Interactive Transcript
0:00
Alright.
0:00
So, we have two more cases to fly through very quickly
0:04
and they are very quick, so I think we'll be fine.
0:07
So this is a 70-year-old woman who had
0:09
a pelvic ultrasound done for evaluation of dysuria.
0:13
She was found to have a right adnexal mass,
0:16
which we're going to...
0:18
which they recommended an MR to further characterize.
0:21
On ultrasound, it looked a lot like an endometrioma.
0:23
I'm not going to show you the images
0:24
because there was no way for me to anonymize them.
0:28
So she does not have endometriosis,
0:30
but she does have this big right adnexel mass.
0:33
It is very T2 dark, homogeneously so,
0:36
and homogeneously T2 bright.
0:39
It looks pretty simple except that there's a little bump
0:43
along the wall right here. And that bump is T1 dark,
0:48
maybe a little bit T2 bright if you hallucinate with me.
0:51
And now we're going to move on and look at a
0:53
different type of sequence and we've looked at before.
0:56
Because this is not an endometrioma, I will give you the spoiler alert.
1:01
So if we look at our...
1:06
If we look at our sagittal
1:07
and this is a subtraction,
1:08
I'm just going to jump right to the important findings.
1:11
So if we look right here,
1:13
this is that little teeny tiny nodule and this is a subtraction image.
1:17
So this cannot be intrinsic T1 hyperintensity.
1:20
This is actually enhancement.
1:22
So we have what looks like
1:24
an endometrioma, but there's a little enhancing nodule along the wall.
1:28
Can we get to the next question, please?
1:32
So which of the following is the most
1:33
specific sign of malignant degeneration in an endometrioma?
1:36
Is it restricted diffusion,
1:38
the presence of septations, loss of T2-shading,
1:40
or an enhancing mural nodule?
1:43
Awesome, everybody got it correct.
1:44
So the enhancing mural nodule is the most suspicious feature.
1:48
Restricted diffusion,
1:49
septations and loss of T2-shading,
1:51
which is basically tumor cells secreting fluid,
1:54
increasing the T2 signal of the endometrioma.
1:57
All of those things can be seen in both benign and malignant endometriomas.
2:02
Endometriomas can degenerate into a malignancy in like 1% to 2% of cases.
2:08
So it's not very many.
2:10
But it is reason enough to follow
2:11
endometriomas when you see them.
2:14
They are more common when the lesion is really large,
2:16
so like greater than 9cm.
2:18
It's uncommon for an endometrioma
2:20
less than 6cm to degenerate into a malignancy.
2:23
And the types of malignancies that these turn into are endometrioid and clear cell.
© 2024 MRI Online. All Rights Reserved.