SONO. CASE PRESENTATION 가천의대길병원 초음파실 R2 이현이

초음파실 통계상황 12/1~12/712/8~12/14 OB7279 GY Target68 Amnio11 Doppler10 BPP00 Aspiration10

CASE I 성 0 주 (26/F) C.C:Abdominal distension P.I : 상기 환자 월 세째주부터 배가 불러와 인천의료원경유하여 난소혹 (?) 있 다고하여 입원함

OBHx: P Mens Hx Regular-6 일 -Moderate-pain(-) Rt ovary – wedge resection Lt ovary – LO state PHx :DM/HTN/Pul.Tbc/Asthma (-/-/-/-) FHx : none

Lab : 10.21(local) a-FP CA CA

Sono finding I TVS Uterus AVF 8.1x4.5x3.7 cm

Sono finding II TVS Transverse view

Sono finding III TVS Endo- metrium 0.6 cm

Sono finding IV TVS Lt. ovary 5.0x4.1cm cystic lesion with echolucent region 관찰됨

Sono finding V TVS Rt.ovary 15.8x16.2x 11.0 cm sized septated cystic lesion

Sono finding VI TVS Rt.ovary

Sono finding VII TAS Rt.ovary 16.9x11.2 cm sized Septated cystic lesion

Sono finding VIII TAS Rt.ovary mass 내 Lt. 쪽 으로 13.5x7.4c m sized echogenic resion with numorous small cystic lesion 관찰 됨

Sono finding IX TAS Rt.ovary RI 0.33

Sono finding X TAS Rt.ovary RI 0.38

Sono finding XI TAS Rt.ovary RI 0.22

Sono finding XII R/O Rt. Ovary cancer R/O Lt. ovary hemorrhagic mass R/O Lt. ovary cystic teratoma

Op date : OP name: Explo-laparotomy (RSO, LO) Bx: Rt.ovary – Yolk sac tumor Lt.ovary – Mucinous cystadenoma

CASE II 김 0 현 (44/F) C.C:Abdominal distension P.I : 상기 환자 10 월초부터 복부에서 mass 만져지고 복통이 동반되어 개인내과의 원방문해서 난소혹 (?) 있다고하여 evaluation 및 수술위해 입원함

OBHx: P Mens Hx Regular-3 일 -scanty-pain(-) PHx :DM/HTN/Pul.Tbc/Asthma (-/-/-/-) FHx : none

Lab : 11/5 11/8 CA CA CEA 8.18

Sono finding I TVS Uterus AVF 7.9 x 4.3 x 4.6 cm

Sono finding II TVS Transverse Scan of Ut.

Sono finding III TVS Endometri um 0.49cm

Sono finding IV TVS PCDS Fluid collection (depth: 2.28cm)

Sono finding V TVS Rt ovary 16.4x13.5x9.9c m Echogenic lesion with numerous cystic lesion 소견 Wall irregular margin

Sono finding VI

Sono finding VII Color flow: (+) RI:0.27

Sono finding VIII RI:0.28

Sono finding IX TVS Lt ovary 3.1x2.0cm

Sono finding X Imp: 1. R/O Rt. Ovarian mucinous cystadenocarcinoma R/O Rt. Ovarian Ca.

CT finding I About 17 x 12 cm sized a huge multicystic mass in pelvic cavity, moderate amount of ascites

CT finding II

CT finding III Pre- enhance

CT finding IV Ovary cancer with peritoneal carcinomatosis R/O Krukenberg tumor

MRI finding I Sagital T2WI About 17 x 12 cm sized a huge multicystic mass in pelvic cavity

MRI finding II Axial T2WI

MRI finding III Axial T1WI

MRI finding IV Axial T1WI Segmental enchancing wall of thickening of rectosigmoi d junction on CT

MRI finding V Sagital T2WI

MRI finding VI Colon cancer Krukenberg tumor, more likely

GSF ( ) : atropic gastritis CSF ( ) : R/O colon cancer, rectosigmoid junction  Bx;adenoca,well diff.(primary)

OP date: OP name:Hartmann ’ s OP with TAH & BSO Bx; Colon, segmental resection ; Adenocarcinoma, moderately differentiated Ovary, right; Metastatic adenocarcinoma Ovary, left; Capsular involvement of metastatic adenocarcinoma

Transvaginal color doppler sonography :parameters ParametersPrabable histology BenignMalignant Vessel location Peripheral Central Other Maximum systolic velocity High Intermediate Low (>15cm/s) (b/w 10~15cm/s) (<10cm/s) Impedance High Intermediate Low PI(>1.5) (b/w 1.0~1.5) (<1.0) RI(>0.6) (b/w 0.4~0.6) (<0.4) Waveform shape +Notch Intermediate -Notch Vessel “density” High Intermediate Low ( 5%) Peripheral Low High + Low Central High Low - High

Typical Transvaginal Color Doppler Sonographic Findings in Benign and Malignant Ovarian Masses Type of massVessel distributionImpedance, Relative Velocity Corpus luteumPeripheralLow, High EndometriomaPeripheralVariable Dermoid cystPeripheral and centralVariable Ovarian torsionAbsentVery high if present Benign epithelial ovarian tumor PeripheralHigh, low Malignant ovarian tumor Peripheral and centralLow, high

Endodermal Sinus Tumors(EST) I (yolk sac carcinomas) Derived from the primitive yolk sac 3 rd most frequent malignant germ cell tumors of the ovary Occurs in median age of 16 to 18 yrs Initial Sx – Abdominal or pelvic pain (75%) Asymptomatic pelvic mass (10%)

Endodermal Sinus Tumors(EST) II (yolk sac carcinomas) Gross appearance – soft grayish-brown Cystic area caused by degeneration are present in rapidly growing lesions Capsule is intact in most cases Unilateral in 100% of cases  Bx of the opposite ovary in such young patients is contraindicated

Endodermal Sinus Tumors(EST) III (yolk sac carcinomas) Surgery 1. surgical exploration, unilateral salpingo-oophorectomy and frozen section for Dx CTx 1. Adjuvant or therapeutic CTx - Cisplatin-containing combination CTx  BEP or POMB-ACE 2 nd -look laparotomy