Recurrent Ovarian Cancer: Spectrum of Imaging Findings
|
|
- Alexia Veronica McKenzie
- 6 years ago
- Views:
Transcription
1 Recurrent Ovarian Cancer Women s Imaging Pictorial Essay Downloaded from by on 03/08/18 from IP address Copyright RRS. For personal use only; all rights reserved WOMEN S IMGING Jin Wei Kwek 1 Revathy. Iyer Kwek JW, Iyer R Keywords: cancer, genitourinary imaging, oncologic imaging, ovarian cancer DOI: /JR Received January 3, 2005; accepted after revision pril 18, oth authors: Department of Diagnostic Imaging, Unit 57, The University of Texas M. D. nderson Cancer Center, 1515 Holcombe lvd., Houston, TX ddress correspondence to R.. Iyer. JR 2006; 187: X/06/ merican Roentgen Ray Society Recurrent Ovarian Cancer: Spectrum of Imaging Findings OJECTIVE. The purpose of this article is to show the appearance of atypical sites of metastasis in patients with recurrent ovarian cancer. CONCLUSION. Metastatic disease from ovarian cancer outside of the peritoneal cavity is generally rare at presentation but is increasingly seen in patients who have recurrent disease, despite multiple therapies. It is important for radiologists to recognize atypical sites of metastasis in patients with recurrent ovarian cancer to facilitate earlier diagnosis and treatment. varian cancer is the second most O common gynecologic malignancy and the most common cause of death in women with gynecologic malignancies [1]. Most women diagnosed with ovarian cancer and treated with debulking surgery and adjuvant chemotherapy will ultimately relapse. Metastases outside of the peritoneal cavity and abdominopelvic lymph nodes are rare at presentation but are increasingly recognized during treatment [2]. This may be because of improving imaging techniques and because the therapy is increasingly successful at controlling peritoneal disease, so that patients live longer and show manifestations of distant disease that would not otherwise have become evident. It is important for radiologists to recognize the unusual sites of recurrent ovarian cancer because such knowledge will facilitate early diagnosis and prompt treatment. Routes of Spread Intraperitoneal dissemination is commonly seen, and disease usually remains confined to the peritoneal cavity at presentation. Ovarian cancer may also spread through lymphatic channels. The most common pathway of lymphatic spread follows the ovarian vessels to retroperitoneal nodes near the renal hila. The second pathway passes laterally in the broad ligament to the internal iliac and obturator nodes along the pelvic sidewall. The third group passes with the round ligament to the external iliac and inguinal nodes. Extraabdominal nodal metastases are rare at presentation but do occur in recurrent disease. Hematogenous spread occurs late during the course of the disease and is more commonly associated with recurrence than with presentation of disease [2 4]. The most common sites of metastases are the pleural cavity, liver, and lung. Sites of parenchymal metastases are similar to those of other carcinomas. The presence of lymphatic and vascular invasion in the primary tumor is predictive of such involvement [5]. lthough most ovarian cancers spread according to the patterns just described, certain tumors may have a predilection for a particular route. For example, dysgerminoma spreads to lymph nodes more commonly, whereas choriocarcinoma predominantly spreads by the hematogenous route. utopsy studies have shown that approximately 50% of distant metastases are asymptomatic, so the true incidence of distant dissemination is probably even higher than reported in clinical series [4]. Treatment and Follow-Up of Ovarian Cancer Primary cytoreductive surgery followed by systemic cisplatin-based chemotherapy is the usual therapeutic option for primary ovarian cancers. fter primary treatment, the patients are followed up with physical examination, serum tumor markers such as cancer antigen (C) 125, imaging, or second-look surgery. CT and MRI are the traditional imaging techniques for surveillance and both have fairly similar accuracy. CT is performed most often because of its availability. PET/CT combines functional and anatomic imaging and may increase diagnostic confidence for the detection of recurrent disease. JR:187, July
2 Downloaded from by on 03/08/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig year-old woman treated with tumor reductive surgery and chemotherapy for stage IV papillary serous adenocarcinoma of the ovary. Patient showed good initial response to chemotherapy, with reduction in size of residual tumor and hepatic metastases. She presented with dizziness and left-sided weakness 1 year after initial diagnosis. and, T2-weighted axial unenhanced MR image of brain () shows heterogeneous metastasis (long arrow) in pons with mass effect on fourth ventricle. nother similar lesion is noted in left cerebellum (short arrow). T1- weighted axial MR image of brain after administration of IV gadolinium () shows heterogeneous enhancement in both metastatic lesions. Fig year-old woman with stage IIIC high-grade papillary serous adenocarcinoma of the ovary treated with cytoreductive surgery and six cycles of carboplatin and paclitaxel. Patient presented 4 years after initial diagnosis with focal jerking of right arm and leg that progressed to a generalized seizure and loss of consciousness for 30 min., T2-weighted axial MR image of brain shows heterogeneous mass (arrow) in right temporal lobe and surrounding edema., T1-weighted axial MR image of brain after administration of IV gadolinium shows heterogeneously enhancing metastasis (arrow). Patient underwent right temporal craniotomy and excision of tumor. Histology was consistent with poorly differentiated metastatic adenocarcinoma. The usual manifestations of recurrent ovarian cancers are pelvic masses in the surgical bed, peritoneal carcinomatosis, retroperitoneal lymph node metastases, pleuropulmonary metastases, and hepatic metastases. Recurrences in extrahepatic solid organs of the abdomen, the CNS, bone, and subcutaneous fat or muscle do occur and are increasingly recognized. Patients who received cisplatin as part of their initial treatment regimen have been reported to have a higher incidence of metastases to the adrenal glands, thoracic nodes, bladder, and liver that were not explained by differences in survival [6]. Recurrence in the CNS Cerebral metastases in epithelial ovarian carcinoma generally occur late in the course of disease, but the incidence is increasing, occurring in patients with a prolonged survival caused by repeated chemosensitive relapses [7] (Figs. 1 and 2). The overall frequency of brain metastasis found at autopsy is reported to be about 6% [5]. The median time for CNS relapse was 46 months in one series, compared with 6 months for hematogenous spread to other sites such as liver and lungs [7]. The brain may be a sanctuary site from systemic chemotherapy because of the blood brain barrier, and long-term survival permits occult CNS metastases to become overt. Isolated cases of leptomeningeal metastases have been reported [8]. Recurrence in the Thorax Pleural effusion is the most common manifestation of thoracic involvement at imaging. The presence of pleural thickening and nodules in association with pleural effusion is diagnostic of pleural metastases (Fig. 3). Thoracentesis yielding malignant cells is required for diagnosis of malignant effusion in the absence of pleural nodules or thickening on CT. The reported incidence of metastatic pulmonary nodules (Fig. 4) ranges from 34% to 38% in all patients with recurrent disease, and most of these are asymptomatic [3, 5]. The frequency of pleural disease at autopsy is approximately 25% [5]. Other less common manifestations include mediastinal lymphadenopathy (Fig. 4), lymphangitic carcinomatosis (Fig. 5), and pericardial and bronchial involvement. 100 JR:187, July 2006
3 Recurrent Ovarian Cancer Downloaded from by on 03/08/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig year-old woman with stage IV recurrent ovarian carcinoma., xial CT section of chest shows left pleural effusion (P) and nodular pleural thickening, consistent with pleural metastases (arrowheads)., CT scan also shows hepatic (black arrow) and splenic (white arrows) metastases. Fig year-old woman with stage IIIC high-grade papillary serous ovarian carcinoma with thoracic recurrence., xial CT section of thorax shows 1.5-cm pulmonary nodule (arrow), consistent with pulmonary metastasis., xial CT section through mediastinum shows enlarged subcarinal (white arrow) and left hilar (black arrow) nodes, compatible with metastatic adenopathy. Fig year-old woman with stage IIIC clear cell carcinoma of the ovary who was receiving chemotherapy after surgery. Dramatic increase of cancer antigen (C) 125 was seen during her chemotherapy. xial CT section of chest shows onset of lymphangitic spread in right lung (arrows), and nodularity is noted in thickened interstitium. JR:187, July
4 Downloaded from by on 03/08/18 from IP address Copyright RRS. For personal use only; all rights reserved Recurrence in Solid Organs of the bdomen Hematogenous dissemination to the abdominal organs may occur in patients with recurrent disease. The liver is the most common site of solid organ metastases in the abdomen (Figs. 3 and 6), with a reported incidence of 45 48% at autopsy [3, 5], followed by the spleen with a reported frequency of 15% at autopsy [2, 5] (Figs. 3 and 6). Isolated splenic metastasis can occur with ovarian cancer, unlike gastrointestinal tumors, although the spleen is still a rare site for recurrent ovarian cancer. The presence of calcifications in metastatic lesions is common in mucinous tumors. Involvement of the pancreas (Fig. 7), adrenals, and kidneys is rare. Distant Lymph Node Recurrence The prevalence of distant lymph node recurrence beyond the pelvic and paraaortic chains in the setting of recurrent ovarian carcinoma has been reported to be 7.1% (Fig. 8). Fig year-old woman with endometrioid ovarian carcinoma that was refractory to chemotherapy after left salpingo-oophorectomy. Her cancer antigen (C) 125 level was rising., aseline axial CT section shows several ill-defined hypodense hepatic metastases (arrowheads)., Follow-up CT scan shows increase in number and size of hepatic metastases and new splenic metastasis (arrow). Fig year-old woman with ovarian cancer treated with cytoreductive surgery and cisplatin-based chemotherapy 10 years earlier. Patient presented with jaundice and pruritus. and, xial CT sections show dilated common bile duct (curved arrow, ) caused by obstruction by ill-defined hypodense mass (straight arrow) in pancreatic head. Patient underwent exploratory laparotomy and biopsy of mass in pancreatic head. Histology was consistent with poorly differentiated metastatic carcinoma of ovarian origin. Incidentally, she had chronic right hydronephrosis (K) related to congenital ureteropelvic junction obstruction and marked thinning of renal parenchyma. 102 JR:187, July 2006
5 Recurrent Ovarian Cancer Fig year-old woman with recurrent papillary serous ovarian carcinoma who presented with palpable left axillary lymphadenopathy., CT scan of chest shows left axillary node (L)., Longitudinal sonogram obtained during fine-needle aspiration biopsy shows enlarged hypoechoic left axillary lymph node and loss of fatty hilum that proved to be metastatic ovarian carcinoma. Downloaded from by on 03/08/18 from IP address Copyright RRS. For personal use only; all rights reserved C Fig year-old woman with recurrent papillary serous ovarian carcinoma who presented with severe lower back pain. High T1 signal anterior to the spine is compatible with prevertebral fat., Lateral lumbar radiograph shows collapsed L3 vertebra. and C, Unenhanced () and gadolinium-enhanced (C) sagittal Tl-weighted MR images of lumbar spine show collapsed L3 vertebra with enhancement (arrow) and retropulsion of bone fragment into spinal canal. CT-guided fine-needle aspiration biopsy showed evidence of bone metastasis. (Fig. 9 continues on next page) JR:187, July
6 Downloaded from by on 03/08/18 from IP address Copyright RRS. For personal use only; all rights reserved Fig. 9 (continued) 44-year-old woman with recurrent papillary serous ovarian carcinoma who presented with severe lower back pain. D, T1-weighted sagittal MR image of thoracic spine shows marrow replacement (asterisk) in T2 vertebral body, in keeping with another site of bone metastasis. Osseous and Soft-Tissue Recurrence one metastases occurred in 1.6% of patients with recurrent ovarian cancer, the most common site of involvement being the vertebral body [4] (Fig. 9). Osseous metastases may manifest as destructive lesions on conventional radiographs; they are associated with a soft-tissue mass on CT and MRI. one scans and PET/CT show increased activity at sites of osseous metastases. Other rare sites of reported recurrences include the skin and subcutaneous tissues, the thymus, the thyroid, the breast, and the urinary tract [2 4]. Of these, metastases to the subcutaneous tissue are probably the most frequent, with a reported incidence of 3.5% [4]. They manifest as discrete enhancing nodules or masses in the subcutaneous fat (Fig. 10). D Summary Unusual sites of ovarian cancer recurrences are increasingly recognized in clinical practice because of advances in chemotherapy and radiation therapy and longer patient survival, and because of the manifestation of distant metastases that may otherwise not occur or be clinically silent. Radiologists should be aware of this changing pattern of disease spread in ovarian cancer patients who receive aggressive chemotherapy or radiation therapy. References 1. Jemal, Tiwari RC, Murray T, et al. Cancer statistics, C Cancer J Clin 2004; 54: Cormio G, Rossi C, Cazzolla, et al. Distant metastases in ovarian carcinoma. Int J Gynecol Cancer 2003; 13: Rose PG, Piver MS, Tsukada Y, Lau TS. Metastatic Fig year-old woman with recurrent ovarian cancer treated with chemotherapy., xial CT scan shows soft-tissue nodule (arrow) in subcutaneous fat of anterior abdominal wall. Surgical biopsy specimens confirmed presence of tumor recurrence in peritoneum., CT scan shows enlarged bilateral superficial (white arrows) and left deep (black arrow) inguinal lymph nodes, consistent with lymph node metastases. patterns in histologic variants of ovarian cancer: an autopsy study. Cancer 1989; 64: Dauplat J, Hacker NF, Nieberg RK, erek JS, Rose TP, Sagae S. Distant metastases in epithelial ovarian carcinoma. Cancer 1987; 60: Dvoretsky PM, Richards K, ngel C, et al. Distribution of disease at autopsy in 100 women with ovarian cancer. Hum Pathol 1988; 19: Reed E, Zerbe CS, rawley OW, icher, Steinberg SM. nalysis of autopsy evaluations of ovarian cancer patients treated at the National Cancer Institute, m J Clin Oncol 2000; 23: Kolomainen DF, Larkin JM, adran M, et al. Epithelial ovarian cancer metastasizing to the brain: a late manifestation of the disease with an increasing incidence. J Clin Oncol 2002; 20: Park CM, Kim SH, Moon MH, Kim KW, Choi HJ. Recurrent ovarian malignancy: patterns and spectrum of imaging findings. bdom Imaging 2003; 28: JR:187, July 2006
performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.
Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician
More informationCase Scenario 1. Pathology report Specimen from mediastinoscopy Final Diagnosis : Metastatic small cell carcinoma with residual lymphatic tissue
Case Scenario 1 Oncology Consult: Patient is a 51-year-old male with history of T4N3 squamous cell carcinoma of tonsil status post concurrent chemoradiation finished in October two years ago. He was hospitalized
More informationRadiology- Pathology Conference 4/29/2012. Lymph Nodes. John McGrath
Radiology- Pathology Conference 4/29/2012 Lymph Nodes John McGrath 1 Presentation material is for education purposes only. All rights reserved. 2012 URMC Radiology Page 1 of 24 Case 1: 51 year-old male
More informationRadiology Pathology Conference
Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights
More informationREVIEW. Typical and atypical metastatic sites of recurrent endometrial carcinoma
Cancer Imaging (2013) 13(1), 113 122 DOI: 10.1102/1470-7330.2013.0011 REVIEW Typical and atypical metastatic sites of recurrent endometrial carcinoma Vikram Kurra a, Katherine M. Krajewski a,b, Jyothi
More informationExtraosseous myeloma: imaging features
Extraosseous myeloma: imaging features C. Santos Montón, R. Corrales, J. M. Bastida Bermejo, M. Villanueva Delgado, R. E. Correa Soto, J. M. Alonso Sánchez; Salamanca/ES Learning objectives -To review
More informationMPH Quiz. 1. How many primaries are present based on this pathology report? 2. What rule is this based on?
MPH Quiz Case 1 Surgical Pathology from hysterectomy performed July 11, 2007 Final Diagnosis: Uterus, resection: Endometrioid adenocarcinoma, Grade 1 involving most of endometrium, myometrial invasion
More informationPre-operative assessment of patients for cytoreduction and HIPEC
Pre-operative assessment of patients for cytoreduction and HIPEC Washington Hospital Center Washington, DC, USA Ovarian Cancer Surgery New Strategies Bergamo, Italy May 5, 2011 Background Cytoreductive
More informationTake Home Quiz 1 Please complete the quiz below prior to the session. Use the Multiple Primary and Histology Rules
Take Home Quiz 1 Please complete the quiz below prior to the session. Use the Multiple Primary and Histology Rules Case 1 72 year old white female presents with a nodular thyroid. This was biopsied in
More informationBoot Camp Case Scenarios
Boot Camp Case Scenarios Case Scenario 1 Patient is a 69-year-old white female. She presents with dyspnea on exertion, cough, and right rib pain. Patient is a smoker. 9/21/12 CT Chest FINDINGS: There is
More informationLung. 10/24/13 Chest X-ray: 2.9 cm mass like density in the inferior lingular segment worrisome for neoplasm. Malignancy cannot be excluded.
Lung Case Scenario 1 A 54 year white male presents with a recent abnormal CT of the chest. The patient has a history of melanoma, kidney, and prostate cancers. 10/24/13 Chest X-ray: 2.9 cm mass like density
More informationRadiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh
Radiological staging of lung cancer Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Bronchogenic Carcinoma Accounts for 14% of new cancer diagnoses in 2012. Estimated to kill ~150,000
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More informationSTAGING AND FOLLOW-UP STRATEGIES
ATHENS 4-6 October 2018 European Society of Urogenital Radiology STAGING AND FOLLOW-UP STRATEGIES Ahmet Tuncay Turgut, MD Professor of Radiology Hacettepe University, Faculty of Medicine Ankara 2nd ESUR
More informationCase Scenario 1. The patient agreed to a CT guided biopsy of the left upper lobe mass. This was performed and confirmed non-small cell carcinoma.
Case Scenario 1 An 89 year old male patient presented with a progressive cough for approximately six weeks for which he received approximately three rounds of antibiotic therapy without response. A chest
More informationTB Intensive Houston, Texas
TB Intensive Houston, Texas October 15-17, 17 2013 Diagnosis of TB: Radiology Rosa M Estrada-Y-Martin, MD MSc FCCP October 16, 2013 Rosa M Estrada-Y-Martin, MD MSc FCCP, has the following disclosures to
More informationPancreas Case Scenario #1
Pancreas Case Scenario #1 An 85 year old white female presented to her primary care physician with increasing abdominal pain. On 8/19 she had a CT scan of the abdomen and pelvis. This showed a 4.6 cm mass
More informationDivision of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
89 Lymphology 28 (1995) 89-94 Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA ABSTRACT The anatomy of the posterior intercostal lymphatics and lymph
More informationChapter 2: Initial treatment for endometrial cancer (including histologic variant type)
Chapter 2: Initial treatment for endometrial cancer (including histologic variant type) CQ01 Which surgical techniques for hysterectomy are recommended for patients considered to be stage I preoperatively?
More informationSEER Summary Stage Still Here!
SEER Summary Stage Still Here! CCRA NORTHERN REGION STAGING SYMPOSIUM SEPTEMBER 20, 2017 SEER Summary Stage Timeframe: includes all information available through completion of surgery(ies) in the first
More informationKidney Case 1 SURGICAL PATHOLOGY REPORT
Kidney Case 1 Surgical Pathology Report February 9, 2007 Clinical History: This 45 year old woman was found to have a left renal mass. CT urography with reconstruction revealed a 2 cm medial mass which
More informationSolitary Skull Metastasis as Initial Manifestation of Hepatocellular Carcinoma A Case Report
Solitary Skull Metastasis as Initial Manifestation of Hepatocellular Carcinoma A Case Report Ellyda MN a and Mohd Shafie A b a Department of Radiology, International Islamic University Malaysia, Kuantan,
More informationAppendix 5. EFSUMB Newsletter. Gastroenterological Ultrasound
EFSUMB Newsletter 87 Examinations should encompass the full range of pathological conditions listed below A log book listing the types of examinations undertaken should be kept Training should usually
More informationMelanoma Case Scenario 1
Melanoma Case Scenario 1 History and physical 11/5/16 Patient is a single, 48-year-old male in good health who presented to his primary physician for a yearly physical exam during which a 3.4 x 2.8 x 1.5
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationRADPrimer Curriculum Breast Topics Covered Basic Intermediate 225
Breast Anatomy & Normal Variants 11 Breast Imaging Modalities 13 BI RADS Lexicon 3 Mammography: Masses 9 Mammography: Calcifications 17 Mammography: Additional Findings 8 Ultrasound Features 10 Ultrasound
More informationGUIDELINES FOR CANCER IMAGING Lung Cancer
GUIDELINES FOR CANCER IMAGING Lung Cancer Greater Manchester and Cheshire Cancer Network Cancer Imaging Cross-Cutting Group April 2010 1 INTRODUCTION This document is intended as a ready reference for
More informationMelanoma Case Scenario 1
Melanoma Case Scenario 1 History and physical 11/5/16 Patient is a single, 48-year-old male in good health who presented to his primary physician for a yearly physical exam during which a 3.4 x 2.8 x 1.5
More informationGENERAL DATA. Sex : female Age : 40 years old Marriage status : married
GENERAL DATA Sex : female Age : 40 years old Marriage status : married CHIEF COMPLAINT Bilateral ovarian tumors discovered by sonography accidentally PRESENT ILLNESS 2003-06-26 :bilateral ovarian tumors
More informationPancreas Quizzes c. Both A and B a. Directly into the blood stream (not using ducts)
Pancreas Quizzes Quiz 1 1. The pancreas produces hormones. Which type of hormone producing organ is the pancreas? a. Endocrine b. Exocrine c. Both A and B d. Neither A or B 2. Endocrine indicates hormones
More informationClinical summary. Male 30 year-old with past history of non-seminomous germ cell tumour. Presents with retroperitoneal lymphadenopathy on CT.
Clinical summary Male 30 year-old with past history of non-seminomous germ cell tumour. Presents with retroperitoneal lymphadenopathy on CT. For restaging PET/CT. PET/CT findings No significant FDG uptake
More informationOvarian Lesion Benign vs Malignant?
Ovarian Lesion Benign vs Malignant? Michele Keenan 1,2 Bernice Dunne 2 Mary Moran 1 Therese Herlihy 1 1. Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland 2. Midland
More informationCASE STUDY. Presented by: Jessica Pizzo. CFCC Sonography student Class of 2018
CASE STUDY Presented by: Jessica Pizzo CFCC Sonography student Class of 2018 Case Presentation April 4, 2017 56 yr old woman presented to ED with lower abdominal pain & swelling, along with constipation.
More informationInteractive Staging Bee
Interactive Staging Bee ROBIN BILLET, MA, CTR GA/SC REGIONAL CONFERENCE NOVEMBER 6, 2018? Clinical Staging includes any information obtained about the extent of cancer obtained before initiation of treatment
More informationQuestion 1 History. Likely Diagnosis Differential. Further Investigation or Management. Requires Paediatric Surgical referral for laparotomy
Question 1 Male newborn spilling green tinged vomit day 1 of life Imaging Abdominal X-Rays performed on 03/05/2012 Upper and lower gastrointestinal contrast studies performed on 03/05/2012 Abdominal X-Rays
More informationSectional Anatomy Quiz II
Sectional Anatomy II Rashid Hashmi Rural Clinical School, University of New South Wales, Wagga Wagga, New South Wales, Australia A R T I C L E I N F O Article type: Article history: Received: 3 Aug 2017
More informationStaging and Treatment Update for Gynecologic Malignancies
Staging and Treatment Update for Gynecologic Malignancies Bunja Rungruang, MD Medical College of Georgia No disclosures 4 th most common new cases of cancer in women 5 th and 6 th leading cancer deaths
More informationMulti-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report
Multi-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report Dr. Mohammed Raza 1, Dr. Sindhuri K 2, Dr. Dinesh Reddy Y 3 1 Professor, Department of Surgery, JSS University, Mysore, India
More informationNAACCR Webinar Series 1 Q&A. Fabulous Prizes. Collecting Cancer Data: Ovary 11/3/2011. Collecting Cancer Data: Ovary
NAACCR 2011 2012 Webinar Series Collecting Cancer Data: Ovary Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching this webinar
More informationCase Scenario 1: Thyroid
Case Scenario 1: Thyroid History and Physical Patient is an otherwise healthy 80 year old female with the complaint of a neck mass first noticed two weeks ago. The mass has increased in size and is palpable.
More informationGenitourinary Imaging Pictorial Essay
rown et al. MRI of the Female Pelvis Genitourinary Imaging Pictorial Essay Downloaded from www.ajronline.org by 37.44.202.41 on 12/17/17 from IP address 37.44.202.41. Copyright RRS. For personal use only;
More informationAbstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 Final Pathology:
Abstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 A 74 year old male with a history of GERD presents complaining of dysphagia. An esophagogastroduodenoscopy
More informationCancers of unknown primary : Knowing the unknown. Prof. Ahmed Hossain Professor of Medicine SSMC
Cancers of unknown primary : Knowing the unknown Prof. Ahmed Hossain Professor of Medicine SSMC Definition Cancers of unknown primary site (CUPs) Represent a heterogeneous group of metastatic tumours,
More informationThe Role of Lymphography in 11 Apparently Localized" Prostatic Carcinoma
16 Lymphology 8 (1975) 16-20 Georg Thieme Verlag Stuttgart The Role of Lymphography in 11 Apparently Localized" Prostatic Carcinoma R. A. Castellino - Department of Radiology, Stanford-University School
More informationCase Scenario 1. Discharge Summary
Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal
More informationMediastinal Staging. Samer Kanaan, M.D.
Mediastinal Staging Samer Kanaan, M.D. Overview Importance of accurate nodal staging Accuracy of radiographic staging Mediastinoscopy EUS EBUS Staging TNM Definitions T Stage Size of the Primary Tumor
More informationMultiple Primary Quiz
Multiple Primary Quiz Case 1 A 72 year old man was found to have a 12 mm solid lesion in the pancreatic tail by computed tomography carried out during a routine follow up study of this patient with adult
More informationProf. Dr. Aydın ÖZSARAN
Prof. Dr. Aydın ÖZSARAN Adenocarcinomas of the endometrium Most common gynecologic malignancy in developed countries Second most common in developing countries. Adenocarcinomas, grade 1 and 2 endometrioid
More informationFDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave
FDG PET/CT STAGING OF LUNG CANCER Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER FDG PET/CT is used in all patients with lung cancer who are considered for curative treatment to exclude occult disease.
More informationImaging Guided Biopsy. Edited & Presented by ; Hussien A.B ALI DINAR. Msc Lecturer,Reporting Sonographer
Imaging Guided Biopsy Edited & Presented by ; Hussien A.B ALI DINAR. Msc Lecturer,Reporting Sonographer Objective By the End of this lessons you should : Define what biopsy Justify Aim to perform biopsy
More informationQuiz. b. 4 High grade c. 9 Unknown
Quiz 1. 10/11/12 CT scan abdomen/pelvis: Metastatic liver disease with probable primary colon malignancy. 10/17/12 Colonoscopy with polypectomy: Adenocarcinoma of sigmoid colon measuring at least 6 mm
More informationRenal Parenchymal Neoplasms
Renal Parenchymal Neoplasms د. BENIGN TUMORS : Benign renal tumors include adenoma, oncocytoma, angiomyolipoma, leiomyoma, lipoma, hemangioma, and juxtaglomerular tumors. Renal Adenomas : The adenoma is
More informationGynecologic Cancer Surveillance and Survivorship: Informing Practice and Policy
Gynecologic Cancer Surveillance and Survivorship: Informing Practice and Policy Stephanie Yap, M.D. University Gynecologic Oncology Northside Cancer Institute Our Learning Objectives Review survival rates,
More informationPlease complete prior to the webinar. HOSPITAL REGISTRY WEBINAR FEMALE REPRODUCTIVE SYSTEM EXERCISES CASE 1: FEMALE REPRODUCTIVE
Please complete prior to the webinar. HOSPITAL REGISTRY WEBINAR FEMALE REPRODUCTIVE SYSTEM EXERCISES PHYSICAL EXAMINATION CASE 1: FEMALE REPRODUCTIVE 3/5 Patient presents through the emergency room with
More informationبسم هللا الرحمن الرحيم. Prof soha Talaat
بسم هللا الرحمن الرحيم Ovarian tumors The leading indication for gynecologic surgery. Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible
More informationPediatric TB Intensive Houston, Texas
Pediatric TB Intensive Houston, Texas November 13, 2009 Radiographic Manifestations of Pediatric TB Susan D. John, MD, FACR November 13, 2009 Radiologic Presentation of Childhood TB Susan D. John, MD,
More informationCase report Osteosarcoma of long bone metastatic to the pancreas-an unusual site of
Osteosarcoma of long bone metastatic to the pancreas-an unusual site of Dr. Santosh Kumar Singh 1, Col (Dr.) Narayanan Kannan 2, Brig (Dr) Rajnish Talwar 3, ABSTRACT Col (Dr) Arvind Kumar Tyagi 4, Dr Adarsh
More informationDiagnosis of TB: Radiology David Finlay, MD
TB Intensive Tyler, Texas June 2-4, 2010 Diagnosis of TB: Radiology David Finlay, MD June 3, 2010 2stages stages- Tuberculosis 1. primary infection 2. reactivation, or post primary disease 2 1 Primary
More informationRadiation Oncology MOC Study Guide
Radiation Oncology MOC Study Guide The following study guide is intended to give a general overview of the type of material that will be covered on the Radiation Oncology Maintenance of Certification (MOC)
More informationCase Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors
CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior
More informationHilar cholangiocarcinoma. Frank Wessels, Maarten van Leeuwen, UMCU utrecht
Hilar cholangiocarcinoma Frank Wessels, Maarten van Leeuwen, UMCU utrecht Content Anatomy Biliary strictures (Hilar) Cholangiocarcinoom Staging Biliary tract 1 st order Ductus hepatica dextra Ductus hepaticus
More information1/25/13 Right partial nephrectomy followed by completion right radical nephrectomy.
History and Physical Case Scenario 1 45 year old white male presents with complaints of nausea, weight loss, and back pain. A CT of the chest, abdomen and pelvis was done on 12/8/12 that revealed a 12
More informationGuidelines for Assigning Summary Stage 2000
Guidelines for Assigning Summary Stage 2000 Mary Lewis, CTR National Program of Cancer Registries 2014 NCRA Annual Meeting May 17, 2014 National Center for Chronic Disease Prevention and Health Promotion
More informationPediatric TB Intensive Houston, Texas October 14, 2013
Pediatric TB Intensive Houston, Texas October 14, 2013 Radiologic Presentation of Childhood TB Susan D. John, MD, FACR October 14, 2013 Disclosures I have no disclosures or conflicts of interest to report
More informationHeme Database Exercise Use the Hematopoietic Database to answer the following questions
Heme Database Exercise Use the Hematopoietic Database to answer the following questions http://seer.cancer.gov/seertools/hemelymph/ 1. Assign a topography and histology code to polycythemia vera 2. List
More informationCase Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Bladder
Cronicon OPEN ACCESS CANCER Case Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Kartik Mittal 1, Rajaram Sharma 1, Amit Dey 1, Meet
More informationCase Report Sarcomatoid Renal Cell Carcinoma Metastasis to the Penis
Case Reports in Urology Volume 2015, Article ID 467974, 4 pages http://dx.doi.org/10.1155/2015/467974 Case Report Sarcomatoid Renal Cell Carcinoma Metastasis to the Penis Victor D. Liou, 1 Oussama M. Darwish,
More informationHematologic Malignancies of the Liver : Spectrum of Disease. Zhou Jian
Hematologic Malignancies of the Liver : Spectrum of Disease Zhou Jian 2015-7-8 Hematologic malignancies include a wide spectrum of lymphoproliferative and myeloproliferative disorders with nodal and extranodal
More informationB REAST STAGING FORM. PATHOLOGIC Extent of disease through completion of definitive surgery. CLINICAL Extent of disease before any treatment
B REAST STAGING FORM CLINICAL Extent of disease before any treatment y clinical staging completed after neoadjuvant therapy but before subsequent surgery (DCIS) (LCIS) (Paget s) mi c a b c d TUMOR SIZE:
More informationB REAST STAGING FORM. PATHOLOGIC Extent of disease through completion of definitive surgery. CLINICAL Extent of disease before any treatment
B REAST STAGING FORM Extent of disease before any treatment y clinical staging completed after neoadjuvant therapy but before subsequent surgery (DCIS) (LCIS) (Paget s) mi a b c a b c d TUMOR SIZE: S TAGE
More informationCase Scenario 1. 1/2/13 History: 64-year-old white female presented with right leg swelling and redness, abdominal pain.
Case Scenario 1 1/2/13 History: 64-year-old white female presented with right leg swelling and redness, abdominal pain. 1/02/13 CT Abdomen/Pelvis: Abnormal area of nodular mesenteric and left anterior
More informationreceive adjuvant chemotherapy
Women with high h risk early stage endometrial cancer should receive adjuvant chemotherapy Michael Friedlander The Prince of Wales Cancer Centre and Royal Hospital for Women The Prince of Wales Cancer
More informationJMSCR Vol 05 Issue 06 Page June 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i6.29 MRI in Clinically Suspected Uterine and
More informationFINALIZED SEER SINQ S MAY 2012
FINALIZED SEER SINQ S MAY 2012 : 20120039 Primary site/heme & Lymphoid Neoplasms: What site do I code this to and what rule applies? How did you arrive at this? Please advise. See discussion. Patient with
More informationMedical Education. CME Article Clinics in diagnostic imaging (125) Padungchaichote W, Kongmebhol P, Muttarak M
1062 Medical Education CME Article Clinics in diagnostic imaging (125) Padungchaichote W, Kongmebhol P, Muttarak M la Ib Ic Fig. I (a) Bilateral mediolateral oblique mammograms; (b) spot right craniocaudal
More informationFDG PET/CT in Lung Cancer Read with the experts. Homer A. Macapinlac, M.D.
FDG PET/CT in Lung Cancer Read with the experts Homer A. Macapinlac, M.D. Patient with suspected lung cancer presents with left sided chest pain T3 What is the T stage of this patient? A) T2a B) T2b C)
More informationRole of imaging (images) in my practice. Dr P Senthur Nambi Consultant Infectious Diseases
Role of imaging (images) in my practice Dr P Senthur Nambi Consultant Infectious Diseases Medical images: My thoughts Images are just images Subject to the intellect of the interpreter View it in conjuction
More informationSurgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer
Ovarian cancer Surgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer JM. Classe, R. Rouzier, O.Glehen, P.Meeus, L.Gladieff, JM. Bereder, F Lécuru Suitable candidates for neo-adjuvant
More informationSex: 女 Age: 51 Occupation: 無 Admission date:92/07/22
Sex: 女 Age: 51 Occupation: 無 Admission date:92/07/22 Chief complaint Unknown fever for one month Hand tremor and left huge renal tumor was noted Present illness Suffered from fever for one month, hand
More informationCancer Cervix with Brain Metastasis- A rare case from a Rural center of Maharashtra
Case report Cancer Cervix with Brain Metastasis- A rare case from a Rural center of Maharashtra 1 Dr Khushboo Rastogi, 2 Dr Vandana Jain, 3 Dr Darshana Kawale, 4 Dr Siddharth Nagshet, 5 Dr Gopal Pemmaraju
More informationCorresponding Author: Ahmed A. Al Ibraheemi, Resident in Clinical Oncology, Al Basheer Hospital, Amman, Jordan
IJHOSCR International Journal of Hematology- Oncology and Stem Cell Research Case Report Case report of metastatic invasive breast lobular carcinoma to the urinary bladder Ahmed A. Al Ibraheemi Resident
More informationCancer Cases Treated and Results
Cancer Cases Treated and Results Below are some of the cases, from more than 30 cases we have treated so far with good results. When reading the PET/CT scans, the picture on the left is before treatment,
More informationRadiology Pathology Conference
Radiology Pathology Conference Nadia F. Yusaf, M.D. PGY-3 1/29/2010 Presentation material is for education purposes only. All rights reserved. 2010 URMC Radiology Page 1 of 90 Case 1 60 year- old man presents
More information8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank
Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,
More informationGenitourinary Imaging Pictorial Essay
Genitourinary Imaging Pictorial Essay Patil et al. PET/CT of Transitional Cell Carcinoma Genitourinary Imaging Pictorial Essay Downloaded from www.ajronline.org by 37.44.193.45 on 01/04/18 from IP address
More informationAJCC-NCRA Education Needs Assessment Results
AJCC-NCRA Education Needs Assessment Results Donna M. Gress, RHIT, CTR Survey Tool 1 Survey Development, Delivery, Analysis THANKS to NCRA for the following work Developed survey with input from partners
More informationMetastatic mechanism of spermatic cord tumor from stomach cancer
Int Canc Conf J (2013) 2:191 195 DOI 10.1007/s13691-013-0-9 CANCER BOARD CONFERENCE Metastatic mechanism of spermatic cord tumor from stomach cancer Masahiro Seike Yoshikazu Kanazawa Ryuji Ohashi Tadashi
More informationAmerican College of Radiology ACR Appropriateness Criteria
American College of Radiology ACR Criteria Radiologic Management of Thoracic Nodules and Masses Variant 1: Middle-aged patient (35 60 years old) with an incidental 1.5-cm lung nodule. The lesion was smooth.
More informationLong Case Set 02. Dr Raviraj Uppoor. Dr Sameer Shamshuddin. Consultant Radiologist Cumberland Infirmary, Carlisle, UK
Long Case Set 02 www.frcrtutorials.com Dr Raviraj Uppoor MBBS, DMRD, DNB, FRCR Consultant Radiologist Cumberland Infirmary, Carlisle, UK Dr Sameer Shamshuddin MBBS, DMRD, FRCR Consultant Radiologist Royal
More informationCase 9551 Primary ovarian Burkitt lymphoma
Case 9551 Primary ovarian Burkitt lymphoma Monteiro V, Cunha TM, Saldanha T Section: Genital (Female) Imaging Published: 2011, Nov. 20 Patient: 23 year(s), female Authors' Institution V Monteiro 1, TM
More informationDynamic MR Lymphangiography
Dynamic MR Lymphangiography Rajesh Krishnamurthy, MD EB Singleton Department of Radiology, Texas Children s Hospital, Baylor College of Medicine, Houston, TX Acknowledgement: Dr. Sheena Pimpalwar, MD Interventional
More informationExercise 15: CSv2 Data Item Coding Instructions ANSWERS
Exercise 15: CSv2 Data Item Coding Instructions ANSWERS CS Tumor Size Tumor size is the diameter of the tumor, not the depth or thickness of the tumor. Chest x-ray shows 3.5 cm mass; the pathology report
More informationCase Scenario 1. History
History Case Scenario 1 A 53 year old white female presented to her primary care physician with post-menopausal vaginal bleeding. The patient is not a smoker and does not use alcohol. She has no family
More informationCT Findings in Posttransplantation Lymphoproliferative Disorder of Renal Transplants
Downloaded from www.ajronline.org by 37.44.207.92 on 12/15/17 from IP address 37.44.207.92. opyright RRS. For personal use only; all rights reserved Pictorial Essay T Findings in Posttransplantation Lymphoproliferative
More informationCase Scenario 1. 1/2/13 History: 64-year-old white female presented with right leg swelling and redness, abdominal pain.
Case Scenario 1 1/2/13 History: 64-year-old white female presented with right leg swelling and redness, abdominal pain. 1/02/13 CT Abdomen/Pelvis: Abnormal area of nodular mesenteric and left anterior
More informationpulmonary metastasis 80EE4727C6037E7F69A9981B7E55A238 Pulmonary Metastasis 1 / 6
Pulmonary Metastasis 1 / 6 2 / 6 3 / 6 Pulmonary Metastasis Metastatic tumors in the lungs are cancers that developed at other places in the body (or other parts of the lungs). They then spread through
More informationAtypical Metastases From Prostate Cancer: 10-Year Experience at a Single Institution
Genitourinary Imaging Original Research Vinjamoori et al. Atypical Metastases From Prostate Cancer Genitourinary Imaging Original Research Anant H. Vinjamoori 1 Jyothi P. Jagannathan Atul B. Shinagare
More informationHepatic Resection is Safe for Metachronous Hepatic Metastases from Ovarian Cancer
182 Cancer Biol Niu Med et al. 2012; Hepatic 9: 182-187 Resection doi: for 10.7497/j.issn.2095-3941.2012.03.005 Ovarian Cancer Liver Metastases Original Article Hepatic Resection is Safe for Metachronous
More informationProf. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.
Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,
More informationCase Scenario 1 History and Physical 3/15/13 Imaging Pathology
Case Scenario 1 History and Physical 3/15/13 The patient is an 84 year old white female who presented with an abnormal mammogram. The patient has a five year history of refractory anemia with ringed sideroblasts
More information