I. De Blasis

Imaging in gynecological disease (9): clinical and ultrasound characteristics of tubal cancer

To describe clinical history and ultrasound findings in patients with tubal carcinoma.

Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis

To elucidate the ultrasound features that can discriminate between benign and malignant ovarian cysts with papillary projections but no other solid component in pregnant women.

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to predict partial response in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery

Chemoradiation‐based neoadjuvant treatment followed by radical surgery is an alternative therapeutic strategy for locally advanced cervical cancer (LACC), but ultrasound variables used to predict partial response to neoadjuvant treatment are not well defined. Our goal was to analyze prospectively the potential role of transvaginal ultrasound in early prediction of partial pathological response, assessed in terms of residual disease at histology, in a large, single‐institution series of LACC patients triaged to neoadjuvant treatment followed by radical surgery.

Burkitt's lymphoma of the breast metastatic to the ovary diagnosed during pregnancy

In September 2010, a 30-year-old primigravida at 16 weeks of gestation was referred to our institution because of rapid and progressive bilateral enlargement of her breasts. Physical examination disclosed enlarged, grossly indurated breasts with tightness of the skin (Figure 1a) and no peripheral adenopathy. Ultrasound examination of the breasts revealed increased glandular vascularization and diffuse parenchymal disease without focal masses (Figure 2). Transvaginal sonography showed bilateral ovoidal solid ovarian masses, 7 cm (right) and 6.4 cm (left) in size, with homogeneous hypoechoic echostructure and regular margins (Figure 1b). On color Doppler examination, rich vascularization was detected; in particular, a main tree-shaped vessel corresponding to the so-called ‘lead vessel’, described in the literature as strongly predictive of metastatic ovarian tumor, was

Ovarian metastasis from adenocarcinoma of the lung

A 38-year-old woman affected by an unresectable pulmonary adenocarcinoma, diagnosed 1 year earlier by bronchoscopy with biopsies and treated with platinum–pemetrexed-based chemotherapy, was referred to our center after the incidental finding of a left ovarian mass. On ultrasound examination a solid lesion, 46 × 36 × 29 mm in size, was detected in the left ovary. The solid lesion appeared as a rounded lobulated mass, with a homogeneous echotexture with no stripes. Ovarian parenchyma adjacent to the mass (the so-called ‘crescent sign’) was clearly visible at the lateral part of the adnexum (size, 19 × 20 × 14 mm) (Figure 1). On power Doppler examination, moderate vascularization was detected (color score, 3) within the ovarian lesion (Figure 2). The contralateral ovary was normal. No free fluid in the pouch of Douglas was detected. Serum tumor markers were: CA 125, 32 U/mL; CA 19.9, 52 U/mL. The ultrasound examiner was uncertain as to the diagnosis. The first suggestion was ovarian fibroma, supported by the presence of a rounded solid lesion with an adjacent ovarian crescent sign, despite the fact that the absence of stripes meant that the echostructure was inconsistent with the typical ovarian fibroma appearance. A diagnosis of metastatic tumor was considered to be improbable because the examiner had never seen the crescent sign in the presence of an ovarian metastatic tumor. An open laparoscopy revealed that the uterus, Fallopian tubes and right ovary were normal, and confirmed the presence of a solid tumor adjacent to normal parenchyma in the left adnexal region. There were no signs of peritoneal carcinomatosis. The surgeon confirmed the suspicion of an ovarian fibroma and proceeded with enucleation of the solid ovarian lesion and its removal from the abdominal cavity through an endoscopic bag. There was no rupture of the tumor in the peritoneal cavity and ovarian parenchyma that appeared normal was left in situ. Final pathology revealed an ovarian metastasis from a poorly differentiated adenocarcinoma of the lung. The morphological diagnosis was confirmed by immunohistochemical staining, which was positive for keratin 7, thyroid transcription factor-1, cyclin-dependent kinase inhibitor 2A and tumor protein 53, and negative for vimentin, estrogen receptor, progesterone receptor, gross cystic disease fluid protein-15, cytokeratin 20 and CDX2 e WT1. Pulmonary metastases to the ovaries are extremely rare. A few cases have been reported in the pathology literature, but only around 5% of women with lung cancer have ovarian metastases at autopsy1. They typically appear as uni/bilateral multinodular lesions, with widespread necrosis and extensive lymphovascular invasion; involvement of the ovarian surface is rare for adenocarcinoma of the lung, while for the small-cell carcinoma histotype, the ovarian parenchyma is usually obliterated2. Figure 1 Gray-scale ultrasound image of ovarian metastasis from lung adenocarcinoma, showing a solid tumor with lobulated margins adjacent to normal ovarian parenchyma, the latter marked by calipers.

OP08.04: Clinical and ultrasound characteristics of malignant ovarian masses in pregnant women: Short oral presentation abstracts

Results The median age was 32.5 (range, 23-42) years old. 2/22 (9%) patients had a mucinous borderline tumor, 8/22 (36.4%) had a serous or endocervicaltype borderline tumor, 7/22 (31.8%) had a primary epithelial ovarian carcinoma and 5/22 (22.8%) had a metastatic tumor to the ovary. On ultrasound, mucinous ovarian borderline tumors were described as multilocular (1/2,50%) or multilocularsolid (1/2,50%) lesions, with a minimal vascularization. Serous/endocervical-type borderline tumors were described as unilocularsolid (3/8, 37.5%) or multilocular-solid (5/8, 62.5%) masses and all of them had papillary projections. Conclusion

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to predict partial response in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery: Cervical cancer and ultrasound

Chemoradiation‐based neoadjuvant treatment followed by radical surgery is an alternative therapeutic strategy for locally advanced cervical cancer (LACC), but ultrasound variables used to predict partial response to neoadjuvant treatment are not well defined. Our goal was to analyze prospectively the potential role of transvaginal ultrasound in early prediction of partial pathological response, assessed in terms of residual disease at histology, in a large, single‐institution series of LACC patients triaged to neoadjuvant treatment followed by radical surgery.

Ultrasound appearance of retroperitoneal pelvic Solitary Fibrous Tumor: US appearance of retroperioneal pelvic SFT

A 44-year-old woman was referred to our center after diagnosis of a pelvic mass on MRI. She had pain in sacral region for the last 8 months. Ultrasound examination showed a retrouterine solid mass of 72x75x86 mm in size, with a spherical shape and regular margins, inhomogeneous echotexture and no stripy shadows (Figure 1a). This article is protected by copyright. All rights reserved.

OP31.05: Ultrasound appearance of decidualised deep endometriosis during pregnancy

Objectives: To assess the changes in the volume of endometriomas and rectovaginal endometriotic nodules (RVE) during 12-month treatment with norethindrone acetate (NETA) versus extended-cycle oral contraceptive. Methods: This patient preference prospective study included women of reproductive age with endometriosis. Patients received either continuous oral treatment with NETA (2.5 mg/day, Primolut-Nor® Schering, Milan, Italy; group A) or a 91-day extended-cycle oral contraceptive (LNG/EE 150/30 mcg for 84 days and EE 10 mcg for 7 days, Seasonique® Teva, Assago, Italy; group B) for 12 months. The volume of the lesions was assessed by virtual organ computer-aided analysis (VOCAL, GE Healthcare, USA). The changes in the volume of endometriomas and RVE were compared between baseline, after 6 and 12 months of treatment. The echogenicity of the endometriomas was subjectively evaluated by the ultrasonographer using a Likert scale. Results: 100 patients were enrolled in the study (50 in each group). 45 patients completed the treatment in group A and 38 in group B. In both study groups, the volume of the cysts significantly decreased at 6 (p<0.05) and 12 months of treatment (p<0.05; percentage reduction: 56.5% in group A and 55.7% in group B) compared with baseline. The decrease in the volume of the cyst between 6-month and 12-month treatment reached statistical significance in both study groups (p < 0.05). After 12 months of treatment, the echogenicity of the endometriomas significantly changed in both study groups (p<0.05). After 6 and 12 months of treatment, the volume of the RVE significantly decreased in both groups compared to baseline. There was a significant reduction in the volume of the RVE between the 6 and 12 months of treatment (p<0.05 for both study groups). Conclusions: Both NETA and Seasonique® are effective in reducing the volume of the endometriomas and RVE.

Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE (PRospective Imaging of CErvical cancer and neoadjuvant treatment) study: the role of ultrasound

Chemoradiation‐based neoadjuvant treatment followed by radical surgery is an alternative therapeutic strategy for locally advanced cervical cancer (LACC), but ultrasound variables used to predict partial response to neoadjuvant treatment are not well defined. Our goal was to analyze prospectively the potential role of transvaginal ultrasound in early prediction of partial pathological response, assessed in terms of residual disease at histology, in a large, single‐institution series of LACC patients triaged to neoadjuvant treatment followed by radical surgery.