Journal of Ultrasound

Imaging of ovarian lymphoma

The aim of the study is to describe the radiological spectrum of appearances of ovarian lymphoma (OL). The manuscript describes the radiological aspects of OL to assist the radiologist in achieving correct orientation of the diagnosis. We conducted a retrospective evaluation of imaging studies of 98 cases of non-Hodgkin's lymphoma, with extra-nodal localisation (ovaries) in three cases (1 primary, 2 secondary). A literature review was also performed. Of the three evaluated women, one had a primary ovarian involvement and two had a secondary ovarian involvement. The most common lesion characteristics were a well-defined, solid homogeneous and hypoechoic mass at US. CT depicts OL as a well-defined, non-infiltrating, homogeneous hypodense solid mass, with mild contrast enhancement. On T1-weight MRI, OL appears as a homogeneous mass of low signal intensity, which enhances avidly following intravenous gadolinium. Clinical and serological presentation of OL can be similar to that of primary ovarian cancer. As imaging plays a central role in the diagnosis of OL, the radiologist should be familiar with US, CT and MRI appearances of this condition to correctly orient the diagnosis and so avoid unnecessary adnexectomy.

Percutaneous radiofrequency ablation of ovarian cancer metastasis in the spleen: a therapeutic option to consider

Abstract Splenic metastasis are rare clinical entities developing in less than 1% of all metastatic cancers and usually in the setting of disseminated disease. To date, splenectomy is traditionally the first line therapy in patient with splenic metastasis, however non-surgical therapies have been reported. Here we described the case of a 57-year-old patient with splenic metastasis from ovarian cancer successfully treated by percutaneous radiofrequency ablation. Furthermore, we performed a literature systematic review of the cases of splenic metastases treated by thermal ablation.

Ruptured large ectopic hydatidiform mole: an infrequent presentation of gestational trophoblastic disease

Gestational trophoblastic disease (GTD) comprises hydatidiform mole, invasive mole, epithelioid trophoblastic tumor, placental site trophoblastic tumor, and choriocarcinoma. Ectopic molar gestation (EMG) is exceedingly rare with similar malignant potential like that of an intrauterine molar pregnancy. We report an uncommon case of EMG diagnosed by ultrasonography (USG) with a brief literature review. A 36-year-multipara presented at 8-weeks gestational age with severe abdominal pain and spotting. She underwent a spontaneous abortion 4 months back. Current transabdominal USG revealed a large right adnexal hydatidiform mole with moderate hemoperitoneum. Right ovary could not be discerned separately. Emergency laparotomy with hysterectomy and right adnexal clearance was done. Histopathology showed complete ectopic hydatidiform mole. USG remains the modality of choice for initial assessment of suspected GTD and it allows reliable evaluation of residual or recurrent disease. This report emphasizes the role of USG in the diagnosis of EMG and also, the importance of including EMG in the differential diagnosis of suspected ectopic pregnancy.

Rare occurrence of ovarian choriocarcinoma: ultrasound evaluation

Choriocarcinoma of the ovary is a rare, highly malignant tumor showing malignant trophoblastic cells and produces human chorionic gonadotropins. It can be classified as gestational and non-gestational choriocarcinoma. Non-gestational choriocarcinoma is extremely rare. Treatment is Methotrexate-based chemotherapy for the gestational type. This case study is a rare case of ovarian choriocarcinoma managed by surgical resection, followed by methotrexate-based chemotherapy, and aimed to evaluate the ultrasound characteristics of ovarian choriocarcinoma and how to arrive at the diagnosis. In cases with an elevated serum beta-human chorionic gonadotropin (beta hCG), the finding of a highly vascularized adnexal mass on ultrasound evaluation should be underlined as a clue for suspecting choriocarcinoma, particularly if the female was young with no marriage history or history of sexual intercourse and also to be highly considered in married females with history of repeated abortions, molar pregnancy or uterine choriocarcinoma.

Can transabdominal shear wave elastography play a role in solving the dilemma of complex cystic and solid ovarian tumors by ultrasound?

We aimed to assess the role of shear wave elastography in better characterizing complex cystic and solid ovarian tumors in correlation with other ultrasound features and histopathology. The study included 40 patients with 40 unilateral complex cystic or solid ovarian lesions with a mean age of 43.2 ± 13.27 (mean ± SD). All patients were subjected to history taking, tumor markers assessment, ultrasound with Doppler assessment giving an ORADS score, and shear wave elastography assessment. (qualitatively and quantitatively). Correlation was done with the final histopathology. According to the final histopathological results of the 40 lesions, 14 (35%) were benign, four were borderline (10%), and 22 (55%) were malignant. Ultrasound and Doppler assessments revealed a higher frequency of irregular margins and Doppler score 4 in borderline/malignant patients compared to benign patients. ORADS ultrasound scoring system of the examined lesions showed a statistically significantly higher frequency of ORADS 5 in the malignant group, with ORADS sensitivity, specificity, and Diagnostic accuracy of 96.2%, 57.1, and 82.5%, respectively. Elastographic color mapping scores and elastographic readings were higher in borderline/malignant patients compared to benign patients and it significantly correlated with the Doppler score, ORADS score, color mapping score, and tumor markers. The study detected significant associations between malignancy and higher tumor markers, marginal irregularity, higher Doppler, and higher ORADS scores. Shear wave elastography positively correlated with tumor markers, Doppler score, and ORADS score. This supports the utility of elastography in discriminating malignant from benign ovarian tumors.

Testicular juvenile granulosa cell tumor: a case report

The Testicular Juvenile Granulosa Cell Tumor (JGCT) is a rare testicular neoplasm that appears in the first months of life as a painless testicular mass. Following an accurate radiological ultrasound diagnosis, through which the cystic appearance of the lesion is observed, and histological confirmation, showing follicular growth pattern and an immunoreactivity for inhibin, the treatment process involves, when feasible, conservative surgery. We present the case of a 2-months old infant with a bilateral JGCT of the testis and we review the classical findings of the patology.

An overview of the use of cutting-edge artificial intelligence (AI) modeling to produce synthetic medical data (SMD) in decentralized clinical machine learning (ML) for ovarian cancer(OC) and ovarian lymphoma(OL)

o point out how novel analysis tools of AI can make sense of the data acquired during OL and OC diagnosis and treatment in an effort to help improve and standardize the patient pathway for these disease. ultilizing programmed detection of heterogeneus OL and OC habitats through radiomics and correlate to imaging based tumor grading plus a literature review. new analysis pipelines have been generated for integrating imaging and patient demographic data and identify new multi-omic biomarkers of response prediction and tumour grading using cutting-edge artificial intelligence (AI) in OL and OC. deline the main AI methods used in OL and OC that we can try to standardize in the clinical radiological and medical practice to ameliorate the patients diagnosis and theraphy. through new AI methods it's possible to combine research into a SwarmDeepSurv, generate new data flow channels, create medical imaging data channels of OL and OC using AI and identify new biomarkers of OL and OC. .

Evaluating the technical experience of transmuscular quadratus lumborum block in prone position: a retrospective observational study

Traditionally quadratus lumborum block has been performed in lateral or supine positions. We propose that transmuscular or anterior quadratus lumborum block performed in a prone position may offer comparable or improved technical conditions, image quality and also aid in resident training. This study aimed to assess the technical ease of performing Tm-QLB in the prone position. This retrospective study included female patients undergoing elective gynecologic oncology surgery via midline incision, who received bilateral preoperative prone-position transmuscular quadratus lumborum block. Block performance was evaluated using a composite score derived from normalized ultrasound image quality, time taken, number of attempts, and redirections. Blocks were categorized into five difficulty levels based on the composite score. Ninety blocks were analyzed. Mean age was 40.18 ± 12.05 years; BMI was 23.90 ± 1.86 kg/m Prone-position Tm-QLB is technically easy and operator-friendly, making it a viable alternative for training and clinical practice in suitable patients.