Diseases
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Clinical manifestations
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Para-clinical findings
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Gold standard
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Additional findings
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Age of onset
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Symptoms
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Physical examination
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Lab Findings
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Imaging
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Immunohistopathology
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pelvic/abdominal pain or pressure
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vaginal bleeding/discharge
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GI dysturbance
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Pleural effusion
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Fever
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Tenderness
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CT scan/US
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MRI
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Gynecologic
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Ovarian
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Follicular cysts
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–
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- It is associated with hyperestrogenism and endometrial hyperplasia
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Theca lutein cysts
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–
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- It is associated with hydatidiform moles and choriocarcinoma
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Serous cystadenoma/carcinoma
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–
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- Most common ovarian neoplasm
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Mucinous cystadenoma/carcinoma
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–
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- It may cause pseudomyxoma peritonei
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Endometrioma
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- Women in reproductive age (15 -45 y/o)
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+
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+
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+/–
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–
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–
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+
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- hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
- Powder burn hemorrhages
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Teratoma
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–
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- High level of HCG and LDH
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- It may cause ovarian torsion
- May content thyroid tissue and cause hyperthyroidism
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Dysgerminoma
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+
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–
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- High level of HCG and LDH
- Hypercalcemia
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- Sheets fried egg appearance cells
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Choriocarcinoma
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- During or after pregnancy
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–
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- Trophoblastic tissue origin
- columns and sheets of trophoblastic tissue invading uterine muscle and blood vessels
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- It is associated with bilateral Theca lutein cysts
- Cannonball metastases to the lungs
- May cause hemoptysis
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Yolk sac tumor
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- Young children
- Male infants
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–
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- Schiller-Duval bodies (glomeruli like structures)
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- The other name is ovarian endodermal sinus tumor
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Fibroma
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- Pulling sensation in the groin
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–
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–
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+/–
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–
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+/–
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- Spindle-shaped fibroblast
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- It may cause Meigs syndrome (ovarian fibroma, ascites, and hydrothorax)
- It may cause ovarian torsion
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Thecoma
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–
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Granulosa cell tumor
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+
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+/–
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–
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–
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_
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- High level of estrogen and progestron
- We may see inhibin, calretinin, and Ki-67 on the surface of granulosa cell tumor cells
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- In US we may see solid, cystic, or multiloculated solid and cystic mass
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- We may see solid, cystic, or multiloculated solid and cystic mass
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- In postmenopausal women may cause breast tenderness
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Sertoli-leydig cell tumor
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+/–
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–
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–
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–
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–
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–
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- In US we may see unilateral Well-defined hypoechoic lesion
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- Low T2 signal intensity
- areas of high signal intensity
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- Lydig cells (Polygonal pink cells with eosinophilic cytoplasm
- Sertoli cells (clear vacuolated cytoplasm)
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Brenner tumor
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+/–
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–
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–
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–
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_
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_
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_
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- In US we may see hypoechoic solid mass and calcification
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- Hypointense on T2 because of fibrous content
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- Yellow/pale appearance
- Transitional cell tumor (resembles bladder)
- Coffee bean nuclei on H&E
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- Most of the times it's an accidental finding
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Krukenberg tumor
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+/–
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–
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+/–
Based on underlying malignancy
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+/–
Based on underlying malignancy
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–
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–
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- In case of metastatic GI cancers we may see iron deficiency anemia
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- Mostly bilateral, complex ovarian lesion
- In CT scan we may see evidence of concurrent malignancy in other organs
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- 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
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- Mucin-secreting signet cell
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Imaging/biopsy
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- The most common primary tumor is in colon, stomach, breast, lung, and contralateral ovary.
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Tubal
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tubo-ovarian abscess
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+
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+
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–
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–
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+
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+
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- High levels of inflammatory markers
- Leukocytosis
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- In US we may see multilocular complex lesion mostly bilateral with debry inside
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- We may see a pelvic mass filled with fluid with thick walls
- hypointense in T1 and heterogeneous in T2
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- In abscess aspiration we may see anaerobic organisms
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- The most common risk factors are previous PID, diabetes mellitus, intrauterine device and history of uterine surgery
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Ectopic pregnancy
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- Women in reproductive age (15 -45 y/o)
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+
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+
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+/–
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–
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–
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+
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- High level of BhCG
- Progesterone level ≤5 ng/ml
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- In US we may see empty uterine cavity, tubal ring sign, ring of fire sign (Doppler), extra-uterine fetal heart rate
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- Any women in reproductive age presenting with abdominal pain or amenorrhea should be screened for ectopic pregnancy
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Hydrosalpinx
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+
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–
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–
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–
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–
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+/–
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–
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- In US we may see tubal longitudinal folds thickening (cogwheel appearance)
- In CT scan we may see tubular adnexal lesion with fluid attenuation
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- Dilated Fallopian tube with fluid signal intensity
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- It is associated with endometriosis (haematosalpinx), ovulation induction, pelvic inflammatory disease, post-hysterectomy, tubal ligation, and tubal malignancy
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Salpingitis
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- Women of reproductive age
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+
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+
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–
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–
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+
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+
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- In US we may see , edematous and thickened endosalpingeal folds
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Fallopian tube epithelial carcinoma
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+
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+/–
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+
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+
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–
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+/–
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- It is associated with para-neoplastic syndromes such as polyneuritis, dermatomyositis, cerebellar degeneration, disseminated intravascular coagulation, hemolytic anemia, acanthosis, or nephrotic syndrome
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Uterine
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Leiomyoma
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- Women of reproductive age
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+
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+
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–
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–
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–
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+/–
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- In chronic cases, we may see mild anemia
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- In US we may see hypoechoic mass with calcification and cystic areas of necrosis or degeneration may
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- 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
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Leiomyosarcoma
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+
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+
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–
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–
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–
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+/–
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- In some cases we may see elevated levels of CA 125 lactate dehydrogenase
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- Heterogeneous mass with central low attenuation (necrosis) and calcification.
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- Increased uterine size
- Irregular central zones of low signal intensity (tumor necrosis)
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- We may see atypical cells, high mitotic rate, geographic areas of coagulative necrosis separated from viable neoplasm
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- In case of rapid uterine growth in post menopausal women we may suspect uterine sarcoma
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Pregnancy
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- Women in reproductive age (15 -45 y/o)
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+/−
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+/−
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+/−
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–
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–
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–
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- In US we may see gestational sac, yolk sac, double bleb sign and fetal pore
- In CT scan we may see cystic structure filled with fluid, curvilinear enhancing structure (placenta) and fetal pore
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- Cystic structure filled with fluid
- Curvilinear enhancing structure (placenta)
- Fetal pore
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- History/laboratory findings
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- We do not perform CT scan and MRI in pregnancy but We may unintentionally image the pregnancy with CT scan and MRI.
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Non-gynecologic
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GIT
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Appendiceal abscess
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+
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–
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+
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+
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+/–
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+
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- Fluid collection in the appendicular region
- appendicolith may be visualized.
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- Fluid collection in the appendicular region
- appendicolith may be visualized.
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- The most common complication of acute appendicitis
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Appendiceal neoplasm[1]
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- 60-70 y/o for adenocarcinoma,
- 30-50 y/o for carcinoid tumors
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+
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–
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+
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+
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–
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+/–
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- In adenocarcinoma type we may have high levels of CEA and CA 19-9
- In carcinoid type we may see high levels of chromogranin A, 5-HIAA and Ki67
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- In CT scan we may see:
- Soft tissue thickening and Cystic lesion with Internal septation
- Wall irregularity
- Calcification
- Periappendiceal fat stranding
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- Soft tissue mass in the appendix
- We may see invasion to other structures
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- Cystic structures with angiolymphatic invasion
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- It is associated with:
- MEN1 Syndome
- Ulcerative colitis
- Neurofibromatosis type 1
- HNPCC
- Smoking
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Diverticular abscess
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+
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–
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+
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+
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+/–
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+
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- Ill-defined lesion with air and fluid inside
- Adjacent bowel loop wall thickening
- Smudged mesenteric fat
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- We may see a lesion with air and fluid inside
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- Diverticular abscess happens in almost 30-40% of patients with diverticulitis
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Colorectal cancer
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+
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–
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+
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–
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–
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+/–
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- We may see tumor mass and the extension of tumor to other structures
- We may see metastasis to the liver, lung and brain
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- Based on the sub-type we may have different histopathological feature (for more information click here)
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- It is associated with smoking, positive family history, processed meat, low fiber diet, lynch Syndrome and familial adenomatous polyposis
- They have apple core lesion on barium enema xray
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Renal
Bladder
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Pelvic kidney
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−/+
In case of sever hydronephrosis or renal stone we may have pelvic pain
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–
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−
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−
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−
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−
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−
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- In sonography we may see normal appearing kidney in pelvic position
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- We may see normal kidney structure
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- It may cause hypertension
- It may cause tract infection (UTI), obstruction, and renal calculi.
- It may be associated with (RCC)
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Bladder cancer
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+
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–
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–
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–
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–
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–
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- In CT scan we may see masses protruding into the bladder lumen or asymmetric thickening of the bladder
- calcifications
- Nodal metastases
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- isointense compared to muscle in T!
- slightly hyperintense compared to muscle in T2
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- Based on the sub-type we may have different histopathological feature (for more information click here)
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- It may presents with hematuria
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Others
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Retroperitoneal sarcoma[2]
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+
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–
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+
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−
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−
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−
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- Mild leukocytosis.
- It may cause hypoglycemia because of production of insulinlike substances
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- We may see irregular solid, semisolid, liquefactive areas and patchy necrosis on CT scan
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- We may see retroperitoneal involement and degree of tumor extenstion
- We may see liver and lung metastasis
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- There are two types: liposarcoma and leiomyosarcoma
- In liposarcomas we may see background of adipocytes with scattered lipoblasts, and inflammatory cell infiltrate
- In leiomyosarcoma we may see smooth muscle cells
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- May cause lower extremity edema, Serous ascites
- we should perform chest CT scan to rule out pulmonary metastases
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