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Genitourinary Cases 26-50

This case directory includes diagnoses such as adrenocortical carcinoma, Gartner's duct cyst, Nabothian cyst, prostatic utricle cyst, and ovarian neoplasm. Learn about the imaging findings and differential diagnoses for each case.

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Genitourinary Cases 26-50

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  1. Genitourinary Cases 26-50

  2. Case directory

  3. Case 26

  4. Adrenocortical carcinoma • Case findings: • Large left adrenal cortical carcinoma with tumor extension into IVC (arrow) • MC > 5 cm at presentation • Large heterogenous suprarenal mass with areas of hemorrhage, necrosis, and calcification • Well circumscribed, despite its large size, and a well defined capsule-like rim • May contain areas of lipid detected on opposed-phase chemical shift imaging • Classic: IVC extension

  5. Case directory Adrenocortical carcinoma Coronal T2: large right adrenal cortical carcinoma with extension of tumor into IVC (arrow)

  6. Case 27

  7. Case directory Gartner's duct cyst • Case findings: • Well circumscribed non-enhancing thin-walled cyst anterolateral to the vagina (paravaginal location) • Retention cyst arising from Gartner’s ducts, occurring along the Wolffian duct remnant • Paravaginal and anterolateral in position • DDX: • Squamous inclusion cyst of the vagina • Ureteric diverticulum • Bartholin’s gland: located more distally and superficially adjacent to the vulva

  8. Case 28

  9. Case directory Nabothian cyst • Case findings: • Multiple clustered small Nabothian cysts • Inclusion cyst formed in the uterine cervix when the opening of a Nabothian duct located within the cervix is covered by epithelial cells and the fluid is then retained

  10. Case 29

  11. Case directory Prostatic utricle cyst • Midline lesion posterior and superior to the verumontanum • Abnormality in the regression of mullerian duct • Can also be acquired due to posterior urethritis and verumontanitis • DDX mullerian duct cyst: larger and extend above the base of the prostate

  12. Case 30

  13. Ovarian neoplasm • Diagnosis: Ovarian serous cystadenocarcinoma • Epithelial: • Serous cystadenoma/cystadenocarcinoma • Mucinous cystadenoma/cystadenocarcinoma • Clear cell carcinoma • Brenner tumor • Stromal: • Granulosa cell tumor (estrogen)  Call-Exner bodies • Sertoli-Leydig (androgen) • Thecoma, fibroma (low T2) • Meig’s syndrome: ovarian fibroma, ascites, pleural effusion

  14. Ovarian neoplasm • Germ cell tumor: • Dysgerminoma (similar to seminoma): radiosensitive • Yolk sac tumor (endodermal sinus tumor): elevated AFP • Embryonal cell carcinoma • Choriocarcinoma • Teratoma (dermoid cyst) • Metastasis: • Lymphoma • Primary uterine tumor • Stomach, colon, breast • Kruckenberg tumor: ovarian metastasis from stomach or colon primary

  15. Case directory Ovarian serous cystadenoma Axial T2: bilateral cystic adnexal masses with minimal internal complexity

  16. Case 31

  17. Case directory Subcapsular renal hematoma • Case findings: • Right kidney is compressed with a delayed nephrogram relative to the left kidney • Page kidney: chronic long-standing compression of underlying renal parenchyma by subcapsular haematoma can result in hypertension, due to local ischemic change causing excess secretion of renin

  18. Case 32

  19. Case directory Urethral diverticulum • Males: congenital urethral diverticula • Females: urethral diverticula are acquired

  20. Case 33

  21. Case directory Epidermoid cyst of the testis(keratocyst) • Case findings: • Solid mass in the right testis with calcification and acoustic shadowing • Comprise layers of keratin, within a fibrous capsule lined with simple squamous epithelium • US: • Solid mass with echogenic rim and peripheral acoustic shadowing • Onion-ring (lamellated) pattern of the periphery with a target appearance • Treatment: enucleation thereby avoiding an orchiectomy • DDX: • Calcified haematoma • Intratesticular cyst (anechoic centre and through transmission) • Teratoma

  22. Case 34

  23. Tubular ectasia of the testis(cystic transformation of rete testis) • Case findings: • US: well-defined tubular structures in the region of the mediastinum testis • Anastomotic ducts are located in the mediastinum testis, in which numerous seminiferous tubules drain and connect with the head of the epididymis • Secondary to obstruction of seminiferous tubules following infection or trauma • Associated with: ipsilateral epididymal cyst

  24. Case directory Tubular ectasia of the testis(cystic transformation of rete testis) • DDX: • Intratesticular varicocele: rare, increases in size on the Valsalva maneuver and shows blood flow • Cystic dysplasia of the testis: rare, associated with congenital abnormalities • Cystic malignant testicular tumor: can occur anywhere in the testis • Teratoma: may present as a cystic tumor, although this is very rare

  25. Case 35

  26. Case directory Seminal vesicle cyst • Case findings: • Slight peripheral enhancement of the cyst wall • No internal septations • Aberrations of distal Wolffian ducts lead to atresia or stenosis of the ejaculatory ducts, resulting in obstruction and congenital seminal vesicle cyst formation • DDX testicular cyst: • Bladder or ureteral diverticulum • Seminal vesicle abscess • Müllerian duct cyst • Cystadenoma of the seminal vesicle or of the prostate • Dermoid cyst • Teratoma • Echinococcus cyst (rare)

  27. Case 36 Axial fat-suppressed T1-weighted

  28. Coronal T2-weighted post-Gd

  29. Coronal fat-suppressed T1WI post-Gd

  30. Ovarian fibroma • Case findings: • Large multilobulated solid ovarian mass • Heterogenous enhancement • Low T2 signal • Fibroma associated with Meig’s syndrome (ovarian fibroma, ascites, pleural effusion)

  31. Case directory Ovarian fibroma • DDX low T2 ovarian lesion (fibrous components): • Fibroma • Fibrothecoma • Cystadenofibroma • Brenner’s tumor

  32. Case 37

  33. Sagittal T2WI Coronal T1WI

  34. Case directory Pseudomyxoma peritonei • Case findings: • US: complex cystic lesion which is septated with solid areas • CT: • Scalloping of the liver due to the gelatinous nature of the fluid • Fluid in the peritoneal cavity with areas of calcification (arrows) • MR T2WI: • Gelatinous fluid in the pelvis and surrounding the viscera • Also seen invading the anterior abdominal wall and extending into the perianal region • Mucinous implants of the peritoneum • Gelatinous ascites secondary to a benign or malignant tumor of the appendix, ovary or other organs (pancreas, colon, etc.) • Enhancement helps to differentiate from ascites • Walls may show calcification

  35. Case 38

  36. Multilocular cystic nephroma (MLCN) • Case findings: • Well-marginated, rounded, or polycyclic cortical mass that extends beyond the normal renal outline • Multilocular cystic renal tumor: term that encompasses two histologically distinct entities • Multilocular cystic nephroma (MLCN) • 1/3 of MLCN theoretical risk of cystic RCC, MC adult women • Cystic partially differentiated nephroblastoma (CPDN) • CPDN: 2/3 of MLCN, MC young children, theoretical risk of Wilms’ tumor • Imaging cannot distinguish between MLCN and CPDN

  37. Multilocular cystic nephroma (MLCN) • Clinical presentation: • Painless abdominal mass with rapid enlargement • Features: • Well-marginated cysts with multiple septa (only septa enhance) • Congenital lesion with large (> 10 cm) cystic lesions • Compared with the poorly defined necrotic cystic appearances of a degenerative Wilms' tumor

  38. Multilocular cystic nephroma (MLCN) • Multilocular cystic renal tumor features: • Round, well-encapsulated multilocular cystic mass • Central location • Invasion into renal sinus • Prolapse into collecting system (pathognomonic finding) • Contain multiple non-communicating cysts with thin septa separating the cysts • DDX: • Cystic Wilms' tumor • Wilms' tumor coexisting with CPDN

  39. Multilocular cystic nephroma (MLCN) • Current thinking suggests that cystic nephroma, CPDN and Wilms’ tumor represent a spectrum of disease • MLCN: benign end of the spectrum • Wilms' tumor: malignant end of the spectrum • CPDN: intermediate stage where blastemal elements are present within internal septa

  40. Case directory Multilocular cystic nephroma

  41. Case 39

  42. Subepithelial hemorrhage • Case findings: • Findings are masked on CECT • CECT: mild calyceal dilatation and constriction of lumen of renal pelvis • NCCT: high-attenuation thickening of pelviureteric wall caused by hemorrhage • Bleeding may be parenchymal, subcapsular, perinephric, subepithelial (rare) • Subepithelial renal sinus hemorrhage is NC seen in coagulopathic patients

  43. Case directory Subepithelial hemorrhage • DDX on IVP: focal pelviureteral wall irregularity may be indistinguishable from • Subepithelial hemorrhage • Transitional cell carcinoma • Pyeloureteritis cystica • Submucosal edema

  44. Case 40

  45. Perinephric hemorrhage • Case findings: • Left perinephric (PN) and anterior pararenal (AP) hematomas • Focal defect in the left renal cortex (arrow) represents renal parenchymal scarring • Selective right renal angiography showed small aneurysms (not shown) • Diagnosis: perinephric hemorrhage due to polyarteritis nodosa • DDX on CECT: • Lymphoma • Perinephric hemorrhage

  46. Perinephric hemorrhage • Causes of subcapsular perinephric hemorrhage: • Trauma: • Renal laceration • Avulsion of the renal artery • Neoplasm • Malignant (renal cell carcinoma) • Benign (angiomyolipoma) • Vasculitis: polyarteritis nodosa • AVM • Aneurysm • Anticoagulant therapy • Acute infection • Acute or chronic nephritis

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