Pelvic Tumors

1
MRI INTERESTING CASES OF PELVIS MASSES
Dr. Manoj Deshmukh Senior Consultant Lilavati
Hospital and Research Centre
2
Case 1
69 year old, female with complaint of difficulty
in passing urine.
3
A large, heterogeneously hypo echoic solid
lesion in pelvis with a central hyper echoic
component. ? Uterine origin.
4
Pelvic Mass with Extension into lower abdomen
5
PET-CT High grade uptake (SUV max 17.6)
6
Differential diagnosis

• Malignant ovarian lesion
• Gastrointestinal Stromal Tumor GIST

7
T2 weighted images in axial, sagittal and coronal
planes showing a large, multilobulated,
predominantly solid soft tissue lesion appearing
is ointense on T2WI, occupying the pelvis and
extending into the abdomen. Bowel is seen
invaginating through the posterior aspect of the
mass.
8
T2 SPAIR images in axial and coronal planes. The
uterus and urinary bladder are pushed
anteriorly. Rectum is seen posteriorly. Both
ovaries are not seen separately.
9
DWI and ADC images in sagittal plane showing
restricted diffusion and drop on ADC.
10
Gradient images in axial plane demonstrating
cystic structure with blood fluid level.
11
Enlarged, periportal and peripancreatic lymph
nodes showing restricted diffusion and drop on
ADC.
12
Prominent right gonadal vein from inferior vena
cava and left gonadal vein from left renal vein.
13
Histopathology
14
Case 2
29 year old female with complaints of heaviness
in pelvis
15
T2WI in Sagittal and axial planes, T1WI in axial
plane showing a large, well circumscribed lesion
in pelvis appearing predominantly hypointense on
T1WI and T2WI, with few T2 hyperintense cystic
changes
16
The lesion pushes the uterus anteriorly, the
sigmoid colon and rectum posteriorly
17
Both ovaries seen separately in T2 SPAIR images
18
No restricted diffusion No hemorrhage or
calcification seen on Gradient imaging
19
Post contrast images in axial and sagittal planes
demonstrating enhancement similar to myometrium
20
Impression

• Broad ligament Leiomyoma.

21
(No Transcript)
22
(No Transcript)
23
Case 3
9 year old female with complaints of abdominal
pain and vomiting. ?Appendicitis
24
CT suggestive of a large, soft tissue, solid mass
in the pelvis. USG shows Rt. adnexal lesion with
central necrotic component.
25

• Young female
• Raised AFP in Thousands.

26
Ovarian Malignant Germ Cell Tumor (OMGCTs 2.6)
27
T2 WI in coronal and axial planes and T1WI in
axial plane showing a fairly well defined solid
cystic lesion in right adnexa appearing
iso-hyperintense on T2 and isointense on T1
28
A unilateral, mixed solid and cystic mass with
hemorrhagic portion. Right ovary is seen abutting
the lesion
29
Areas of restricted diffusion on DWI with drop on
ADC. Haemorrhagic areas on gradient imaging
30
Post contrast images in axial, coronal and
sagittal planes showing peripheral enhancement
with central necrosis
31
(No Transcript)
32
(No Transcript)
33
Case 4

• A 10 year old female
• Pain in abdomen
• Raised CBC , ESR
• Outside CT scan Tubo - ovarian mass .

34
Solid cystic mass in right adnexa on USG
35
Axial and coronal T2WI showing multiple,
conglomerated collections with T2 hyperintense
signals in right adnexa
36
T2WI in axial and coronal planes Right ovary is
pushed medially.
37
Central restricted diffusion is seen with
corresponding drop on ADC
38
Intense enhancement in the lesion and surrounding
it
39
Differentials

• Tubo-ovarian abscess
• Perforated appendicular abscess

40
A tubular structure with thickened and enhancing
walls, seen within the lesion ?Appendix
41
Diagnosis

• Perforated appendicular abscess

• MRI depicted
• Extraovarian
• Infection / collection
• Thin tubular structure ( part of appendix )
  embedded in the collection

42
Nougaret S, Nikolovski I, Paroder V et al (2019)
MRI of tumors and tumor mimics in the female
pelvis Anatomic pelvic space based approach.
Radio graphics 3912051229
43
(No Transcript)