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CLASIFICACIN
HISTOLGICA: OMS
3 incidencia} PATOLOGA GINECOLOGICA EDAD} CRITERIO
* > mortalidad} 50% a los 5 aos IMPORTANTE
MASAS QUSTICAS
Criterios 1 Criterios 2
1. RI (ndice de resistencia)
<: 0.4
2. Pi (ndice de pulsatibilidad)
<: 0.1
CISTOADENOCACIRNOMA SEROSO
ULTRASONIDO
1. > heterogneo que cistoadenoma seroso
2. proyecciones papilares, septos gruesos y / o
componentes slidos
presencia de ascitis
diseminacin metastsica peritoneal (depsitos
discretos)
RM componente T1 T2
QUISTICO BAJA ALTA
TC + HEMORRAGICO ALTA ALTA
1. Calcificacin en ~ 12%} inespecfica,
2. ESTADIFICACIN PREOPERATORIA
SOLIDO (maligno) INTERMEDIO INTERMEDIO
Realza gadolinio*
Figure 13
SEROUS CYSTADENOCARCINOMA. A 53-year-old woman with lower pelvic discomfort, weight loss. Axial pre contrast T1
weighted image (A), axial T2 weighted image (B), axial fat suppressed post contrast T1 weighted image (C), showing a
large complex right ovarian cystic lesion with septations, papillary projections and solid nodular components (arrowheads).
Cystic component is low signal on pre contrast axial T1 weighted image and high signal on T2 weighted image (arrow).
Septae, papillary projections and solid component are isointense on pre contrast T1 weighted and T2 weighted images with
a significant post contrast enhancement.
CISTOADENOCACIRNOMA MUCINOSO
ULTRASONIDO
Multiloculares}
~ cistoadenoma mucinoso ovrico + espesamiento quistes lisos de
mural, componentes slidos o caractersticas agresivas. pared delgada
+ material
mucoide
+ /- desechos
hemorrgicos o
celulares.
RM
componente T1 T2
TC
1. Alta atenuacin en algunos loculi} contenido de MUCINA () DEPENDE DEPENDE
protenas (mucoide) SOLIDO (maligno) INTERMEDIO INTERMEDIO
Realza gadolinio*
Mucinous cystadenocarcinoma in a 57-year-old
woman. (a) Axial, (b)coronal and (c) sagittal T2-weighted
images show a large mass with mixed solid and multilocular
cystic appearance with low signal intensity of the solid
component and variable signal intensity .
CARCINOMA DE CLULAS CLARAS
RM
1. masa ovrica cstica con el margen suave.
TC 2. Protuberancias slidas} redondos y pocos en nmero.
1. Gran masa unilocular} qustica, suave y marginada
2. Porcin slida sobresaliente de lumen T1: puede variar de bajo a muy alto (componente)
3. Porcin qustica: alta atenuada
Clear cell carcinoma. A 49-year-old woman with abdominopelvic mass. Contrast enhanced
computed tomography images of the lower abdomen and pelvis (A and B), showing a large
lobulated complex cystic mass with enhancing nodular and solid component (arrows) ..
CARCINOMA ENDOMETRIOIDE
ULTRASONIDO
1. Masa cstica grande y compleja con componentes Similar a la de otras lesiones epiteliales; ocasionalmente,
slidos. completamente slido.
2. Espesamiento endometrial asociado, evidencia de Histolgicamente, aparicin de glndulas tubulares, (endometrio).
endometriosis diferenciacin escamosa >1/3
3. Contralateral Asociaciones
hiperplasia endometrial} un tercio de los casos
Ubicacin - lateral
bilateral}25-40%
RM
T2
relativamente baja} pared tumoral
TC
signo de sombreado
T1 C + (Gd)
mejoramiento leve
Endometrioid adenocarcinoma in a 60-year-old woman. (a) Coronal and
(b) sagittal T2-weighted images show a predominantly cystic mass with
solid component arising from the inferior wall (white arrowheads). (c)
Axial fat-suppressed T1-weighted image shows.
TUMOR DEL SENO ENDODERMAL
ULTRASONIDO
Componentes ecognicos e hipoecoicos
Masa plvica grande y compleja} slidos y
Alrededor de la segunda dcada de vida, tumor de clulas
qusticos.
germinales maligno ms comn del ovario en nios
reas qusticas se componen de quistes rodeadas
Encapsulados de forma redonda a masas ovaladas.
de epitelio} producidos por el tumor o de
Asociaciones} surgir de un quiste dermoide ovrico
teratomas maduros coexistentes.
preexistente
Marcadores: elevado AFP
RM
1. Vacos de seal prominentes
*zonas de hemorragia.
TC
Yolk sac tumour in a 26-year-old woman. (a) Sagittal and (b) axial T2-weighted
images show a mixed cystic and solid mass (white arrows). (c) Axial T1-weighted
image shows haemorrhagic areas with high signal intensity within the lesion
(white arrowhead ...
DISGERMINOMA
ULTRASONIDO
1. Masa de ovario septada con ecogenicidad Tumores de clulas germinales malignas ms comunes del ovario
variable. ~ 1%
2. Flujo prominente dentro del septo fibrovascular mujeres jvenes (20- 30 aos)
Son generalmente slidos y multi-lobulados.
10-17%} bilaterales.
Marcadores: clulas gigantes sincitiotrofoblsticas (5%) }HCG
RM
TC T2: los septos suelen ser hipointensos o isointense
1. Calcificacin} patrn moteado. T1 C + (Gd): los septos muestran a menudo una mejora
2. Masas slidas multilobuladas con septos
prominentes fibrovasculares.
*Contraste: realce de los septos.
Dysgerminoma in a 17-year-old girl. (a) Axial turbo spin-echo T2-weighted MR
Dysgerminoma in an 18-year-old image (3,800/99) shows a large, multilobulated mass with intermediate signal
woman. Contrast-enhanced CT scan intensity and persistent low signal intensity of the septa (arrows). The irregular
shows a large, multilobulated solid high-signal-intensity areas (arrowheads) indicate necrosis. (b) Axial gadolinium-
mass with highly enhancing enhanced turbo spin-echo T1-weighted MR image (782/14) demonstrates
fibrovascular septa (arrows) and relatively homogeneous enhancement with persistent low signal intensity of the
cystic change (arrowheads). septa (arrows) and unenhanced necrotic areas (arrowheads).
TERATOMA INMADURO
ULTRASONIDO
gran masa heterognea con un componente slido Grandes masas encapsuladas que tienen un componente
prominente. slido prominente.
Los teratomas inmaduros tienden a ser ms grandes Presentan muchos de los componentes observados en un
que los teratomas csticos teratoma maduro, como el cabello, el cartlago, el hueso y la
calcificacin.
Asociaciones
Teratoma cstico maduro ipsilateral: ~ 25% 1
teratoma inmaduro contralateral: ~ 10% 1
RM
TC
1. Componente slido prominente + calcificaciones +
pequeos focos de grasa es sugerente.
2. Componentes qusticos pueden contener material
sebceo seroso, mucinoso o graso.
3. Hemorragia.*
Immature teratoma in a 23-year-old woman.
(a) Contrast-enhanced pelvic CT scan shows a
large mass with a large soft-tissue component,
a cystic portion, small foci of fat, and scattered
calcifications. (b) CT scan obtained at the level
of the renal hilum demonstrates extensive
retroperitoneal adenopathy.
CARCINOMA ENDOMETRIOIDE
RM
TC
Estatificacin, depende del sitio original del tumor
Coriocarcinoma metastsico gestacional uterino
estadificacin estndar de coriocarcinoma.
Coriocarcinoma primario no gestacional
neoplasias ovaricas
CARCINOMA EMBRIONARIO
RM
TC
ULTRASONIDO TUMORES DE CLULAS DE LA GRANULOSA DEL OVARIO
Crecimiento lento, predominantemente slidos con
cantidades variables de cambio qustico y hemorragia
Sntomas inespecficos como dolor abdominal, distensin o
intratumoral.
hinchazn + manifestaciones hormonales
Aspecto vara ampliamente: slida, slida-qustica
Asociaciones: Hiperoestrogenemia} Hiperplasia endometrial,
multiloculada, puramente qustica
plipos endometriales
hemorragia o fibrosis*
Subtipos
Adulto granulosa tumor de clulas del ovario: ~ 95%
Tumor juvenil de la clula granulosa del ovario
RM
TC
1. Gran masa ovrica de baja atenuacin bien
definida
Figure 21b. Granulosa cell tumor in
a 71-year-old woman. (a) Sagittal
turbo spin-echo T2-weighted MR
image (4,275/138) shows a
lobulated multilocular cystic mass that
resembles a cystadenocarcinoma.
However, no evidence of a papillary
projection is noted. The endometrial
cavity (arrows) is unusually prominent
for a patient this age, a finding that is
consistent with endometrial
hyperplasia. (b) Gadolinium-
enhanced fat-suppressed FLASH T1-
weighted MR image (148/4.8)
demonstrates multiple well-enhanced
septa, with numerous large cystic
spaces lined by granulosa cells. These
findings represent an extreme
example of the macrofollicular patter
Granulosa cell tumor in a 55-year-old woman.
Contrast-enhanced CT scan shows a large,
complex mass with a lobular contour, multiple cysts
with a bunch of grapes appearance on the right
(arrows), and an irregularly enhancing solid
portion on the left (). U = uterus.
FIGO