MyPACS.net: Radiology Teaching Files > Case 7391449

Never visited OVARIAN DYSGERMINOMA. 12.2 YEARS OLD
Contributed by: Corning Benton, Radiologist, Cincinnati Children's Hospital Medical Center, Ohio, USA.
History: 16 year old girl seen in the ED for periumbilical pain.
Images:[small]larger

Fig. 1: 1. AP Abdomen

Fig. 2: 2. Upright abdomen

Fig. 3: 3. CT survey view

Fig. 4: 4. CT showing retroperitoneal metastasis (arrow)

Fig. 5: 5. CT showing serpiginous vessels (arrows) on the underdurface of the tumor.
Findings: CLINICAL HISTORY: PERIUMBILICAL PAIN.

PROCEDURE COMMENTS: 5 MM HELICAL IMAGES ARE OBTAINED FROM JUST ABOVE THE
DIAPHRAGM THROUGH THE ILIAC CREST. 23 OZ OF GASTROVIEW AND 85 CC OF
OPTIRAY WERE GIVEN.

COMPARISON: NONE.

FINDINGS: THE LUNG BASES ARE CLEAR. NO PLEURAL EFFUSIONS ARE SEEN.

THE LIVER IS NORMAL IN ATTENUATION WITHOUT EVIDENCE OF MASS OR METASTATIC
DISEASE. NO INTRAHEPATIC BILIARY DUCTAL DILATATION IS SEEN. THE
GALLBLADDER, SPLEEN, PANCREAS, BOTH ADRENALS ARE WITHIN NORMAL LIMITS.
THE RENAL COLLECTING SYSTEMS ARE SLIGHTLY PROMINENT BUT UNABLE TO BE
TRACED INTO THE PELVIS.

JUST BELOW THE LEFT RENAL VEIN AN AREA OF ROUNDED DECREASED ATTENUATION
WHICH MEASURES 2.4 CM IN A LARGER AREA WHICH MEASURES 3.6 CM AND PARTIALLY
SURROUNDS THE AORTA. ON THE RIGHT SIDE BELOW THIS LEVEL THERE IS A 3.5 CM
AREA OF SOFT TISSUE. THIS ONE SEEN ON THE RIGHT BELOW THIS AREA
COMPRESSES THE INFERIOR VENA CAVA WHICH ONLY MEASURES 2.4 MM AT THIS
LEVEL. THE SOFT TISSUE DENSITY EXTENDS INFERIORLY ALONG THE PERIAORTIC
REGION COMPATIBLE WITH LYMPHADENOPATHY. THE LYMPHADENOPATHY DOES APPEAR
TO PARTIALLY ENCASE THE AORTA. THE VISUALIZED LOOPS OF SMALL BOWEL AND
COLON WITHIN THE UPPER ABDOMEN APPEAR NORMAL. NO FREE AIR OR FREE FLUID
IS SEEN WITHIN THE UPPER ABDOMEN. THE LARGE PELVIC MASS WHICH WILL BE
DESCRIBED ON THE PELVIC CT REPORT DOES EXTEND INTO THE UPPER ABDOMEN AND
MEASURES AT LEAST 13 CM AT THE LEVEL OF THE UMBILICUS.

IMPRESSION: LARGE PELVIC MASS EXTENDING INTO THE UPPER ABDOMEN MEASURING
AT LEAST 13 CM WITH PERIAORTIC METASTATIC DISEASE.



EXAMINATION:(CT) - CT PELVIS W/CONTRAST 02/13/2003 19:47

CLINICAL HISTORY: PERIUMBILICAL PAIN AND MASS SEEN ON PLAIN FILM.

PROCEDURE COMMENTS: 5 MM HELICAL IMAGES ARE OBTAINED FROM JUST ABOVE THE
DIAPHRAGM THROUGH THE PELVIS. IV INTERVAL CONTRAST WERE ADMINISTERED.

COMPARISON: NONE.
FINDINGS: A HUGE MASS IS SEEN WITHIN THE PELVIS DISPLACING THE BOWEL.
THE UTERUS AND OVARIES ARE NOT IDENTIFIED. MULTIPLE VESSELS ARE SEEN
ALONG THIS MASS WHICH MAY REPRESENT INCREASED ARTERIAL FLOW. MULTIPLE
NECROTIC AREAS ARE SEEN WITHIN THE MASS AND THE MASS MEASURES AT LEAST
14.2 X 10.0 CM.

THE VISUALIZED LOOPS OF SMALL BOWEL AND COLON WITHIN THE PELVIS APPEAR
NORMAL. A NORMAL RETROCECAL APPENDIX IS SEEN. ON THE LAST COUPLE OF
IMAGES THE BILATERAL COMMON FEMORAL VEINS ARE NOTED TO BE LOW ATTENUATION.
THIS WAS NOT NOTICED ON INITIAL SCAN SO DELAYED IMAGES WERE NOT OBTAINED.
THIS MAY BE RELATED TO THE FACT THAT EXAM WAS PERFORMED IN ARTERIAL PHASE.
HOWEVER DUE TO THE LOW ATTENUATION DVT CANNOT BE TOTALLY EXCLUDED.

1. HUGE MASS WITHIN THE PELVIS CAUSING MASS EFFECT WITH NECROTIC REGIONS
PRESENT AND PERIAORTIC METASTATIC DISEASE AS DESCRIBED IN THE ABDOMEN.
THIS IS FELT TO MOST LIKELY REPRESENT BURKITT'S LYMPHOMA. AN OVARIAN TUMOR
SHOULD ALSO BE CONSIDERED.
2. LOW ATTENUATION WITHIN THE COMMON FEMORAL VEINS WHICH COULD REPRESENT
DVT OR DELAYED BOLUS. THESE RESULTS WERE DISCUSSED WITH THE HEMOC TEAM
WHO STATED PATIENT HAD NO SYMPTOMS AT THIS TIME BUT WOULD MONITOR HER AND
ORDER A DOPPLER EXAM IF SHE DEVELOPED SYMPTOMS.

Differential diagnosis based on this appearance includes Burkitt's lymphoma, rhabdomyosarcoma, or ovarian tumor
Diagnosis: OVARIAN DYSGERMINOMA - PROVEN
Comments:
No comments posted.
Additional Details:

Case Number: 7391449Last Updated: 2006-12-01
Anatomy: Genitourinary (GU)   Pathology: Neoplasm
Access Level: Readable by all users
Keywords: ovary, germ cell tumor

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.
You can help keep MyPACS tidy: if you notice a case which is not useful (e.g. a test case) or inaccurate, please contact us.