0:01

Okay, so here we have a case of an

0:04

enormous cystic mass in this woman.

0:06

She's perimenopausal.

0:08

You can see that the uterus has been displaced

0:12

anteriorly, and it's kind of compressed.

0:14

The bladder is this thin black line here.

0:17

So this is another case.

0:18

Okay.

0:19

The reason that we ask our patients to

0:20

empty their bladder prior to the scan,

0:23

if we know that we're imaging a mass, it

0:26

makes it more, well, more comfortable or as

0:28

comfortable as it can be for these patients.

0:31

If they have a full bladder, then it makes it

0:33

really difficult to stay still for the scan.

0:36

So this enormous mass is what

0:39

we're evaluating in this study.

0:41

So you can see on the

0:42

T2-weighted images here,

0:45

it's fairly homogeneous, so it doesn't

0:47

really have any septations within it.

0:50

It's composed of primarily just

0:53

simple high T2 signal fluid.

0:56

And then on the post-contrast T1

0:58

weighted images here, you can see

0:59

that the fluid again is simple.

1:02

There's no proteinaceous component

1:04

and no hemorrhagic component.

1:06

But what's interesting is we've got these

1:07

very irregular-looking two focal areas.

1:11

They almost look like, you know, flowers

1:13

or what a bladder calculus would look

1:16

like, but they're kind of multiflocculated

1:18

stellate structures that are low T2 signal.

1:23

They do enhance.

1:25

So this is what that black sponge

1:27

appearance looks like, where you've got

1:29

the below T2 signal and entrapped or

1:32

punctate areas of high T2 signal within it.

1:35

And that's pretty typical

1:36

of a cystadenofibroma.

1:38

And what can be a little bit confusing

1:40

and alarming is that these lesions, uh,

1:43

the solid component rather enhances.

1:47

So even though these are benign,

1:49

they do have some features which

1:50

are concerning for malignancy.

1:52

And regardless of whether this is benign

1:54

or malignant, this needs to come out.

1:55

So just first of all, just based on

1:58

the size, and then secondly, because of

2:00

these peripheral enhancing components.

2:03

So this is a really nice example of a

2:05

cystadenofibroma with the black sponge.