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.

[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.

[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.

[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.

[Application of echography to the diagnosis of chromaffinomas of extra-adrenal localization]. / Primenenie ékhografii dlia diagnostiki khromaffinom vnenadpochechnikovoí lokalizatsii.

Sixty-one patients with chromaffinoma were examined by echography. Of these, 6 patients (9.8%) had extraadrenal tumors. Application of echography permitted a correct topical diagnosis to be made in 5 patients. In 2 persons, the tumor was located in Zuckerkandl's fascia, in 2 in the paraaortal ganglia at the level of the splenic vein and the left hilus renalis, and in 1 patient, it was located in the urinary bladder. In one of the cases, no chromaffinoma was found. Since the majority of extraadrenal chromaffinomas (96%) are located in the retroperitoneal space echography can successfully be used for diagnosing such tumors with the exception of intrathoracic tumors which cannot be visualized in connection with the presence of air in the lungs. In such cases use should be made of computer-aided tomography.

[The importance of echography in the diagnosis of precancer and cancer of the endometrium]. / Znachenie ékhografii v diagnostike predraka i raka éndometriia.

Ten-year experience with ultrasonography was gained at an outpatient center. Within this period, 27000 examinations were performed in 11996 females. The credibility of the method in diagnosing endometrial pathology was 85.8%. Cancer morbidity for the last 5 years was compared in the ultrasonography and no ultrasonography groups. Endometrial cancer morbidity was 6.2 times higher in the latter group. Large-scale application of the procedure followed by adequate treatment assures significantly lower incidence of said pathology.

[Role of echography in early detection of ovarian tumors]. / Rol' ékhografii v rannem vyiavlenii opukholei iaichnikov.

Within the last 10 years, ultrasonic screening was carried out in 11,996 females (27,000 examinations on the whole) on an outpatient basis. The reliability of the procedure in diagnosing ovarian tumors proved as high as 94.1%. Cancer morbidity for the last 5 years was compared in the ultrasonography and no ultrasonography groups. The occurrence of cancer in the former group was 7 times lower which was attributed to timely detection and removal of tumors capable of malignant transformation. It was concluded that large-scale application of ultrasonography assures significantly lower incidence of ovarian cancer.

[Value of echography in the differential diagnosis of benign and malignant corticosteromas]. / Znachenie ekhografii v differentsial'noi diagnostike dobrokachestvennykh kortikosterom.

Altogether 34 patients with corticosteroma were examined. In 29 (85%) of them accurate topical diagnosis was established as a result of ultrasonic investigation. All erroneous results were obtained only for corticosteromas of small sizes (4 cm and less in diameter). Tumors not exceeding 4 cm in diameter were benign in 88% of cases. If tumor sizes were over 4 cm, they were malignant in 89%. The earliest possible investigation for the presence or absence of a tumor was indicated to patients with hypercorticism.

[Use of echography for diagnosing aldosteromas]. / Primenenie ékhografii dlia diagnostiki al'dosterom.

Altogether 23 patients were examined to assess the value of echography in the diagnosis of aldosteromas. Tumors were diagnosed at operation in 21 (2 malignant tumors) and adrenal hyperplasia in 2. The accuracy of diagnosis with regard to the presence or absence of aldosteromas was 82.6%. An analysis of the causes of erroneous results showed that they were noted in small size formations less than 2 cm in diameter, in corpulent patients and in the left-side tumor site due to more complicated anatomotopographic interrelationships of the organs in this area.

[Artefacts, acoustic phenomena and basic principles of echogram interpretations]. / Artefakty, akusticheskie fenomeny i osnovnye printsipy interpretatsii ékhogramm.

Careful consideration is given to such important practical problems as the emergence and features of artefacts and acoustic phenomena arising in ultrasonic images. These are reverberation, comet's tail, hyperbolic artefacts, artefacts of reflection, refraction, focal distance, beam length, changes in velocity, marginal rays, etc.. Principles of uniform reading of ultrasound images are suggested.

[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.

[Experience in utilizing ultrasonic compound scanning in obstetrics]. / Opyt ispol'zovaniia ul'trazvukovogo slozhnogo skanirovaniia v akusherstve

A promising method of ultrasonic diagnostics is compound or multiple scanning. Its application in obstetrics makes it possible to more distinctly define the contours of the structures studied. Results subsequent to an examination of 750 pregnant women showed that by using this method it becomes possible to determine the position of the fetus, biparietal diameter of its head, the size of the placenta, abnormalities in the development of the fetus, etc. The advantages of compound scanning are particularly spectacular in estimating the growth of the fetal head during early periods of gestation.