0:01

Here's another case of a very large

0:03

pelvic mass in a 47-year-old patient.

0:05

She came to us for both ultrasound and CT.

0:09

So in the ultrasound you can see

0:11

a huge mass with multiple internal

0:14

thin septations and multiple locules.

0:17

And then on the CT.

0:19

The locules are separated by thin

0:22

septations that don't show much enhancement.

0:24

There's no real nodular enhancement.

0:26

But what's interesting is if you

0:28

look at the composition of the

0:30

locules, there's variable density.

0:33

So this one here looks more like simple fluid.

0:35

And then these two locules here

0:37

have a bit more density to them.

0:40

So potentially they may have some hemorrhage

0:43

or some protein in it, or maybe some mucin.

0:46

And this is a pretty characteristic

0:48

appearance of a mucinous lesion.

0:50

This one turned out to be a

0:51

very large mucinous cystadenoma.

0:53

So lots of locules with variable

0:55

internal density or internal signal.

0:57

And that's pretty typical

0:59

for mucinous composition.

1:02

So I want you to just try

1:03

and remember this image.

1:04

So remember the, the thin septations and

1:07

the multiple loculations, the absence

1:10

of really significant enhancement.

1:12

There's maybe a bit of enhancement here,

1:14

hard to tell, but really these multiple

1:17

cystic spaces separated by thin septations.

1:21

So this is obviously a very different situation.

1:24

So this is a huge, very bizarre

1:26

looking, heterogeneous, complex

1:29

mass, and this is characteristic of

1:31

an epithelial ovarian malignancy.

1:33

So this would be, without

1:35

a doubt, an ORADS 5 lesion.

1:37

So big mass, the T2 signal is very heterogeneous

1:41

with areas of high signal, intermediate signal,

1:43

low signal, and then look at the enhancement.

1:45

So there's nodular enhancement,

1:47

solid enhancement, the septations

1:51

look much thicker than we saw in the other case.

1:54

So you can see how the complexity changes

1:56

over that spectrum from benign to malignant.

1:59

So that's an ORADS 5.