Color Doppler sonography with contrast in the differentiation of ovarian tumors

The objective of this study was to differentiate benign ovarian tumors from malignant ones before surgery using color and pulsed Doppler sonography, and to compare results obtained before and after use of contrast medium, thereby verifying whether contrast results in an improvement in the diagnostic sensitivity. METHODS: Sixty two women (mean age 49.9 years) with ovarian tumors were studied, 45 with benign and 17 with malignant tumors. All women underwent a transvaginal color Doppler ultrasonographic exam. A study of the arterial vascular flow was made in all tumor areas, as well as an impedance evaluation of arterial vascular flow using the resistance index. RESULT: Localization of the vessels in the tumor revealed a greater proportion of malignant tumors with detectable internal vascular flows (64 percent) than benign tumors with such flows (22 percent). There was a considerable overlap of these findings. The use of contrast identified a greater number of vessels with confirmation in the totality of tumors, but did not improve the Doppler capacity in tumoral differentiation. Malignant tumors presented lower values of resistance index than the benign ones, whether or not contrast was used. The cutoff value for resistance index that better maximized the Doppler sensitivity and specificity was 0.55. Through this value, an increase of the sensitivity after contrast use was obtained, varying from 47 percent to 82 percent, while specificity remained statistically unchanged. CONCLUSION: Although the injection of a microbubble agent improved the sensitivity of the method detecting vascularization of tumors, a positive finding for vascularization by this method was not clinically useful in the differentiation of benign and malignant ovarian tumors

Dermatomiosite - expressao paraneoplasica do cancer de ovario / Dermatomyositis - paraneoplastic expression of the ovarian cancer

Ha algumas afeccoes cutaneas que podem estar associadas com tumores viscerais. Sao as chamadas afeccoes paraneoplasicas. A dermatomiosite esta incluida neste grupo. E propria de adultos e associa-se mais frequentemente com carcinoma broncogenico, adenocarcinoma de mama, ou ovario, e em menor grau, com outros tumores, inclusive linfomas. O caso que relatamos corresponde a uma paciente de 68 anos sem antecedentes familiares, nem pessoais a destacar que, em progressiva, apenas 4 meses de evolucao, levando nos 2 ultimos a prostracao e disfagia, e com achados clinico-radiologicos sugestivos de neoplasia maligna de ovario em etapa avancada. Foi submetida a histerectomia total + anexectomia bilateral + linfadenectomia pelvica + omentectomia com diagnostico anatomopatologico de carcinoma indiferenciado de ovario