Diffusion Magnetic Resonance Imaging in Differentiation of Ovarian Cystic Lesions

Background: MRI can specifically diagnose some certain pathologic types by providing accurate information on fat, collagen and hemorrhage. Diffusion-weighted magnetic resonance imaging, an emerging non-invasive MRI technique, is of the capability to evaluate the extent of microscopic diffusion which might exist in biologic tissues. Evidence has shown that DWI-MRI and ADC were beneficial in differentiating malignant from benign ovarian lesions and may be helpful to predict suboptimal cytoreduction in ovarian cancer. The aim of this study to assess the role of magnetic resonance imaging with diffusion weighted images in the assessment and differentiation of ovarian cystic lesions. Methods: This prospective study was conducted on 30 female patients who are proved by ultrasound to have ovarian cystic lesions. Selected patients were given butylscopolamine bromide (20mg) administered IV or intramuscularly at the beginning of the examination. Imaging is performed with the patient in the supine position with an empty urinary bladder. A distended urinary bladder is not recommended because it increases phase ghost artifacts and can compress the uterus. Results: As regards diagnosis according to Ultrasound examination, revealed that ovarian cancer and simple cyst were the most frequent (26.7% and 20% respectively), followed by Tubo-ovarian hydrosalpinx and Hemorrhagic cyst (10%) each. Ovarian serous cyst adenoma constituted (6.7%), while pyosalpinx, PCO, hydrosalpinx, and endometrial cyst constitutes (3.3%) each. As regards diagnosis according to MRI examination, Simple cyst and ovarian cancer were the most frequent (13.3%) each, followed by Tubo-ovarian hydrosalpinx and Hemorrhagic cyst (10%) each. Krekenberg tumor, Ovarian dermoid, and Ovarian serous cyst adenoma constituted 6.7% each. As regards the ADC value was significantly lower in the malignant lesions (0.7*103) than benign ones (0.9*103). As regards histopathologic confirmation, 23 cases of the studied women, Ovarian cancer (17.4%), Tubo-ovarian hydrosalpinx (13.0%), and Hemorrhagic cyst (13.0%) were the most common diagnosis. Ovarian dermoid, Krekenberg tumor, and Ovarian serous cyst adenoma constituted 8.7% each. Other less frequent diagnosis included Endometeriotic cyst, Hydrosalpnix, Mucinous cystadenoma, Ovarian serous cyst adenocarcinoma, Ovarian dysgerminoma and Terato-dermoid (4.3%) each. The mean ADC value was significantly lower in the malignant lesions than benign ones. At a cut off ≤0.7, ADC showed a significant good diagnostic value of malignant lesions with sensitivity, Specificity, and an accuracy. Conclusions: DWI to conventional MRI is an important tool. It improves the specificity of MRI and thus increasing radiologist’s confidence in image interpretation which will finally reflect on patients’outcome and prognosis. Cost effective technique (no additional cost to MRI examination), was easily added to MR study protocols.

A Retrospective Clinicopathological Study of Malignant Ovarian Tumors: A 3 Year Experience in a Tertiary Health Care Center of Dhaka, Bangladesh

Background: Ovarian tumors are a heterogeneous group of neoplasm that have become increasingly important now-a-days because of their large variety of neoplastic entities and gradually increased rate of mortality due to female genital cancers. Objectives: The aim of this study was to analyze the histopathological pattern and clinical presentation of malignant ovarian tumors according to the WHO classification of ovarian tumors [2003] in a tertiary care center of Dhaka, Bangladesh. Materials and Methods: This retrospective study included and studied a total of 54 cases of malignant ovarian tumors at the Department of Obstetrics and Gynecology, Popular Medical College Hospital, Dhaka, Bangladesh over a period of 3 years from Jan 2015 to Dec 2017. Results: The mean age was 47.44±14.24 years old (age ranged from 20-70 years). Of the 54 malignant ovarian tumors studied, the commonest histological pattern observed in the study was serous cyst adenocarcinoma constituting 26 cases (48.15%) followed by adenocarcinoma of ovary (25.9%), mucinous cyst adenocarcinoma (14.8%), endometriod adenocarcinoma (3.7%), dysgerminoma (3.7%) and ovarian choriocarcinoma (3.7%). High level of serum CA125 was found in most of the cases (n=48; 88.89%). The chief complaints were abdominal pain (n=38; 70.37%) and abdominal distension (n=29; 53.70%). Majority were admitted with less than one month duration of symptoms. The size of the tumor varied from 2.2 to 20 cm. All the patients were admitted in III and IV stage. Conclusions: Serous cyst adenocarcinoma was the common finding of this study. The prognosis and varying therapeutic strategies of malignant ovarian tumors necessitate an accurate histopathological evaluation. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 100-105

A Study on Histopathological Pattern of Ovarian Tumours in Chittagong Medical College Hospital

Background: Ovarian tumours may either be asymptomatic, found on the routine ultrasound examination or symptoms may be vague till the patient has an acute emergency like torsion or rupture of a benign cyst. The worst is late presentation of malignant ovarian tumour. There is marked variation in the presentation of the tumour as well as in histological types. This study was under taken to analyse modes of presentation and various histopathological patterns of ovarian tumour. Materials and Methods: A total of 69 cases were selected consecutively. The age range was 13-70 years. This study was carried out in the Department of Pathology, Chittagong Medical College and Department of Gynaecology and obstetrics, Chittagong Medical College Hospital during the period from July 2013 to June 2014. The specimens of ovarian tumours were subjected to histopathological examination in the histopathology section. Results : Out of 69 cases, 54(78.3%) were benign and 15(21.7%) were malignant tumour. There was no borderline malignancy in our study. The commonest histological pattern in this study was surface epithelial tumour 49(70.6%) including both benign and malignant tumour followed by germ cell tumour 6(8.7%). The commonest benign tumour was serous cyst cyst adenoma 23(33.4) and malignant tumour was serous cyst adenocarcinoma 5(7.2%). Conclusion : Surface epithelial tumours are the commonest variety of ovarian tumour followed by germ cell tumour. The histological type of ovarian tumour correlates with the prognosis of the tumour. Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 13-17

Excerpt from the meeting of the Council of Physicians of the Kazan Tubernsk Zemsky Hospital on April 13, 1894

Dr. IM Lvov showed the following preparations: 1) A cancerous-degenerated uterus removed through the vagina in a 37-year-old patient, the cervix was crater-like eaten away, but the cellulose was not affected. Operation without any particular difficulty; the patient is recovering. 2) The right ovary enlarged to the size of a goose egg and containing a septicemic focus the size of a hen's egg and the same size serous cyst, removed together with the right fallopian tube through the vagina in a 25-year-old patient who also had retraversionem uteri fixatam. The operation is very easy, the uterus is separated from the joints and placed in the correct position. The patient recovered. 3) a 3-week-old fertilized egg with an embryo in it.

An unusual presentation of huge paraovarian cyst as papillary serous cyst adenofibroma: a rare case report

Paraovarian cysts constitute 10-20% of all adnexal masses and are usually less than two centimeter in diameter. Authors reported a 20-year-old unmarried female with vague abdominal discomfort since 1 year. On examination abdomen was uniformly distended with central position of umbilicus. Ultrasonography showed a large cystic mass extending from pelvis to pancreas likely of ovarian origin. Biochemical evaluation was not suggestive of malignant nature of this cystic mass. So, with due care of cosmesis, surgery was planned. After the midline vertical incision, peritoneal washings were collected for oicytological analysis to further exclude malignancy. Then 5mm cannula with trocar was inserted into the cyst to suck out the fluid then shrunken cystic wall was exteriorised. Right ovary was absolutely healthy. Enucleation of the cyst was done with preservation of ovary. Histopathology reported as a papillary serous cyst adenofibroma. Follow up period was uneventful.