Mariana Horta

Hydropic leiomyoma of the uterus presenting as a giant abdominal mass

We describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. Magnetic resonance imaging (MRI) was performed to further characterise and revealed a myometrial pedunculated tumour. Despite its marked T2-signal heterogeneity and volume, there were no other suspicious findings to suggest a malignant nature; therefore, fertility-sparing myomectomy was performed. Leiomyomas frequently undergo degenerative changes altering their imaging appearances. Leiomyomas with uncommon degenerative changes may be difficult to differentiate from malignant myometrial tumours, based solely on imaging. To the best of our knowledge, a diffuse hydropic degeneration imaging appearance has only been described twice in the literature. We describe the imaging appearance of this rare form of leiomyoma drawing attention to its differential diagnosis.

Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review.

Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alpha-fetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrine-inactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker.

Chondrosarcoma of the hyoid bone: an atypical site of a sarcoma of the head and the neck.

We describe a case of a 73-year-old man with a chondrosarcoma of the hyoid bone. The patient presented with a painless palpable lump in the upper anterior cervical region that had been growing for over 10 months. Fine-needle aspiration cytology suggested pleomorphic adenoma but further imaging investigation with CT revealed an exophytic tumour originating from the body of the hyoid bone with prominent chondroid-like calcifications typical of a chondrosarcoma. Histopathology of the surgical specimen confirmed the diagnosis of a moderately differentiated chondrosarcoma. Chondrosarcomas account for 11% of all bone cancers, of which up to 12% are in the head and neck. Primary sites of the head and the neck include the skull base, the nasal cavity, the maxilla, the mandible and the larynx. Chondrosarcomas of the hyoid bone are exceptionally rare, with only 20 such cases previously reported in the English literature.

Mistakes in assessment of endometrial cancer

Purpose: To gather opinions of radiographers regarding the use of humour among students and professionals, and to apprehend possible positive and/or negative impacts of its use on the care relationship. Methods: Sample. Six hundred forty-one senior radiographers and 411 first, second or third year undergraduate radiographers, for a total sample of 1052 subjects from all over France. Material. Within a quantitative phase, both professionals radiographers and radiographers-in-training were assessed on several Likert-type scales involving concepts such as the functions of humour, and a second, qualitative phase based on open survey questions further focused on investigating the most salient concepts, notably within the senior radiographer sample. Results: Although radiographer apprentices saw the major benefits of humour in their relationships with patients (i.e. building a trust relationship, distraction technique), the senior radiographers put forward benefits especially regarding their colleagues or their own person (pleasant working environment, coping strategy during stressful events). Positive aspects of humour do prevail over the negative ones in both radiographer groups, but professionals emphasize the contextualized aspects of humour and warn that it may infringe on patients and their dignity. Conclusion: Considering humour as a personal and a professional value among the samples studied opens new perspectives on use of humour and its training within both institutional and educational contexts, preventing any possible harmful use.

Pitfalls in Imaging of Female Pelvic Masses

Purpose of ReviewThe purpose of this review is to highlight potential magnetic resonance (MR) imaging pitfalls that may mask and simulate ovarian cancer.Recent FindingsMR imaging is the standard method for evaluating female pelvic masses of indeterminate origin, especially sonographically indeterminate adnexal masses.To define the correct origin and nature of a pelvic mass has an enormous clinical impact, namely in females of child-bearing age. This is particularly true in adnexal lesions. Ovarian cancer usually requires a cytoreductive surgery in a specialized oncological centre. In contrast, a benign ovarian lesion may be treated by simple resection in a general hospital.To help preventing diagnostic errors and in order to guide appropriate therapeutic management, radiologists should be aware of potential MR pitfalls that may mask and simulate ovarian cancer.SummaryThe first section of this article will describe the MR imaging protocol that authors perform in their oncological centre, highlighting how imaging techniques can be optimized in order to reduce pitfalls in the characterization of an indeterminate pelvic mass.In the next section, authors will revise the main anatomic and organ-specific signs that may allow the radiologist to determine the ovarian origin of a pelvic mass.Finally, benign gynaecological masses that may simulate ovarian cancer in a non-emergency setting will be discussed, with emphasis on features that may provide important clues to their diagnosis.

Ovarian Cancer from Anatomy to Functional Imaging

Ovarian carcinoma is the most common cause of death from a gynecologic malignancy with more than 2/3 of patients having peritoneal involvement at the time of diagnosis. Treatment is principally dependent on stage and extent of disease and center expertise. Patients with advanced disease are treated either by primary cytoreductive surgery (debulking) followed by adjuvant chemotherapy, or neoadjuvant chemotherapy prior to debulking surgery. Imaging at the time of initial presentation has become critical in the selection of patients who may benefit from neoadjuvant chemotherapy instead of primary debulking surgery. Moreover, with the development of neoadjuvant treatment and molecularly targeted drug, evaluation of treatment response has becoming both critical and challenging. Indeed, evaluating early tumor changes, for example, relies more on functional (assessment of tumor vascularity, necrosis, etc.) rather than macroscopic changes in tumor size. This highlights a need for novel non-invasive biomarkers to allow implementation of personalized treatment. Thus, in this review, we focus on the advances of imaging in the diagnosis and management of ovarian cancer including functional imaging and radiogenomics.