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Mucinous Cystadenoma & Epithelial Ovarian Malignancy

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Here's another case of a very large

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pelvic mass in a 47-year-old patient.

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She came to us for both ultrasound and CT.

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So in the ultrasound you can see

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a huge mass with multiple internal

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thin septations and multiple locules.

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And then on the CT.

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The locules are separated by thin

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septations that don't show much enhancement.

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There's no real nodular enhancement.

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But what's interesting is if you

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look at the composition of the

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locules, there's variable density.

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So this one here looks more like simple fluid.

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And then these two locules here

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have a bit more density to them.

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So potentially they may have some hemorrhage

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or some protein in it, or maybe some mucin.

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And this is a pretty characteristic

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appearance of a mucinous lesion.

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This one turned out to be a

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very large mucinous cystadenoma.

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So lots of locules with variable

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internal density or internal signal.

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And that's pretty typical

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for mucinous composition.

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So I want you to just try

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and remember this image.

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So remember the, the thin septations and

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the multiple loculations, the absence

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of really significant enhancement.

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There's maybe a bit of enhancement here,

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hard to tell, but really these multiple

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cystic spaces separated by thin septations.

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So this is obviously a very different situation.

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So this is a huge, very bizarre

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looking, heterogeneous, complex

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mass, and this is characteristic of

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an epithelial ovarian malignancy.

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So this would be, without

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a doubt, an ORADS 5 lesion.

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So big mass, the T2 signal is very heterogeneous

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with areas of high signal, intermediate signal,

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low signal, and then look at the enhancement.

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So there's nodular enhancement,

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solid enhancement, the septations

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look much thicker than we saw in the other case.

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So you can see how the complexity changes

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over that spectrum from benign to malignant.

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So that's an ORADS 5.

Report

Faculty

Zahra Kassam, MD, FRCPC

Associate Professor of Medical Imaging, Division Head of Body Imaging

Western University

Tags

Ultrasound

Ovaries

Non-infectious Inflammatory

Neoplastic

MRI

Gynecologic (GYN)

CT

Body

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