Imaging of gynecological disease (6): clinical and ultrasound characteristics of ovarian dysgerminoma.

OBJECTIVES: To describe the clinical history and ultrasound findings in patients with ovarian dysgerminoma. METHODS: This was a retrospective study of patients with a histological diagnosis of ovarian dysgerminoma who had undergone preoperative ultrasound examination. The patients were identified from the databases of 11 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed all available electronic ultrasound images (gray-scale images and color/power Doppler images were available for 18 patients and 14 patients, respectively) and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings (here called pattern recognition). RESULTS: Twenty-one patients with ovarian dysgerminoma were identified (including one woman with bilateral masses). Twenty patients had a primary ovarian dysgerminoma (including the one with bilateral masses) and one patient had a recurrence of dysgerminoma in her retained ovary. One of the 21 patients was pregnant. All tumors except one were pure dysgerminomas, one being a mixed germinal cell tumor with 30% dysgerminoma component. Median age was 20 (range, 16-31) years. Information on clinical symptoms was available for 18 patients. In four patients, the tumor was detected incidentally, whereas 14 patients presented with one or more of the following symptoms: acute pain (n = 4), chronic pain (n = 8), bloating (n = 8), menstrual disorders (n = 5) and infertility problems (n = 1). One (5%) patient had ascites. Using the IOTA terms and definitions, all but one dysgerminoma were moderately (43%) or very well (50%) vascularized solid tumors. One tumor was multilocular-solid. According to pattern recognition, most dysgerminomas were highly vascularized, purely solid tumors with heterogeneous internal echogenicity divided into several lobules, had a smooth and sometimes lobulated contour and were well-defined relative to the surrounding organs. CONCLUSION: The ultrasound finding of a highly vascularized, large, solid, lobulated adnexal mass with irregular internal echogenicity in a woman 20-30 years old should raise the suspicion of ovarian dysgerminoma.

Imaging of gynecological disease (2): clinical and ultrasound characteristics of Sertoli cell tumors, Sertoli-Leydig cell tumors and Leydig cell tumors.

OBJECTIVE: To describe the clinical history and ultrasound findings in women with ovarian Sertoli cell, Sertoli-Leydig cell and Leydig cell tumors. METHODS: Women with a histological diagnosis of Sertoli cell tumor, Sertoli-Leydig cell tumor or Leydig cell tumor who had undergone preoperative ultrasound examination were identified from the databases of each of three participating ultrasound centers. The tumors were characterized on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions published by the International Ovarian Tumor Analysis (IOTA) group. In addition, all images were reviewed and described using pattern recognition. RESULTS: Of 22 patients identified, 15 had Sertoli-Leydig cell tumors, two had Sertoli cell tumors and five had Leydig cell tumors. Four patients were postmenopausal, one 48-year-old woman had undergone hysterectomy, 16 were of fertile age and one was a 4-year-old girl. Most patients (82%, 18/22) had endocrine symptoms, the most common being bleeding disturbance (64%, 14/22) and hirsutism (32%, 7/22). Twenty-two (96%) of 23 tumors (one woman had bilateral tumors) contained a solid component; 16 (70%) were purely solid. Pattern recognition showed that the Leydig cell tumors were small solid tumors (four of five had a largest diameter of 1-3 cm) and the two Sertoli cell tumors were somewhat larger solid tumors (4 cm and 7 cm); the Sertoli-Leydig cell tumors were either small (3-4 cm) or medium-sized (6-7 cm) solid tumors, or multilocular solid tumors of any size (3-18 cm) with purely solid areas mixed with areas of innumerable closely packed small cyst locules. CONCLUSIONS: On the basis of endocrine symptoms, the woman's age and ultrasound findings, it should be possible to suggest a correct preoperative diagnosis of Sertoli cell, Sertoli-Leydig cell or Leydig cell tumors in many cases.

[Prenatal differential diagnosis of fetal urinary malformations].

To elaborate prenatal differential-diagnostic criteria of functional and obstructive uropathies, we examined 3287 pregnant women. Obstructive fetal urinary malformations (FUM) were detected in 42 (1.3%) cases. Prenatal ultrasonic assessment of fetal pelvis size depending on filling of the urinary bladder allowed identification of two groups: bladder-independent and bladder-dependent. Basing on our findings, we established prognostically significant differential-diagnostic criteria of a FUM variant. Thus, dependence of the size of caliculopelvic complex and the ureter on filling of the urinary bladder is a basic echographic criterion in functional obstruction. The absence of such dependence is the criterion of organic obstruction.

[Urodynamic parameters of fetal lower urinary tract in physiological pregnancy].

The study of urodynamic parameters in 76 fetuses in physiological course of pregnancy at gestation term from 20 to 40 weeks has shown that urodynamics of the lower urinary tract in the prenatal period directly correlate with embryon and fetus formation. Urodynamic indices of fetal lower urinary tract have 13 significant correlations out of possible 43, indicating distinct interactions of various organs and strictures of fetal urinary system. The analysis of the structure of correlations between different urodynamic indices of the lower urinary tract of the fetus demonstrates that they vary greatly in pregnancy trimester II and remain constant in trimester III. Thus, interrelations between basic urodynamic parameters of the lower urinary tract get established to the end of trimester II.

[Urodynamics of the lower urinary tract of the fetus during physiological pregnancy].

To evaluate urodynamic parameters of the fetal lower urinary tracts in physiological pregnancy and without malformations, a monitoring of filling and voiding of fetal urinary bladder was made by the results of ultrasonic study of 76 fetuses at getation term 20-40 weeks. All the infants of the first year of life have undergone clinical examination of urination, 24-h monitoring of spontaneous voiding rhythms, ultrasonic measurements of residual urine. Normal urodynamic parameters of fetal lower urinary tract depending on gestation duration were obtained. These parameters can be used as prognostic criteria in diagnosis of intrauterine urinary disorders.

[Magnetic resonance imaging in the diagnosis of different forms of endometriosis]. / Magnitno-resonansnaia tomografiia v diagnostike razlichnykh form éndometriozov.

The present paper examines the capacities of non-invasive MRI in the diagnosis of endometriosis. A standardized study algorithm is proposed, indications and methodology for MRI in different forms of endometriosis (EM) are specified. It is shown that in the diagnosis of different types of EM there are specific changes in the MR pattern of small pelvic organs, which allow one to make a differential diagnosis of this disease with a higher sensitivity (96%) and specificity (87%) as compared with ultrasound study. MRI makes it possible to assess the degree of invasion of endometrioid heterotopies into the wall of the intestine and cervix uteri with a high degree of accuracy and to judge the degree and extent of intestinal luminal narrowing. Diagnostic errors in solving these problems (as well as those associated with the detection of extragenital foci of EM in the small pelvis) are due first of all to movement artefacts a (respiration and intestinal motility) particularly in the presence of a significant adhesive process and/or after surgical intervention. MRI does not virtually yield false-negative conclusions in the diagnosis of different forms of genital endometriosis (less than 3%), which, in the authors' opinion, rather justifies some hyperdiagnosis (about 11%) made by this method in the diagnosis of endometriosis of the rectovaginal septum. MRI is a closing, specifying stage of instrumental diagnosis of not only EM, but also other small pelvic diseases.

[A case of total ureteral obturation of a single kidney with urate calculi]. / Sluchai total'noi obturatsii mochetochnika edinstvennoi pochki uratnymi kamniami.

The authors report a case of a male patient with urate nephrolithiasis aggravated with postrenal anuria due to total obturation of the single kidney's ureter with multiple calculi located as a path. The outcome was satisfactory.

[Ultrasonographic diagnosis of tumors of the gallbladder]. / Ul'trazvukovaia diagnostika opukholei zhelchnogo puzyria.

The role of echography in the diagnosis of gallbladder tumors was investigated. Benign tumors (papilloma and adenoma) were diagnosed in 2 patients and carcinoma in 18 subjects. This technique failed to diagnose carcinoma in 2 patients. Two more procedures had false-positive results (in one patient multiple clots in the dramatically enlarged bladder were taken for the tumor while ++post-inflammatory granulation in the other patient was mistaken for the tumor as well). Echographical signs of gallbladder tumors were presented, as were the criteria permitting one to differentiate carcinoma from other pathological formations in the gallbladder (echogenic bile, cholesterol polyps, cholecystitis, adenomyomatosis). High informative value of echographic investigation in the diagnosis of gallbladder tumors was noted.

[Transvaginal echography in the diagnosis of endometrioid cysts of the ovaries]. / Transvaginal'naia ékhografiia v diagnostike éndometroidnykh kist iachnikov.

Research into the value of transvaginal echography in the diagnosis of endometrioid ovarian cysts has shown that this pathology is characterized by the presence of a round or oblong formation, filled with small-dotted suspension of mean or high echogeneity, by a dense hyperechogenic component of small sizes and wall thickening up to 0.2-0.3 cm. The accuracy of diagnosis of endometrioid ovarian cysts was 92.3%.

[Prenatal ultrasonographic diagnosis of congenital isolated developmental defects of fetal extremities]. / Antenatal'naia ul'trazvukovaia diagnostika vrozhdennykh izolirovannykh porokov razvitiia konechnostei ploda.

The paper shows that echography can be used in the diagnosis of most congenital fetal limb developmental defects. The detection accuracy for severe anatomic defects was 83.3%. That for mild hand and foot developmental defects was achieved in 54.8% of the cases. Bilateral coxofemoral joint dislocation was diagnosed only in 2 fetuses. The paper also presents echograms of most malformations detected and emphasizes that it is essential to make a comprehensive and detailed examination of all fetal limbs.

[Echographic characteristics of uterine sarcomas]. / Ekhograficheskaia kharakteristika sarkom matki.

Sonographic potentials in the diagnosis of uterine sarcomas have been evaluated. Sarcomas were identified in 9 patients. Their populational incidence was 0.67:100,000. Specific sonographic signs of this disease were absent. The most characteristic presentation of uterine sarcomas were an anecho enic area in the myomatous node in the absence of acoustic effects of dorsal accentuation, appearance of cystic degeneration of the tumor, and a marked uterine enlargement during a follow up. It is suggested that these criteria may provide a diagnosis accuracy in a number of cases.

[Possibilities of echography in the diagnosis of polycystic ovary syndrome]. / Vozmozhnosti ékhografii v diagnostike sindroma polikistoznykh iaichnikov.

An examination was made to define the significance of echography in the diagnosis of the polycystic ovary syndrome. A total of 276 patients with the morphologically verified disease and 70 healthy females of reproductive age were studied. It was found that the reliable results in detecting the disease might be obtained when the ovarian-uterine index (OUI) proposed by the authors was calculated. The OUI is the quotient obtained when the mean ovary volume was divided by the uterine thickness. It was ascertained that the OUI greater than 3.5 was indicative of the polycystic ovary syndrome in 91%. The index lower than the threshold value was suggestive of normal ovaries in 85%. In general, the accuracy of the presence or absence of the polycystic ovary syndrome was 87% when the OUI was estimated.

[Ultrasonic diagnosis of malformations during the 1st trimester of pregnancy]. / Ul'trazvukovaia diagnostika anomalii razvitiia v I trimestre beremennosti.

Available are the results of ultrasonic investigations for 11 women with embryonal anomalies in the I pregnancy trimester. Echography was demonstrated to detect gross CNS malformations (anencephaly, exencephaly), lymphangiomas, omphalocele, conjoined twins, acardia of amorphic embryo, etc. Transvaginal sensors proved highly informative.

[Ultrasonographic diagnosis of developmental facial defects in fetuses]. / Ul'trazvukovaia diagnostika porokov razvitiia litsa u ploda.

Findings of 55 ultrasound examinations have been evaluated in 35 fetuses with various facial malformations detected by ultrasound and confirmed at birth. Ultrasonographic presentations and diagnostic criteria are given for major facial, palate and lip clefts, abnormal nasal shape, hypo and hypertelorism, microphthalmia, exophthalmia, micro and macrogenia, macroglossia. Ultrasonography proves to be a highly revealing diagnostic study with the provision of a good structural visualization and physicians' skill.

[Ultrasonic study in the diagnosis of developmental defects and diseases of the urinary system in children]. / Ul'trazvukovoe issledovanie v diagnostike porokov razvitiia i zabolevanii mochevoi sistemy u detei.

Echography has recently become one of the leading methods of examination in different branches of medicine. Despite its high informativeness, however, it is not used widely in pediatrics. The article generalizes the practical experience accumulated in ultrasonic examination of urinary organs in children with developmental anomalies and diseases of the kidneys, ureters, urolithiasis, and Wilms' tumor. Besides, the possibility of echography as a screening test in outpatient examination of children with changed values of urinalysis is shown for the first time in pediatric practice. The authors describe the advantages of the method in combined developmental anomalies and regular medical examination of patients after various methods of treatment. They emphasize its merits (absolute safety, no injurious effect, high informativeness, the possibility of performing it in children who are in a grave condition, its extensive use under outpatient conditions, etc.). It is shown the ultrasonic examination in outpatient clinics makes it possible to divert from the traditional plan of radiourological examination of children, which includes excretory urography performed in children in inpatient clinics as a rule. It is obvious that the use of echography as a diagnostic test will make it possible to exclude the radiation load which is most harmful for the growing and developing organism and will not require mass hospitalization, which will undoubtedly have a high therapeutic and economical effect.