Diseases
|
Clinical manifestations
|
Para-clinical findings
|
Gold standard
|
Additional findings
|
Age of onset
|
Symptoms
|
Physical examination
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Lab Findings
|
Imaging
|
Immunohistopathology
|
pelvic/abdominal pain or pressure
|
vaginal bleeding/discharge
|
GI dysturbance
|
Fever
|
Tenderness
|
CT scan/US
|
MRI
|
Gynecologic
|
Ovarian
|
Follicular cysts
|
- Women in reproductive age (15 -45 y/o)
|
+/–
|
–
|
–
|
–
|
+/–
|
- High level of estrogen +/–
|
- In US we may see a >3 cm simple cyst with no internal echo and with posterior acoustic enhancement
|
- simple cyst with no internal echo or septa
|
|
|
- It is associated with hyperestrogenism and endometrial hyperplasia
|
Theca lutein cysts
|
- Women in reproductive age (15 -45 y/o)
|
+/–
|
–
|
–
|
–
|
+/–
|
- Depends on the underlying etiology
|
- In US we may see bilaterally enlarged ovaries with multiple cysts
|
|
- theca interna cell Hyperplasia
|
|
- It is associated with hydatidiform moles, choriocarcinoma, diabetes mellitus and clomiphene intake (ovulation induction)
|
Serous cystadenoma/carcinoma
|
|
+/–
|
–
|
–
|
–
|
+/–
|
|
|
|
- Cyst wall consist of benign/malignant Fallopian epithelial layer
|
|
- Most common ovarian neoplasm
|
Mucinous cystadenoma/carcinoma
|
|
+/–
|
–
|
–
|
–
|
+/–
|
|
|
|
|
|
- It may cause pseudomyxoma peritonei
|
Endometrioma
|
- Women in reproductive age (15 -45 y/o)
|
+
|
+
|
+/–
|
–
|
+
|
|
|
- hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
- Powder burn hemorrhages
|
|
|
|
Teratoma
|
|
+/–
|
–
|
–
|
–
|
+/–
|
- High level of HCG and LDH
|
- In US we may see cystic adnexal mass with mural components and echogenic lesion due to calcification
- The iceberg sign
- Dot-dash pattern
|
- We may see evidence of fat components
|
- All three germ layers cell
|
|
- It may cause ovarian torsion
- May content thyroid tissue and cause hyperthyroidism
- In plane radiography we may see calcification due to the presence of tooth in the tumor
|
Dysgerminoma
|
- in the second to third decade of life
|
+
|
+/–
|
–
|
–
|
+/–
|
- High level of HCG and LDH
- Hypercalcemia
|
- Multilobulated solid masses
|
- We may see ovarian mass with septation which are hyperintense on T1 and hypo or isointense on T2 imaging
|
- Sheets fried egg appearance cells
|
|
|
Yolk sac tumor
|
- Young children
- Male infants
|
+
|
–
|
–
|
–
|
+
|
|
- In US we may see a combination of echogenic and hypoechoic components
|
- Ovarian mass with hemorrhagic areas
|
- Schiller-Duval bodies (glomeruli like structures)
|
|
- The other name is ovarian endodermal sinus tumor
|
Fibroma
|
|
- Pulling sensation in the groin
|
–
|
–
|
–
|
+/–
|
|
- In CT scan we may see a unilateral mass with poor contrast enhancement
|
- Low signal intensity on T1 and T2
- We may see scattered hyperintense areas due to edema or cystic degeneration
|
- Spindle-shaped fibroblast
|
|
- It may cause Meigs syndrome (ovarian fibroma, ascites, and hydrothorax)
- It may cause ovarian torsion
- It may cause pleural effusion
|
Thecoma
|
|
+/–
|
|
–
|
–
|
–
|
|
- In US we may see non-specific ovarian mass
- We may see evidence of endometrial hyperplasia due to increased level of estrogen
|
- Hyperintense on T2
- T1 intensity depends on the amount of fibrous tissue (fibrous tissue lead to hypointensity)
|
- Lipid-laden stromal cells with pale, vaculolated cytoplasm
|
|
- We may see endometrial cancer as e result of hyper-estrogenism
- We may see ovarian fibrothecoma (mixture of fibroma and thecoma)
|
Granulosa cell tumor
|
|
+
|
|
+/–
|
–
|
–
|
- High level of estrogen and progestron
- We may see inhibin, calretinin, and Ki-67 on the surface of granulosa cell tumor cells
|
- In US we may see solid, cystic, or multiloculated solid and cystic mass
|
- We may see solid, cystic, or multiloculated solid and cystic mass
|
|
|
- In postmenopausal women may cause breast tenderness
|
Sertoli-leydig cell tumor
|
|
+/–
|
–
|
–
|
–
|
–
|
|
- In US we may see unilateral Well-defined hypoechoic lesion
|
- Low T2 signal intensity
- areas of high signal intensity
|
- Lydig cells (Polygonal pink cells with eosinophilic cytoplasm
- Sertoli cells (clear vacuolated cytoplasm)
|
|
|
Brenner tumor
|
|
+/–
|
–
|
–
|
–
|
–
|
–
|
- In US we may see hypoechoic solid mass and calcification
|
- Hypointense on T2 because of fibrous content
|
- Yellow/pale appearance
- Transitional cell tumor (resembles bladder)
- Coffee bean nuclei on H&E
|
|
- Most of the times it's an accidental finding
|
Krukenberg tumor
|
|
+/–
|
–
|
+/–
Based on underlying malignancy
|
–
|
–
|
- In case of metastatic GI cancers we may see iron deficiency anemia
|
- Mostly bilateral, complex ovarian lesion
- In CT scan we may see evidence of concurrent malignancy in other organs
|
- Mostly bilateral, complex ovarian lesion with solid components
- Internal hyperintensity on T1 and T2 weighted MR images because of mucin
- Evidence of concurrent malignancy in other organs
|
- Mucin-secreting signet cell
|
|
- The most common primary tumor is in colon, stomach, breast, lung, and contralateral ovary
- Based on underlying malignancy it may cause peural effusion
|
Tubal
|
tubo-ovarian abscess
|
|
+
|
+
|
–
|
+
|
+
|
- High levels of inflammatory markers
- Leukocytosis
|
- In US we may see multilocular complex lesion mostly bilateral with debry inside
|
- We may see a pelvic mass filled with fluid with thick walls
- hypointense in T1 and heterogeneous in T2
|
- In abscess aspiration we may see anaerobic organisms
|
|
- The most common risk factors are previous PID, diabetes mellitus, intrauterine device and history of uterine surgery
|
Ectopic pregnancy
|
- Women in reproductive age (15 -45 y/o)
|
+
|
+
|
+/–
|
–
|
+
|
- High level of BhCG
- Progesterone level ≤5 ng/ml
|
- In US we may see empty uterine cavity, tubal ring sign, ring of fire sign (Doppler), extra-uterine fetal heart rate
|
|
|
|
- Any women in reproductive age presenting with abdominal pain or amenorrhea should be screened for ectopic pregnancy
|
Hydrosalpinx
|
|
+
|
–
|
–
|
–
|
+/–
|
–
|
- In US we may see tubal longitudinal folds thickening (cogwheel appearance)
- In CT scan we may see tubular adnexal lesion with fluid attenuation
|
- Dilated Fallopian tube with fluid signal intensity
|
|
|
- It is associated with endometriosis (haematosalpinx), ovulation induction, pelvic inflammatory disease, post-hysterectomy, tubal ligation, and tubal malignancy
|
Salpingitis
|
- Women of reproductive age
|
+
|
+
|
–
|
+
|
+
|
|
- In US we may see , edematous and thickened endosalpingeal folds
|
|
|
|
|
Fallopian tube carcinoma
|
|
+
|
+
|
+
|
–
|
+/–
|
|
- US findings are non specific (complex mass on Fallopian tube
- We may see papillary projections
|
- In case of hemorrhage inside the tumor we may see high signal intensity on T1
- Low or of intermediate signal on T2
- In case of serous fluid inside the tumor we may see high signal intensity on T2
|
- Based on the tumor type we may have different biopsy finding
|
|
- We may see Latzko triad (abdominal pain, vaginal discgarge, pelvic mass)
- It may cause pleural effusion
|
Uterine
|
Leiomyoma
|
- Women of reproductive age
|
+
|
+
|
–
|
–
|
+/–
|
- In chronic cases, we may see mild anemia
|
- In US we may see hypoechoic mass with calcification and cystic areas of necrosis or degeneration may
|
- Low to intermediate signal intensity on T1 and T2
- In case of necrosis inside the mass, there might be some high signal lesions on T2
|
|
|
|
Choriocarcinoma
|
- Women in reproductive age (15 -45 y/o)
|
+
|
+
|
+/–
|
–
|
+
|
|
- In US we may see heterogeneous mass infiltrating myometrium
- Enlarged uterus
- Necrosis +
- Hemorrhage +
- In CT scan we may see evidence of metastasis to brain, lung and other organs
|
- We may see an infiltrative uterine mass and thickening of uterine wall
|
- Trophoblastic tissue origin
- columns and sheets of trophoblastic tissue invading uterine muscle and blood vessels
|
|
- It is associated with bilateral Theca lutein cysts
- Cannonball metastases to the lungs
- May cause hemoptysis
- We may see passing of grapes like tissue from the vagina
|
Leiomyosarcoma
|
|
+
|
+
|
–
|
–
|
+/–
|
|
|
- Increased uterine size
- Irregular central zones of low signal intensity (tumor necrosis)
|
|
|
|
Pregnancy
|
|
+/−
|
+/−
|
+/−
|
–
|
–
|
|
|
|
|
|
|
Non-gynecologic
|
GIT
|
Appendiceal abscess
|
|
+
|
–
|
+
|
+/–
|
+
|
|
|
|
|
|
|
Appendiceal neoplasm[1]
|
|
+
|
–
|
+
|
–
|
+/–
|
|
|
- Soft tissue mass in the appendix
- We may see invasion to other structures
|
- Cystic structures with angiolymphatic invasion
|
|
- It is associated with:
- It may cause pleural effusion
|
Diverticular abscess
|
|
+
|
–
|
+
|
+/–
|
+
|
|
- Ill-defined lesion with air and fluid inside
- Adjacent bowel loop wall thickening
- Smudged mesenteric fat
|
- We may see a lesion with air and fluid inside
|
|
|
|
Colorectal cancer
|
|
+
|
–
|
+
|
–
|
+/–
|
|
|
- We may see tumor mass and the extension of tumor to other structures
|
|
|
|
Renal
Bladder
|
Pelvic kidney
|
|
−/+
In case of sever hydronephrosis or renal stone we may have pelvic pain
|
–
|
−
|
−
|
−
|
−
|
|
- We may see normal kidney structure
|
|
|
- It may cause tract infection (UTI), obstruction, and renal calculi.
- It may be associated with RCC
|
Bladder cancer
|
|
+
|
–
|
–
|
–
|
–
|
|
|
- isointense compared to muscle in T!
- slightly hyperintense compared to muscle in T2
|
|
|
|
Others
|
Retroperitoneal sarcoma[2]
|
|
+
|
–
|
+
|
−
|
−
|
|
|
|
|
|
|