울산의대 서울아산병원 영상의학과 김미현 Introduction Benign disease of uterus Malignant disease of uterus Non-tumorous condition of ovary Tumorous condition of ovary Transvaginal – 소변(-) Transabdominal – 소변(+) Tranrectal or transperineal - virgin Sonohysterography Thick or irregular endometrium on transvaginal US Endometrium Basal layer – echogenic Functional layer – hypoechoic Endometrial stripe Endometrium 가임기 증식기 4-12 mm 분비기 8-15 mm 폐경기 5 mm 미만 Myometrium Innermost layer junctional zone Ovary Oval shape Central medulla – hyperecho Peripheral cortex (follicle) - hypoecho Benign disease of uterus Ectopic endometrial glands and stroma in the myometrium m/c cause of vaginal bleeding Due to unopposed estrogen Overgrowth of EM glands and stroma US Focally increased EM thickening DDx (HSG-US helpful) Hyperplasia Submucosal myoma < EM cancer m/c pelvic tumor Submucosal, intramural, subserosal US Well-defined hypoechoic solid mass Variable echogenicity due to degeneration Interface vessels btw tumor and uterus bridging vascular sign(+) Subserosal myoma > ovary tumor M U Cause Dilatation and currettage Gestational trophoblastic disease Complication of malignancy Previous surgery Uterine myoma Endometriosis Antagonist of the estrogen receptor in breast tissue Agonist in the endometrium EM hyperplasia Antagonist of the estrogen receptor in breast tissue Agonist in the endometrium EM hyperplasia Malignant disease of uterus Cervical cancer Endometrial cancer Gestational trophoblastic disease US- poor sensitivity for diagnosis • 45F, premenopause • EM thickness: < 15mm • But, heterogeneity • 34F, premenopause • Obliteration of normal EM lining Spectrum of disease originated from the placental trophoblast Serum β hCG ↑ Hydatidiform mole Complete(46 XX,XY) Partial H-mole (69 XXX,XXY,XYY) Gestational trophoblastic tumor Invasive mole Choriocarcinoma Placental site trophoblastic tumor US findings of complete H-mole Solid mass with numerous anechoic cysts within EM cavity “Snowstorm”, “granular”, “vesicular” appearance 32F, vaginal bleeding, β hCG (20만) 32 F, vaginal bleeding, β hCG (20만) Non-tumorous condition of ovary Follicular cyst Corpus luteal cyst Theca lutein cyst 35F, abdominal pain • serum ß-hcg elevation • GTD • Twin pregnancy • Hormone therapy for infertility • Bilateral • Complex endocrinologic disorder Chronic anovulation (infertility) Hirsutism Obesity US findings At least 15 cysts (2-10 mm) in periphery Echogenic stroma Ovary, uterine ligaments, rectovaginal septum, cul-de-sac, pelvic peritoneum Salpingitis oophoritis tubo-ovarian complex TOA US findings Thick & irregular-walled cysts Peri-lesional hypervascularity 33F, abdominal pain and fever U M M Benign lesion (dermoid, parovarian cysts) Normal ovary: infants and children Rt > Lt (d/t sigmoid colon) US Twisted vascular pedicle Absence or diminished venous flow Radiographics 2008; 28;1355 Tumorous condition of ovary Surface epithelial-stromal tumor Germ cell tumor Sex cord-stromal tumor Metastasis Complex cystic mass (favor malig.) Solid portion (vascularity on Doppler) Irregular/thick wall and septum (>3mm) Nodule in the septum or wall m/c histologic type 40-70세 호발 Serum CA-125 ↑ Solid and cystic appearance ~ solid tumor • 61F • CA-125: 1000 (0-35 U/mL) • 61F • CA-125: 1000 (0-35 U/mL) • PATH: papillary serous adenocarcinoma • 32F • CA-125: 25 (0-35 U/mL) • 32F • CA-125: 25 (0-35 U/mL) • PATH: clear cell carcinoma with endometriosis Borderline tumor Subset of epithelial ovarian tumor Favorable prognosis No stromal invasion of ovary 2nd largest group 30세 미만 호발 Mature cystic teratoma (dermoid cyst): m/c Dysgerminoma Yolk sac tumor (endodermal sinus tumor, αFP ↑) Embryonal carcinoma (αFP & βHG ↑) Choriocarcinoma (βHG ↑) Benign malignant transformation 2%, postmenopausal women, SCC Cx: torsion, rupture, infection US findings Cystic lesion with Rokitansky nodule Diffuse bright echoes, post. shadowing(±) Thin, echogenic bands(hair) within the cyst EMS Fibroma, thecoma m/c type, benign Similar feature of myoma DDx: subserosal myoma (bridging vascular sign, visible normal ovary) Gastrointestinal tract: m/c Breast, uterus US findings Bilateral ov. enlargement by solid masses Colon ca – cystic appearance RO LO RO LO • Stomach cancer metastasis Ut • Colon cancer metastasis • Appendiceal mucinous neoplasm with ovary meta .