Endometriosis MRI: Atypical cases, pitfalls and mimics.

Endometriosis is a common but often underdiagnosed chronic gynaecological disease. Endometriosis mimics other diagnoses both clinically and radiographically, presenting a diagnostic challenge. Endometriosis can be categorised as superficial pelvic endometriosis, deep invasive endometriosis (DIE) or endometrioma. Endometrioma and DIE, including polypoid endometriosis, can masquerade as invasive neoplasms. Endometriosis can be misdiagnosed in less common locations or during pregnancy. Ultrasound is the initial investigation for endometriosis; however, MRI is advantageous in providing a larger field of view for increased detection of nodules as well as distinguishing malignancy with greater certainty. This review highlights endometriosis mimics, pitfalls and atypical cases on MRI.

Think of ink: Tattoo pigment masquerading as a breast mass.

Migration of tattoo pigment to axillary lymph nodes mimicking calcifications is a recognized phenomenon, however, pigment in an intra-mammary node masquerading as a breast mass is a rare complication of cosmetic tattoos. As the prevalence of tattooing increases among women presenting to Breastscreen, radiologists may expect to encounter this lesion mimicking a breast neoplasm. We present a 50-year-old female with extensive tattoos on her arms, chest wall and abdomen, recalled for a small calcified breast mass on her first screening mammogram. Tomosynthesis-guided vacuum-assisted biopsy demonstrated intra-mammary lymph node with abundant tattoo pigment.

Polycystic ovary syndrome in type 2 diabetes: does it predict a more severe phenotype?

OBJECTIVE: To examine the prevalence of a history of polycystic ovary syndrome (PCOS) in women with type 2 diabetes (DM2) and to compare metabolic and reproductive outcomes between women with and without PCOS. DESIGN: Cross-sectional study. SETTING: Tertiary hospital. PATIENT(S): Female inpatients age 18-75 years with DM2. INTERVENTION(S): A face-to-face questionnaire was administered. MAIN OUTCOME MEASURE(S): Age at diagnosis of diabetes, history of gestational diabetes, family history of diabetes, and reproductive history, fertility history, number of miscarriages, and morbidity in pregnancy. RESULT(S): One hundred seventy-one inpatients with DM2 participated. The prevalence of a history of PCOS was 37%. Women with PCOS had an earlier mean age of diagnosis of DM2 (44.2 vs. 48.8 years), higher recalled peak body mass index (BMI; 43.1 kg/m2 vs. 36.8 kg/m2), higher rate of gestational diabetes (28% vs. 18%), and higher rate of hypertension in pregnancy (40% vs. 22%). Women with PCOS were less likely to have a family history of DM2 than those without PCOS (45% vs. 67%). CONCLUSION(S): A history of PCOS in women with DM2 is associated with earlier onset of DM2, higher BMI, and a more severe phenotype. Since PCOS subjects were less likely to have a family history of DM2, lack of a family history of DM2 in women with PCOS is not reassuring for DM2 risk. We recommend identifying PCOS in early life and intervening to reduce the risk of diabetes and its comorbidities and suboptimal reproductive outcomes.