0:00

Alright.

0:00

So, we have two more cases to fly through very quickly

0:04

and they are very quick, so I think we'll be fine.

0:07

So this is a 70-year-old woman who had

0:09

a pelvic ultrasound done for evaluation of dysuria.

0:13

She was found to have a right adnexal mass,

0:16

which we're going to...

0:18

which they recommended an MR to further characterize.

0:21

On ultrasound, it looked a lot like an endometrioma.

0:23

I'm not going to show you the images

0:24

because there was no way for me to anonymize them.

0:28

So she does not have endometriosis,

0:30

but she does have this big right adnexel mass.

0:33

It is very T2 dark, homogeneously so,

0:36

and homogeneously T2 bright.

0:39

It looks pretty simple except that there's a little bump

0:43

along the wall right here. And that bump is T1 dark,

0:48

maybe a little bit T2 bright if you hallucinate with me.

0:51

And now we're going to move on and look at a

0:53

different type of sequence and we've looked at before.

0:56

Because this is not an endometrioma, I will give you the spoiler alert.

1:01

So if we look at our...

1:06

If we look at our sagittal

1:07

and this is a subtraction,

1:08

I'm just going to jump right to the important findings.

1:11

So if we look right here,

1:13

this is that little teeny tiny nodule and this is a subtraction image.

1:17

So this cannot be intrinsic T1 hyperintensity.

1:20

This is actually enhancement.

1:22

So we have what looks like

1:24

an endometrioma, but there's a little enhancing nodule along the wall.

1:28

Can we get to the next question, please?

1:32

So which of the following is the most

1:33

specific sign of malignant degeneration in an endometrioma?

1:36

Is it restricted diffusion,

1:38

the presence of septations, loss of T2-shading,

1:40

or an enhancing mural nodule?

1:43

Awesome, everybody got it correct.

1:44

So the enhancing mural nodule is the most suspicious feature.

1:48

Restricted diffusion,

1:49

septations and loss of T2-shading,

1:51

which is basically tumor cells secreting fluid,

1:54

increasing the T2 signal of the endometrioma.

1:57

All of those things can be seen in both benign and malignant endometriomas.

2:02

Endometriomas can degenerate into a malignancy in like 1% to 2% of cases.

2:08

So it's not very many.

2:10

But it is reason enough to follow

2:11

endometriomas when you see them.

2:14

They are more common when the lesion is really large,

2:16

so like greater than 9cm.

2:18

It's uncommon for an endometrioma

2:20

less than 6cm to degenerate into a malignancy.

2:23

And the types of malignancies that these turn into are endometrioid and clear cell.