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Endometriosis on MRI Case 8

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Alright.

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So, we have two more cases to fly through very quickly

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and they are very quick, so I think we'll be fine.

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So this is a 70-year-old woman who had

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a pelvic ultrasound done for evaluation of dysuria.

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She was found to have a right adnexal mass,

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which we're going to...

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which they recommended an MR to further characterize.

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On ultrasound, it looked a lot like an endometrioma.

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I'm not going to show you the images

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because there was no way for me to anonymize them.

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So she does not have endometriosis,

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but she does have this big right adnexel mass.

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It is very T2 dark, homogeneously so,

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and homogeneously T2 bright.

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It looks pretty simple except that there's a little bump

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along the wall right here. And that bump is T1 dark,

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maybe a little bit T2 bright if you hallucinate with me.

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And now we're going to move on and look at a

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different type of sequence and we've looked at before.

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Because this is not an endometrioma, I will give you the spoiler alert.

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So if we look at our...

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If we look at our sagittal

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and this is a subtraction,

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I'm just going to jump right to the important findings.

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So if we look right here,

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this is that little teeny tiny nodule and this is a subtraction image.

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So this cannot be intrinsic T1 hyperintensity.

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This is actually enhancement.

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So we have what looks like

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an endometrioma, but there's a little enhancing nodule along the wall.

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Can we get to the next question, please?

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So which of the following is the most

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specific sign of malignant degeneration in an endometrioma?

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Is it restricted diffusion,

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the presence of septations, loss of T2-shading,

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or an enhancing mural nodule?

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Awesome, everybody got it correct.

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So the enhancing mural nodule is the most suspicious feature.

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Restricted diffusion,

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septations and loss of T2-shading,

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which is basically tumor cells secreting fluid,

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increasing the T2 signal of the endometrioma.

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All of those things can be seen in both benign and malignant endometriomas.

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Endometriomas can degenerate into a malignancy in like 1% to 2% of cases.

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So it's not very many.

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But it is reason enough to follow

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endometriomas when you see them.

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They are more common when the lesion is really large,

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so like greater than 9cm.

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It's uncommon for an endometrioma

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less than 6cm to degenerate into a malignancy.

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And the types of malignancies that these turn into are endometrioid and clear cell.

Report

Faculty

Kristine S Burk, MD

Instructor in Radiology, Harvard Medical School

Brigham and Women's Hospital

Tags

Uterus

MRI

Gynecologic (Gyn)

Gynecologic (GYN)

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