ARRS 2022 Abstracts

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E1588. Adnexal Lesions Gone Wild: Imaging Pearls and Pitfalls in the Evaluation of Adnexal Lesions
Authors
  1. Abiola Femi-Abodunde; University of North Carolina, Chapel Hill
  2. Ellie Lee; University of North Carolina, Chapel Hill
  3. Lauren Burke; University of North Carolina, Chapel Hill
  4. Katrina McGinty; University of North Carolina, Chapel Hill
  5. Kristen Olinger; University of North Carolina, Chapel Hill
Background
There is a wide plethora of both benign and malignant pathologies involving the adnexa. Additionally, there are non-gynecological conditions that can be challenging to distinguish from primary ovarian malignancy. In fact, the ability of these ‘mimickers’ to closely resemble ovarian malignancy is often astounding when revealed by final pathology. Although tissue diagnosis is confirmatory, understanding key multimodality imaging features can help radiologists guide clinicians in deciding appropriate management and for surgical planning. Most adnexal lesions do tend to be benign, and for those, expectant management may be logical. However, there are overlapping imaging characteristics between some benign and malignant lesions, and the utility of advanced imaging techniques (e.g., MRI) as problem-solving tools cannot be underestimated.

Educational Goals / Teaching Points
The objective of this educational exhibit is to first review common benign pathologies involving the adnexa including infection, ischemia, endometriomas and benign cystic lesions. Categories of primary ovarian malignancies to be discussed include epithelial tumors, germ cell tumors, sex-cord tumors, and metastatic tumors. There will be close emphasis placed on GI malignancies that often closely resemble primary ovarian malignancies. The management of both benign and malignant ovarian lesions and ‘mimickers’ will be briefly discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multimodality imaging of adnexal pathology will be discussed including sonographic (US) and CT. Advanced MRI as a problem-solving tool would be emphasized. Specifically, T1 and T2-weighting imaging characteristics, such as in-out of phase and diffusion sequences, are extremely valuable in depicting the contents of ovarian tumors, which further aid in their classification (e.g., mucin/hemorrhage, fat, etc). Histopathology analysis is often critical for making the final diagnosis; however, even final pathology can be challenging and must be considered in tandem with the clinical scenario. Krukenberg tumors, now called mucin-secreting signet ring cell carcinoma, for example, would require specific immunohistochemical analysis.

Conclusion
A wide range of possibilities exist when imaging adnexal lesions, including primary ovarian neoplasms and extra-ovarian malignancies. Although there are key imaging features associated with common adnexal pathology, confounding factors and overlapping radiographic appearances can make the appropriate diagnosis challenging on imaging. With a better understanding of the spectrum of pathology, radiologists can play a crucial role in regards to appropriate management of these findings and surgical planning.