaginal cylinders or newer techniques like tomotherapy to
Incidental adnexal masses were detected in 4.1% of asymptomatic women age 50 and older undergoing low-dose CT colonography screening. Of the 118 women found to have indeterminate adnexal masses, further imaging and surgery revealed benign findings such as cysts and teratomas in all cases. No ovarian cancers were identified prospectively. Additionally, 4 cases of ovarian cancer were later diagnosed in women who had a normal adnexal finding on their initial CT screening. This suggests that a single CT screening may not be effective at detecting early-stage ovarian cancers. More research is needed to determine if screening higher-risk groups could improve ovarian cancer outcomes.
CES202101 - Clase 15 parte 1 - Cáncer de cérvix Mauricio Lema
The document outlines the FIGO staging systems for ovarian cancer, endometrial cancer, and cervical cancer. It describes the stages from I to IV, defining the extent of primary tumor and metastasis involvement for each type of cancer. It then focuses on cervical cancer, discussing the TNM classification system and how it can guide therapy depending on whether the cancer is non-bulky or bulky. Treatment options including surgery, radiation, chemotherapy, and chemoradiation are covered.
- The most common benign ovarian tumor is a cystadenoma, while the most common ovarian carcinoma is a papillary serous cystoadenocarcinoma.
- Germ cell tumors are classified as benign, such as mature teratomas, or malignant, including dysgerminoma, endodermal sinus tumors, and immature teratomas. Tumor markers help identify specific germ cell tumors.
- Sex cord-stromal tumors include granulosa cell tumors and Sertoli-Leydig cell tumors, which can secrete testosterone.
- Metastatic tumors to the ovaries also occur, such as the Krukenberg tumor from gastric cancer.
- Risk factors
Ovarian cancer arises from the epithelial tissue lining the ovaries. There are several classifications of ovarian cancer including surface epithelial tumors, germ cell tumors, and sex cord stromal tumors. Risk factors include nulliparity and family history. Symptoms are often vague but include abdominal pain or bloating. Staging involves examining if the cancer is localized to the ovaries or has spread within the pelvis or further. Treatment depends on the stage but commonly involves surgery to remove the ovaries and chemotherapy. Prognosis is best for early stage disease and worse for late stage disease.
Urology gynecology correlative imaging of gynecological diseases t lamJFIM
This document discusses the use of correlative imaging techniques for gynecological diseases. It provides examples of using structural imaging like MRI and CT to detail anatomy and lesion characteristics. It also explores tissue characterization to differentiate tissues and tumors. Cancer staging is discussed, highlighting how imaging can accurately assess tumor extent and involvement of surrounding structures. Functional imaging techniques like PET/CT are also summarized for evaluating tumor response to treatment and detecting metastases in ovarian and other gynecological cancers.
Prostate cancer is the most common cancer among men. It develops in the prostate gland. Some key risk factors include age, family history, and ethnicity. Staging of prostate cancer involves determining the extent of spread using the TNM system. Treatment options depend on staging and include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Common side effects of treatment include erectile dysfunction, urinary incontinence, and loss of sexual desire. Nursing care focuses on managing side effects, preventing infections, maintaining skin integrity, and providing psychosocial support.
This document provides information about bladder cancer including its definition, types, risk factors, signs and symptoms, staging, diagnostic tests, and treatment options. It defines bladder cancer as uncontrolled growth of cells in the bladder and lists the main types as urothelial carcinoma, squamous cell carcinoma, and flat carcinoma. Risk factors include smoking, chemicals, and chronic infections. Signs may include blood in urine, urinary changes, bone pain, and weight loss. Staging uses TNM criteria and treatments include surgery, chemotherapy, radiation, immunotherapy, and managing side effects.
Uterine or endometrial cancer is the most common gynecological malignancy, with a lifetime risk of 2.6%. It typically affects post-menopausal women around age 61. Most cases are diagnosed at an early stage. Treatment involves surgery such as a hysterectomy along with removal of ovaries and lymph nodes, with additional radiation therapy recommended for high-risk features like deep invasion or spread. Later stage cancers may have spread to lymph nodes, requiring radiation to additional areas. Prognosis depends on stage and grade, with 5-year survival rates ranging from over 90% for early stage to under 20% for late stage. Radiation is commonly delivered through vaginal cylinders or newer techniques like tomotherapy to
Incidental adnexal masses were detected in 4.1% of asymptomatic women age 50 and older undergoing low-dose CT colonography screening. Of the 118 women found to have indeterminate adnexal masses, further imaging and surgery revealed benign findings such as cysts and teratomas in all cases. No ovarian cancers were identified prospectively. Additionally, 4 cases of ovarian cancer were later diagnosed in women who had a normal adnexal finding on their initial CT screening. This suggests that a single CT screening may not be effective at detecting early-stage ovarian cancers. More research is needed to determine if screening higher-risk groups could improve ovarian cancer outcomes.
CES202101 - Clase 15 parte 1 - Cáncer de cérvix Mauricio Lema
The document outlines the FIGO staging systems for ovarian cancer, endometrial cancer, and cervical cancer. It describes the stages from I to IV, defining the extent of primary tumor and metastasis involvement for each type of cancer. It then focuses on cervical cancer, discussing the TNM classification system and how it can guide therapy depending on whether the cancer is non-bulky or bulky. Treatment options including surgery, radiation, chemotherapy, and chemoradiation are covered.
- The most common benign ovarian tumor is a cystadenoma, while the most common ovarian carcinoma is a papillary serous cystoadenocarcinoma.
- Germ cell tumors are classified as benign, such as mature teratomas, or malignant, including dysgerminoma, endodermal sinus tumors, and immature teratomas. Tumor markers help identify specific germ cell tumors.
- Sex cord-stromal tumors include granulosa cell tumors and Sertoli-Leydig cell tumors, which can secrete testosterone.
- Metastatic tumors to the ovaries also occur, such as the Krukenberg tumor from gastric cancer.
- Risk factors
Ovarian cancer arises from the epithelial tissue lining the ovaries. There are several classifications of ovarian cancer including surface epithelial tumors, germ cell tumors, and sex cord stromal tumors. Risk factors include nulliparity and family history. Symptoms are often vague but include abdominal pain or bloating. Staging involves examining if the cancer is localized to the ovaries or has spread within the pelvis or further. Treatment depends on the stage but commonly involves surgery to remove the ovaries and chemotherapy. Prognosis is best for early stage disease and worse for late stage disease.
Bladder cancer is usually urothelial carcinoma, with increased risk from smoking and industrial carcinogens. Symptoms include painless blood in urine during urination, frequent or urgent urination, and pelvic pain. Diagnosis involves cystoscopy and biopsy, while staging uses TURBT, imaging of kidneys and ureters. Treatment depends on invasion - non-invasive gets TURBT and immunotherapy in bladder, muscle invasion gets radical cystectomy and chemotherapy, while metastatic disease receives systemic chemotherapy and immunotherapy.
This document discusses bladder cancer including incidence, risk factors, histology, staging, and treatment approaches. Some key points:
- Bladder cancer is the 4th most common cancer in Egypt and the 6th-7th most common in the USA. Risk factors include occupational exposures, Schistosomiasis, smoking, and certain drugs.
- Treatment depends on stage and grade. Non-muscle invasive cancers are treated with transurethral resection and intravesical therapies. Muscle invasive cancers require radical cystectomy, chemotherapy, or chemoradiation.
- Egyptian bladder cancers have higher rates of squamous cell carcinoma compared to the USA due to higher Schistosomiasis rates
Prof james bently endometrial ca generalistBasalama Ali
This document discusses endometrial cancer care by a gynecologist. It provides information on the epidemiology, risk factors, pathology, staging, management after diagnosis, role of adjuvant therapies like radiation and chemotherapy, surgical approaches, who needs radiation or chemotherapy, and follow up care for endometrial cancer patients. It emphasizes evaluating patients carefully and working with gynecologic oncologists for advanced or high risk cases. Guidelines for investigation, surgery, and adjuvant therapies in endometrial cancer are also referenced.
Ovarian cancer is the seventh most common cancer in women worldwide. It has a high mortality rate due to over 75% of cases being diagnosed at late stages when the cancer has spread. The major risk factors include genetic mutations, such as BRCA1 and BRCA2, as well as reproductive factors like fewer pregnancies. The main types are epithelial ovarian carcinomas, which make up 90% of ovarian cancer cases. Screening tools include transvaginal ultrasounds, CA125 testing, and the OVA1 test, but early detection remains a challenge due to asymptomatic nature in early stages. Research is ongoing into novel therapies and molecular targets for the different subtypes of this cancer.
This document summarizes key information about bladder cancer, including:
- Bladder cancer is the 5th most common cancer in men and 9th in women, with smoking being the main risk factor.
- Transitional cell carcinoma accounts for 90% of cases. Muscle-invasive bladder cancers have a 5-year survival rate ranging from 31-65% depending on stage, while non-muscle invasive cancers have a over 85% 5-year survival rate.
- Diagnosis involves cystoscopy, biopsy, and imaging tests. Treatment depends on stage and includes transurethral resection, intravesical therapy, chemotherapy, and radical cystectomy for muscle-invasive tumors.
Ovarian cancer is the fifth leading cause of cancer death in women. 75% of cases present with stage III or IV disease due to vague symptoms. Risk factors include increasing age, family history, nulliparity, infertility and BRCA gene mutations. Diagnosis involves imaging such as ultrasound and CT scan along with serum marker CA-125. Staging follows the FIGO system and 5-year survival ranges from 80% for stage I to 10% for stage IV disease. Treatment involves surgical debulking followed by chemotherapy, with the goal of optimal cytoreduction to improve prognosis.
The document discusses premalignant and malignant disorders of the uterine corpus, specifically endometrial carcinoma. It covers the epidemiology, risk factors, classification, clinical presentation, diagnosis, staging, prognosis, differential diagnosis, and treatment of endometrial carcinoma. The highest incidence is in white North Americans over age 60. Risk factors include obesity, diabetes, nulliparity, late menopause, and unopposed estrogen use. Diagnosis involves endometrial biopsy and ultrasound. Prognosis depends on stage - stage I has an 85% 5-year survival rate. Treatment involves hysterectomy, with radiation for higher stages or risk factors.
Uterine sarcoma is a rare and challenging type of cancer that grows rapidly. It accounts for 2-5% of uterine malignancies and is diagnosed in about 17 per 1000 women annually. Risk factors include prior pelvic radiation and black race. Long-term tamoxifen use also increases the risk. The most common presenting symptom is vaginal bleeding. Surgery is the primary treatment but the benefits of adjuvant radiation and chemotherapy are unclear due to limited data. Prognosis is generally poor, especially for later stages, and more research is needed to determine optimal adjuvant therapies.
Ovarian cancer is a major cause of morbidity and mortality in gynecological patients. They often present late with pressure symptoms caused by their large size. The most common type is high grade serous carcinoma. Treatment involves surgical staging and debulking followed by chemotherapy with carboplatin, which is the standard treatment. Prognosis is poor due to lack of effective screening, and most cases are diagnosed at advanced stages, with overall 5-year survival rates ranging from 5-30% for stages III and IV.
Phyllodes Tumors: What is the Best Therapeutic Option?_ Crimson PublishersCrimsonpublishers-IGRWH
1) Phyllodes tumors of the breast are rare fibroepithelial tumors that resemble fibroadenomas. They are classified as benign, borderline, or malignant based on histological features.
2) Surgical resection is considered the best therapeutic option due to the high recurrence rate of 27% for malignant phyllodes tumors. For small (<5cm) benign tumors, tumor resection with 1-2cm margins is recommended, while mastectomy is recommended for malignant tumors or those >5cm.
3) The role of adjuvant therapies after surgery is still unclear due to limited studies with small sample sizes. Individualization of adjuvant treatment based on tumor characteristics may be considered.
Primary Endometrial Stromal Sarcoma arising from Cervixiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
1. Ovarian cancer is the most common type of ovarian tumor and the 7th most common cancer in women.
2. Early stages of ovarian cancer are often asymptomatic but later stages can cause pressure symptoms like abdominal pain or bloating.
3. Ovarian cancer commonly spreads directly to nearby structures in the abdomen or through the lymphatic system to distant lymph nodes.
This document discusses bladder carcinoma, including its incidence, risk factors, pathogenesis, clinical features, imaging, histopathology, staging, and treatment options. It provides details on transitional cell carcinoma and other rare types. Treatment may involve transurethral resection of the tumor, intravesical chemotherapy or immunotherapy, radical cystectomy, radiation, chemotherapy, or a combination based on the stage and grade of cancer. The goal is to prevent recurrence, progression, and spread to lymph nodes or distant sites.
This document discusses breast cancer awareness month and provides details on a case of a 37-year-old woman presenting with a rapidly growing mass in her right breast. The mass was examined and found to be a large, firm, irregular mass. Differential diagnoses included giant fibroadenoma, phyllodes tumor, and carcinoma. Further workup and histological analysis determined it was a phyllodes tumor, a rare benign breast tumor that can occasionally become malignant. Treatment options and outcomes for phyllodes tumors are summarized.
This document provides information on ovarian carcinoma, including its epidemiology, aetiology, types, symptoms, investigations, staging, treatment, and chemotherapy agents and side effects. The key points are:
- Ovarian carcinoma is believed to be caused by repeated damage to the ovarian surface during ovulation. Risk factors include nulliparity, early menarche/late menopause, and factors that suppress ovulation.
- The main types are epithelial (65%), germ cell (15%), and sex cord-stromal (10%). Serous cystadenocarcinoma is the most common epithelial type.
- Symptoms are non-specific but include abdominal discomfort/fullness. CA125 is an
Malignant ovarian tumours are associated with ovulation and reproduction. There are two main theories for their development: the incessant ovulation theory related to repeated ovulation trauma causing genetic mutations, and excess gonadotrophin secretions promoting higher estrogen levels and epithelial proliferation. Ovarian cancers are classified into epithelial, sex cord stromal, germ cell, and metastatic tumours. Epithelial tumours make up 80% of cases and include serous, mucinous, endometrioid, clear cell, and undifferentiated subtypes. Surgery is the initial treatment and involves staging and cytoreductive procedures. Post-operative chemotherapy with a taxane/platinum combination is standard treatment except for
Bladder cancer is one of the most common cancers in the United States. It typically begins in the innermost tissue layer of the bladder called the urothelium. The most common type is transitional cell carcinoma, which accounts for around 90% of cases. Risk factors include smoking, exposure to certain chemicals, and bladder infections. Diagnosis involves tests like cystoscopy, CT scans, and urine analysis. Treatment depends on the stage of cancer, and may include surgery to remove part or all of the bladder or chemotherapy and radiation.
non surgical therapies of bladder cancerSujay Susikar
This document summarizes the management of bladder cancer, including both superficial and invasive forms. It discusses:
1) Staging and prognosis based on TNM classification, with 5-year survival rates ranging from over 85% for stage 0 to 24% for stage IV disease.
2) Treatment options for superficial bladder cancer including transurethral resection, intravesical chemotherapy or immunotherapy like BCG, with the aim of identifying risk factors and providing aggressive treatment or prophylaxis for high-risk patients.
3) Treatment of muscle-invasive bladder cancer including radical cystectomy with lymph node dissection or alternatives like radiation therapy, with adjuvant chemotherapy possibly providing a benefit for high-risk patients.
This document provides an overview of ovarian neoplasms, discussing their classification, histopathology, immunohistochemistry, and other characteristics. The major groups include surface epithelial tumors, sex cord-stromal tumors, germ cell tumors, and metastatic tumors. Surface epithelial tumors include serous, mucinous, endometrioid, clear cell, seromucinous, and Brenner tumors. Sex cord-stromal tumors comprise granulosa cell tumor, thecoma, Sertoli-Leydig cell tumor, and steroid cell tumor. Germ cell tumors are dysgerminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, teratoma. Risk factors, tumor markers, gross
This document discusses the role of chemotherapy in gynecological malignancies, specifically ovarian cancer. It notes that ovarian cancer is a leading cause of death from gynecologic cancer and chemotherapy has improved 5-year survival rates. For advanced stage ovarian cancer, the standard treatment is primary cytoreductive surgery followed by platinum-based chemotherapy. Optimal debulking to less than 1cm residual disease results in better outcomes. For unresectable tumors, neoadjuvant chemotherapy may be given followed by interval debulking surgery. The combination of carboplatin and paclitaxel is currently the standard first-line chemotherapy regimen.
Bladder cancer is usually urothelial carcinoma, with increased risk from smoking and industrial carcinogens. Symptoms include painless blood in urine during urination, frequent or urgent urination, and pelvic pain. Diagnosis involves cystoscopy and biopsy, while staging uses TURBT, imaging of kidneys and ureters. Treatment depends on invasion - non-invasive gets TURBT and immunotherapy in bladder, muscle invasion gets radical cystectomy and chemotherapy, while metastatic disease receives systemic chemotherapy and immunotherapy.
This document discusses bladder cancer including incidence, risk factors, histology, staging, and treatment approaches. Some key points:
- Bladder cancer is the 4th most common cancer in Egypt and the 6th-7th most common in the USA. Risk factors include occupational exposures, Schistosomiasis, smoking, and certain drugs.
- Treatment depends on stage and grade. Non-muscle invasive cancers are treated with transurethral resection and intravesical therapies. Muscle invasive cancers require radical cystectomy, chemotherapy, or chemoradiation.
- Egyptian bladder cancers have higher rates of squamous cell carcinoma compared to the USA due to higher Schistosomiasis rates
Prof james bently endometrial ca generalistBasalama Ali
This document discusses endometrial cancer care by a gynecologist. It provides information on the epidemiology, risk factors, pathology, staging, management after diagnosis, role of adjuvant therapies like radiation and chemotherapy, surgical approaches, who needs radiation or chemotherapy, and follow up care for endometrial cancer patients. It emphasizes evaluating patients carefully and working with gynecologic oncologists for advanced or high risk cases. Guidelines for investigation, surgery, and adjuvant therapies in endometrial cancer are also referenced.
Ovarian cancer is the seventh most common cancer in women worldwide. It has a high mortality rate due to over 75% of cases being diagnosed at late stages when the cancer has spread. The major risk factors include genetic mutations, such as BRCA1 and BRCA2, as well as reproductive factors like fewer pregnancies. The main types are epithelial ovarian carcinomas, which make up 90% of ovarian cancer cases. Screening tools include transvaginal ultrasounds, CA125 testing, and the OVA1 test, but early detection remains a challenge due to asymptomatic nature in early stages. Research is ongoing into novel therapies and molecular targets for the different subtypes of this cancer.
This document summarizes key information about bladder cancer, including:
- Bladder cancer is the 5th most common cancer in men and 9th in women, with smoking being the main risk factor.
- Transitional cell carcinoma accounts for 90% of cases. Muscle-invasive bladder cancers have a 5-year survival rate ranging from 31-65% depending on stage, while non-muscle invasive cancers have a over 85% 5-year survival rate.
- Diagnosis involves cystoscopy, biopsy, and imaging tests. Treatment depends on stage and includes transurethral resection, intravesical therapy, chemotherapy, and radical cystectomy for muscle-invasive tumors.
Ovarian cancer is the fifth leading cause of cancer death in women. 75% of cases present with stage III or IV disease due to vague symptoms. Risk factors include increasing age, family history, nulliparity, infertility and BRCA gene mutations. Diagnosis involves imaging such as ultrasound and CT scan along with serum marker CA-125. Staging follows the FIGO system and 5-year survival ranges from 80% for stage I to 10% for stage IV disease. Treatment involves surgical debulking followed by chemotherapy, with the goal of optimal cytoreduction to improve prognosis.
The document discusses premalignant and malignant disorders of the uterine corpus, specifically endometrial carcinoma. It covers the epidemiology, risk factors, classification, clinical presentation, diagnosis, staging, prognosis, differential diagnosis, and treatment of endometrial carcinoma. The highest incidence is in white North Americans over age 60. Risk factors include obesity, diabetes, nulliparity, late menopause, and unopposed estrogen use. Diagnosis involves endometrial biopsy and ultrasound. Prognosis depends on stage - stage I has an 85% 5-year survival rate. Treatment involves hysterectomy, with radiation for higher stages or risk factors.
Uterine sarcoma is a rare and challenging type of cancer that grows rapidly. It accounts for 2-5% of uterine malignancies and is diagnosed in about 17 per 1000 women annually. Risk factors include prior pelvic radiation and black race. Long-term tamoxifen use also increases the risk. The most common presenting symptom is vaginal bleeding. Surgery is the primary treatment but the benefits of adjuvant radiation and chemotherapy are unclear due to limited data. Prognosis is generally poor, especially for later stages, and more research is needed to determine optimal adjuvant therapies.
Ovarian cancer is a major cause of morbidity and mortality in gynecological patients. They often present late with pressure symptoms caused by their large size. The most common type is high grade serous carcinoma. Treatment involves surgical staging and debulking followed by chemotherapy with carboplatin, which is the standard treatment. Prognosis is poor due to lack of effective screening, and most cases are diagnosed at advanced stages, with overall 5-year survival rates ranging from 5-30% for stages III and IV.
Phyllodes Tumors: What is the Best Therapeutic Option?_ Crimson PublishersCrimsonpublishers-IGRWH
1) Phyllodes tumors of the breast are rare fibroepithelial tumors that resemble fibroadenomas. They are classified as benign, borderline, or malignant based on histological features.
2) Surgical resection is considered the best therapeutic option due to the high recurrence rate of 27% for malignant phyllodes tumors. For small (<5cm) benign tumors, tumor resection with 1-2cm margins is recommended, while mastectomy is recommended for malignant tumors or those >5cm.
3) The role of adjuvant therapies after surgery is still unclear due to limited studies with small sample sizes. Individualization of adjuvant treatment based on tumor characteristics may be considered.
Primary Endometrial Stromal Sarcoma arising from Cervixiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
1. Ovarian cancer is the most common type of ovarian tumor and the 7th most common cancer in women.
2. Early stages of ovarian cancer are often asymptomatic but later stages can cause pressure symptoms like abdominal pain or bloating.
3. Ovarian cancer commonly spreads directly to nearby structures in the abdomen or through the lymphatic system to distant lymph nodes.
This document discusses bladder carcinoma, including its incidence, risk factors, pathogenesis, clinical features, imaging, histopathology, staging, and treatment options. It provides details on transitional cell carcinoma and other rare types. Treatment may involve transurethral resection of the tumor, intravesical chemotherapy or immunotherapy, radical cystectomy, radiation, chemotherapy, or a combination based on the stage and grade of cancer. The goal is to prevent recurrence, progression, and spread to lymph nodes or distant sites.
This document discusses breast cancer awareness month and provides details on a case of a 37-year-old woman presenting with a rapidly growing mass in her right breast. The mass was examined and found to be a large, firm, irregular mass. Differential diagnoses included giant fibroadenoma, phyllodes tumor, and carcinoma. Further workup and histological analysis determined it was a phyllodes tumor, a rare benign breast tumor that can occasionally become malignant. Treatment options and outcomes for phyllodes tumors are summarized.
This document provides information on ovarian carcinoma, including its epidemiology, aetiology, types, symptoms, investigations, staging, treatment, and chemotherapy agents and side effects. The key points are:
- Ovarian carcinoma is believed to be caused by repeated damage to the ovarian surface during ovulation. Risk factors include nulliparity, early menarche/late menopause, and factors that suppress ovulation.
- The main types are epithelial (65%), germ cell (15%), and sex cord-stromal (10%). Serous cystadenocarcinoma is the most common epithelial type.
- Symptoms are non-specific but include abdominal discomfort/fullness. CA125 is an
Malignant ovarian tumours are associated with ovulation and reproduction. There are two main theories for their development: the incessant ovulation theory related to repeated ovulation trauma causing genetic mutations, and excess gonadotrophin secretions promoting higher estrogen levels and epithelial proliferation. Ovarian cancers are classified into epithelial, sex cord stromal, germ cell, and metastatic tumours. Epithelial tumours make up 80% of cases and include serous, mucinous, endometrioid, clear cell, and undifferentiated subtypes. Surgery is the initial treatment and involves staging and cytoreductive procedures. Post-operative chemotherapy with a taxane/platinum combination is standard treatment except for
Bladder cancer is one of the most common cancers in the United States. It typically begins in the innermost tissue layer of the bladder called the urothelium. The most common type is transitional cell carcinoma, which accounts for around 90% of cases. Risk factors include smoking, exposure to certain chemicals, and bladder infections. Diagnosis involves tests like cystoscopy, CT scans, and urine analysis. Treatment depends on the stage of cancer, and may include surgery to remove part or all of the bladder or chemotherapy and radiation.
non surgical therapies of bladder cancerSujay Susikar
This document summarizes the management of bladder cancer, including both superficial and invasive forms. It discusses:
1) Staging and prognosis based on TNM classification, with 5-year survival rates ranging from over 85% for stage 0 to 24% for stage IV disease.
2) Treatment options for superficial bladder cancer including transurethral resection, intravesical chemotherapy or immunotherapy like BCG, with the aim of identifying risk factors and providing aggressive treatment or prophylaxis for high-risk patients.
3) Treatment of muscle-invasive bladder cancer including radical cystectomy with lymph node dissection or alternatives like radiation therapy, with adjuvant chemotherapy possibly providing a benefit for high-risk patients.
This document provides an overview of ovarian neoplasms, discussing their classification, histopathology, immunohistochemistry, and other characteristics. The major groups include surface epithelial tumors, sex cord-stromal tumors, germ cell tumors, and metastatic tumors. Surface epithelial tumors include serous, mucinous, endometrioid, clear cell, seromucinous, and Brenner tumors. Sex cord-stromal tumors comprise granulosa cell tumor, thecoma, Sertoli-Leydig cell tumor, and steroid cell tumor. Germ cell tumors are dysgerminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, teratoma. Risk factors, tumor markers, gross
This document discusses the role of chemotherapy in gynecological malignancies, specifically ovarian cancer. It notes that ovarian cancer is a leading cause of death from gynecologic cancer and chemotherapy has improved 5-year survival rates. For advanced stage ovarian cancer, the standard treatment is primary cytoreductive surgery followed by platinum-based chemotherapy. Optimal debulking to less than 1cm residual disease results in better outcomes. For unresectable tumors, neoadjuvant chemotherapy may be given followed by interval debulking surgery. The combination of carboplatin and paclitaxel is currently the standard first-line chemotherapy regimen.
This document discusses the optimal surgical management of ovarian cancer. It covers assessing pelvic masses, the epidemiology and etiology of ovarian cancer, recent trends in surgical approaches including primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery, management of recurrent cancer, and palliative surgery. Key points include the importance of comprehensive surgical staging for early disease, achieving optimal cytoreduction for advanced disease to improve survival outcomes, and considering secondary cytoreduction for recurrent platinum-sensitive disease.
Breast cysts can be benign or malignant. Ultrasound is often sufficient for diagnosis and uses morphology and Doppler features. Cysts are classified into types from I-VI based on features. Type I-III cysts are simple cysts assessed as BI-RADS 2 with very low risk. Type IV cysts are complicated with low level echoes and assessed as BI-RADS 3 with <2% risk. Types V-VI have solid components and are assessed as BI-RADS 4 due to higher 2-95% risk. Features, assessment, and recommended management are described for each cyst type.
CARCINOMA OF THE BREAST for mbbs 600L studentsIgbashio
This document summarizes information about carcinoma of the breast, including:
- It is the most common malignancy affecting women worldwide, with risk factors including age, family history, reproductive factors, and lifestyle.
- Types include ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma.
- Signs and symptoms include painless breast lumps, nipple discharge or retraction, and potential metastases.
- Staging uses TNM and Manchester systems and involves investigations like biopsy, imaging and blood tests.
- Treatment involves surgery, radiation, chemotherapy, hormonal therapy and other targeted approaches.
Ovarian cancer is a leading cause of death from gynecologic cancers. Chemotherapy plays an important role in its treatment. For advanced stage disease, the standard treatment is 6 cycles of carboplatin and paclitaxel chemotherapy. Neoadjuvant chemotherapy may be given for very advanced cases to allow for optimal debulking surgery. Prognostic factors like residual tumor size after surgery and tumor stage help determine prognosis and treatment. Maintenance chemotherapy may improve progression-free survival for high risk early stage disease.
Talk by Sir. Michael Brady, given at the Department of Computer Science, University of Cyprus.
Date: 24 June, 2015
This talk has two inter-twined aims. First, it introduces the medical challenges, and the science that is being developed to address those challenges, that underlie my (current) companies: Mirada Medical, Volpara Solutions, Perspectum Diagnostics, ScreenPoint bv, further illustrated by Guidance Navigation Holdings, IRISS Medical Technologies, and Acuitas Medical. Second, it asks why I am driven by the translation of mathematics and computing (white board) to clinical practice (white coats).
Professor Sir Michael Brady is currently Professor in Oncological Imaging in the Department of Oncology at the University of Oxford, having recently retired as Professor in Information Engineering (1985-2010). Mike is co-Director of the Oxford Cancer Imaging Centre, one of four national cancer imaging centres in the UK. He is the author of over 750 articles and 45 patents in computer vision, robotics, medical image analysis, and AI, and the author or editor of ten books. He has successfully supervised the PhD theses of 115 students. He is particularly well known for his pioneering research in quantitative methods for mammography and breast cancer more generally. Mike has a continuing strong commitment to commercialisation of his science and to entrepreneurial activity more generally. Current companies he has founded are: Mirada Medical; Matakina; Perspectum Diagnostics; Guidance; and ScreenPoint. As well, he is an NED of IRISS Medical Technologies; Acuitas Medical; and colwiz. He recently stepped down after 19 years as Deputy Chairman of Oxford Instruments plc. Finally, he is a member of the Syncona Advisory Board and Chair of the Royal Society Publications Board.
The document discusses breast cancer risk factors associated with shift work and night shifts. It finds an increased risk of breast cancer for those who do not sleep during typical melatonin secretion hours. Surgical options for breast cancer treatment are also examined, including mastectomy procedures and reconstruction options.
This document discusses cervical carcinoma, including its definition, epidemiology, risk factors, screening and prevention methods, diagnosis, staging, and treatment. It notes that cervical cancer is the 4th most common cancer in women worldwide, with over 80% of cases occurring in developing countries. Screening methods discussed include the Pap smear, HPV testing, and visual inspection with acetic acid. Treatment depends on the stage of cancer, and may include surgery such as hysterectomy or cone biopsy, radiation therapy, or chemoradiation for more advanced stages. The document provides details on the FIGO staging system and comparisons between the 2018 and 2009 versions.
The document discusses several uterine disorders including endometrial polyps, uterine fibroids, endometriosis, and adenomyosis. It provides details on their characteristics, risk factors, clinical presentation, investigations, and treatment options. The document also discusses malignant disorders of the uterus including endometrial cancer and cervical cancer. It covers their etiology, staging, signs and symptoms, diagnostic workup, and management approaches.
Breast cancer is the most common female cancer in the US and the second most common cause of cancer death in women. Risk factors include age, family history, lifestyle factors, and reproductive history. Evaluation of breast complaints requires a thorough history, physical exam including triple assessment with mammography, ultrasound and biopsy. Staging involves assessing tumor size, lymph node involvement and metastasis. Treatment may involve neoadjuvant chemotherapy, surgery such as mastectomy or lumpectomy with radiation, and adjuvant systemic therapy.
Presentation at Chittaranjan Seva Sadan, Kolkata where Dr Dasgupta was invited as faculty in the CME organized by Medical Education and research Committee, Bengal Obstetrics and Gynaecological Society
1. The document discusses breast anatomy and lymphatic drainage, as well as benign and malignant breast conditions including gynecomastia, fibrocystic changes, fibroadenoma, intraductal papilloma, fat necrosis, and various types of breast cancer.
2. Treatment options described include surgery, radiation, chemotherapy, and hormonal therapy. Factors that influence prognosis and treatment selection include disease stage, hormone receptor status, menopausal status, and patient age and health.
3. Conservative breast surgery along with radiation is now a standard treatment option for early stage breast cancer, offering survival rates equivalent to mastectomy with less morbidity. Adjuvant therapies further improve survival outcomes.
MRI is useful for staging cervical, endometrial, and vaginal cancers. It can determine tumor size and extent, parametrial invasion, lymph node involvement, and distant metastases. Accurate staging helps guide treatment decisions such as surgery versus radiation or chemotherapy. Diffusion-weighted imaging may help identify malignant lymph nodes and assess tumor response to treatment.
This document discusses endometriosis and its relationship to infertility. It covers several key points:
1. Endometriosis has three main types - peritoneal, ovarian, and rectovaginal - which are different entities.
2. Endometriosis can result in infertility through mechanical effects, endocrine abnormalities, changes to peritoneal fluid, immune system issues, and defects in oocytes.
3. Diagnosis is confirmed through laparoscopy, and mild or minimal endometriosis associated with infertility can be treated through laparoscopic destruction, expectant management, or GnRH agonists. Surgery aims to decrease inflammation and toxicity.
4. For endometriomas,
Cervical dysplasia and cervical cancer are caused by HPV infection, with high-risk factors including young age at first intercourse, multiple sexual partners, and smoking. Precancerous lesions are classified as CIN (cervical intraepithelial neoplasia) grades 1-3 based on pathology. Diagnosis involves cytology, colposcopy, and biopsy. Treatment depends on cancer stage and may include surgery, radiation, or chemoradiation.
Peritoneal Surgery and
Intraperitoneal Chemotherapy, presented by Garrett Nash, MD of Memorial Sloan-Kettering at the Mesothelioma Applied Research Foundation's conference in New York, NY on September 28, 2012. www.curemeso.org
This document discusses gastric carcinoma. It begins by defining gastric carcinoma as a malignant lesion of the stomach. It then discusses the epidemiology and risk factors, noting that incidence is highest in Japan and declining worldwide. Common clinical presentations include dyspepsia, epigastric pain, weight loss, and vomiting. Diagnostic tests include endoscopy with biopsy, which has high accuracy. Staging involves evaluating depth of invasion and lymph node involvement. Treatment options are surgery, chemotherapy, and radiotherapy. Prognosis depends on stage, with early-stage carcinoma having high 5-year survival rates.
Similar to Selma Beljord diffusion perfusion mri in ovarian lesions jfim ifupi milan 2018 (20)
Common: 200 000 TC/an, 12 000 death
Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury
CT: first-line of imaging
MR imaging being recommended in specific settings
MR imaging DTI, blood oxygen level–dependent fMRI, MR spectroscopy, perfusion imaging are of particular interest in identifying further injury CT and MRI are normal, as well as for prognostication in patients with persistent symptoms
However, it is an invasive procedure that is not straightforward to perform so is often reserved as a problem-solving tool when both the aortic root and valve are the prime source of interest.
This document provides information to help diagnose cervical masses. It discusses the location, onset, and elements that help determine diagnosis, such as anatomy, structure, clinical data and imaging findings. Common pathologies included cysts, solid lesions, infections and tumors. Dermoid cysts, ranulas, branchial cleft cysts, lipomas and lymphangiomas are described as typical cystic lesions. Lymphomas, schwannomas and metastases are examples of solid lesions discussed. Imaging like CT scans and MRI can help characterize lesions and rule out other conditions.
The document discusses Horner syndrome, which is caused by a lesion along the ipsilateral oculosympathetic pathway. It describes the three-neuron pathway and the clinical signs caused by disruption at different points along the pathway, including ptosis, miosis, and anhidrosis on the affected side of the face. Common causes of Horner syndrome include trauma, tumors, carotid dissection, lung cancer, and neuroblastoma in children. Imaging workup may include MRI of the brain, neck, and chest to localize the lesion causing the syndrome depending on whether it is a first, second, or third-order lesion.
This document provides guidance on avoiding errors in uterine imaging through proper technique and interpretation. It emphasizes using ultrasound first for clinical symptoms, then MRI if the diagnosis is unknown or for pre-treatment planning of uterine fibroids or carcinoma of the cervix or endometrium. Key factors for accurate assessment of cervical and endometrial cancers include using motion-corrected T2 sequences, diffusion-weighted imaging, and dynamic contrast-enhanced MRI to evaluate lesion size, myometrial invasion, and lymph node involvement. Following standardized protocols and being aware of limitations and pitfalls can help optimize uterine imaging.
1) Thoracic biopsies and ablations often have complications that can be avoided by following lessons learned from past errors and cases.
2) Three case examples are described where complications such as pneumothorax, hemorrhage, and nerve damage occurred but were managed by applying techniques like choosing shorter needle paths, coagulating bleeding with ablation, and preventing direct contact with nearby structures.
3) Overall the document emphasizes knowing anatomy, being cautious with new devices or patients with other health factors, and applying preventative measures to avoid life-threatening complications during thoracic procedures.
This document discusses non-contrast MR lymphography for evaluating the lymphatic system. It can be used to diagnose lymphedema through detecting fluid collections, infiltration patterns, and dermal thickening. It also describes evaluating lymph node metastasis, lymphangiomas, and other lymphatic abnormalities and complications. MR lymphography is non-invasive and can uniquely image lymphatic anatomy while having limitations in spatial resolution. It provides diagnosis and localization of various lymphatic diseases and postoperative conditions.
1) Arterial spin labeling (ASL) is an MRI technique that allows non-invasive measurement of cerebral blood flow without using an exogenous contrast agent. It works by magnetically labeling arterial blood water protons upstream of the imaging region.
2) There are different ASL techniques including continuous, pulsed, and pseudo-continuous ASL. Image processing is needed to generate perfusion maps from labeled and control image pairs.
3) ASL has applications in neurology for assessing cerebral perfusion in conditions such as dementia. It is also used for functional MRI to localize brain activity with improved spatial precision compared to BOLD imaging.
The document discusses the use of MRI in diagnosing dementia. It recommends performing an MRI scan in all newly diagnosed cases of dementia to rule out other causes and search for evidence of primary degenerative dementia. The standard MRI protocol includes 3D T1, axial FLAIR, coronal T2, axial T2*, and axial diffusion sequences. The diagnostic approach involves assessing for atrophy patterns characteristic of different dementias, as well as white matter abnormalities, hemorrhages, and perfusion changes. Quantification of hippocampal atrophy and global atrophy progression over time can aid diagnosis. Multimodal imaging such as PET-MRI may provide further insights in the future.
This document discusses advanced imaging techniques for pancreatic lesions. It begins by introducing new concepts in pancreatic imaging including downstaging of adenocarcinoma and prognostic stratification of neuroendocrine tumors. It then describes the multi-parametric MR protocol used, highlighting the added value of different sequences for detecting and characterizing lesions. Advanced techniques such as texture analysis of downstaged tumors on CT and 3D texture analysis of neuroendocrine neoplasms are also mentioned. The document emphasizes that imaging is becoming more quantitative and able to provide prognostic information beyond simple detection and characterization of lesions.
This document summarizes current approaches to diagnosing small hepatocellular carcinoma (HCC) in patients with liver cirrhosis. It discusses that cirrhosis is associated with an increased risk of HCC due to factors like hepatitis B, C, alcohol, and non-alcoholic fatty liver disease. Guidelines recommend ultrasound surveillance every 6 months for HCC detection in cirrhotic patients. While ultrasound has reasonable sensitivity, specificity is improved when combined with tumor markers or additional imaging modalities. The document reviews vascular changes, imaging features, and protocols for CT, MRI, and contrast agents that optimize detection of small HCCs in this high-risk population.
Stereotactic body radiotherapy (SBRT) delivers high doses of radiation to liver lesions while sparing surrounding tissues. For hepatocellular carcinoma (HCC), SBRT results in local control rates of 87% at 1 year and median overall survival of 17 months. For liver metastases, SBRT achieves complete and partial response rates of 60-80% and median progression-free survival of 15.1 months. Response is evaluated using multiparametric MRI and RECIST/mRECIST criteria. Persistent enhancement after SBRT may indicate fibrosis rather than tumor in some cases. SBRT is a feasible, low toxicity treatment option for selected liver lesions.
The document discusses gadolinium retention in brain and other tissues following administration of gadolinium-based contrast agents for MRI. It provides evidence from several studies that small amounts of gadolinium can be retained in brain regions like the dentate nucleus and globus pallidus. Linear agents appear to result in higher retention than macrocyclic agents. While the long-term risks are unknown, no evidence currently suggests harm. European regulators have suspended approval for intravenous linear agents except two. The document emphasizes using contrast only when essential diagnostic information cannot be obtained without.
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- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
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O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Selma Beljord diffusion perfusion mri in ovarian lesions jfim ifupi milan 2018
1. S . B E L D J O R D - I . T H O M A S S I N - N A G G A R A - M . B A Z O T
DIFFUSION- AND PERFUSION-WEIGHTED
MRI IN OVARIAN LESIONS
1st Italian-French Update Imaging – IFUPI
Advanced Multiparametric Imaging - How to use in daily practice
MILAN March 23-24 2018
2. INTRODUCTION
• Ovarian tumors : leading indication for gynecologic
surgery +++
• Imaging techniques :
• Reducing the number of women unnecessarily undergoing
cancer surgery
• preserving fertility in young women (laparoscopy versus
laparotomy)
• Referring patients to a cancer centre with specialist
gynecological oncologist (better outcome)
• Misdiagnoses with frozen intra-operative histology
Bazot M et al Eur Radiol 2006
3. MRI : INDETERMINATE OR COMPLEX
ADNEXAL MASSES
Accuracy:
MRI > CT or US+Doppler
Cost effectiveness :
Risk of malignancy is small
Improvement of surgical
diagnoses
Earlier diagnosis of cancer
Kinkel et al. Radiology 2005
Mucinous benign cystadenoma
5. MRI : « THE 4 STEPS PRACTICAL
APPROACH »
• Step 1 : Is this an ovarian mass ? T2
• Step 2 : Is there fat or blood component ? T1/T1FS
• Step 3 : Is there solid tissue ? T1 post-gado
• Step 4 : Is there malignant tissue ? T2 + DWI + PWI
6. MRI : « THE 4 STEPS PRACTICAL
APPROACH »
• Step 1 : Is this an ovarian mass ? T2
• Step 2 : Is there fat or blood component ? T1/T1FS
• Step 3 : Is there solid tissue ? T1 post-gado
• Step 4 : Is there malignant tissue ? T2 + DWI + PWI
7. MRI : « THE 4 STEPS PRACTICAL
APPROACH »
• Step 1 : Is this an ovarian mass ? T2
• Step 2 : Is there fat or blood component ? T1/T1FS
• Step 3 : Is there solid tissue ? T1 post-gado
• Step 4 : Is there malignant tissue ? T2 + DWI + PWISECOND TISSUE PORTION CHARACTERIZATION
8. 1st : Looking for homolateral normal ovary
Para ovarian cyst
Ovarian fibromaEndometrial cysts
2nd : Looking for residual ovarian tissue: crescent sign
STEP 1 : LOCATION : IS THIS AN OVARIAN
MASS ? T2
3rd : Looking for lombo-ovarian pedicle
Peritoneal cyst
16. STEP 3 : IS THERE SOLID TISSUE?
T1 GADO ++
Gadolinium injection is very useful for
adnexal mass characterization because
absence of enhancement is highly
predictive of benign disease
21. STEP 3 : IS THERE SOLID TISSUE ?
T1 GADO ++
• Absence of solid tissue
• No wall enhancement or no internal enhancement
including purely cystic, endometriotic, fatty mass
• Others with internal enhancement : Bi or
multiloculate cyst with regular septa
• Presence of solid tissue >>> characterization
• T2 weighted sequence
• Diffusion weighted imaging (DWI)
• Perfusion weighted imaging (PWI)
BENIGN
PROBABLY BENIGN
(PPV<5%)
22. STEP 4 : IS THERE MALIGNANT TISSUE ? T2 /
DWI / PWI
Thomassin-Naggara I, et al. Radiology 2011
23. STEP 4 : IS THERE MALIGNANT TISSUE ?
T2 / DWI / PWI
T2 signal : Detection of fibrous component ++
Intermediate T2 signal Low T2 signal
T2T2
Siegelman ES et al... Radiology 1999
Outwater EK, et al.. J Magn Reson Imaging 1997
Sohaib et al. AJR 2003
24. STEP 4 : IS THERE MALIGNANT TISSUE ? T2 /
DWI / PWI
T2
DWI
Ovarian
cystadenocarcinoma
Invasive
malignant
tumor always
displays high
b1000 signal ….
Ovarian fibroma
…But some
benign tumors
may also display
high b1000 signal
T2
DWI
DWI : Signal
Qualitative analysis
25. STEP 4 : IS THERE MALIGNANT TISSUE ?
T2 / PWI / DWI
T2
In contrast, the absence of high b1000
signal is highly predictive of benignity
(PLR = 10.1)
Cystadenofibroma
T1FS gado DWI
DWI : Signal
Thomassin-Naggara I, et al. Eur Radiol 2009
26. STEP 4 : IS THERE MALIGNANT TISSUE ?
T2 / PWI / DWI
PWI : Time Intensity curve and neoangiogenesis
Invasive malignant tumorBorderline tumorBenign tumor
Sensitivity 70%
Specificity 90.3%
Sensitivity 62.5%
Specificity 87%
Sensitivity 66%
Specificity 100%
Thomassin-Naggara I. et al. JMRI 2008
27. STEP 4 : IS THERE MALIGNANT TISSUE ?
T2 / DWI / PWI
PWI : Time Intensity curve and neoangiogenesis
Pericyte coverage index
VEGFR-2
Thomassin-Naggara et al.. Radiology 2008
37. WHAT IS YOUR DIAGNOSIS?
A. ADNEXMR SCORE 1
B. ADNEXMR SCORE 2 Benign (PPV = 0)
C. ADNEXMR SCORE 3 Probably benign (PPV<5%)
D. ADNEXMR SCORE 4 Indeterminate
E. ADNEXMR SCORE 5 Probably malignant (PPV>95%)
43. ADNEXMR SCORING SYSTEM
Thomassin-Naggara I, et al. Radiology 2013
ADNEXMR SCORE >4 predicts malignancy
with a sensitivity 93.5% and a specificity of 96.6%
ADNEXMR SCORE <3 predicts benignity
with a sensivity 96,6% and a specificity of 93,5%
Cancer center
Follow up
Conservative
surgery
ADNEXMR SCORING system relays radiologist’s suspicions to clinician and
would help to standardize MR imaging reporting with the potential aim of
improving patient management.
44. TAKE HOME MESSAGES
T1-weighted MRI = essential for cystic component
T2-weighted MRI = essential for solid component
- Low signal intensity T2-w and diffusion : benign
- Intermediate signal intensity T2-w: suspicious
DWI valuable when low signal intensity on B1000
PWI with 3 valuable time-intensity curves