Browsing by Author "Horta, Mariana"
Now showing 1 - 10 of 11
Results Per Page
Sort Options
- Avaliação radiológica do carcinoma do ovárioPublication . Horta, Mariana; Cunha, Teresa Margarida
- Diagnóstico clínico e radológico do cancro do ovárioPublication . Henriques, Isabel; Horta, Mariana; Cunha, Teresa Margarida; Correia, Paulo
- Endometrial cancerPublication . Horta, Mariana; Cunha, Teresa MargaridaEndometrial cancer is the most common gynecological malignancy in well-developed countries. Biologically and clinicopathologically, endometrial carcinomas are divided into two types: type 1 or estrogen-dependent carcinomas and type 2 or estrogen-independent carcinomas. Type 1 cancers correspond mainly to endometrioid carcinomas and account for approximately 90 % of endometrial cancers, whereas type 2 cancers correspond to the majority of the other histopathological subtypes. The vast majority of endometrial cancers present as abnormal vaginal bleedings in postmenopausal women. Therefore, 75 % of cancers are diagnosed at an early stage, which makes the overall prognosis favorable. The first diagnostic step to evaluate women with an abnormal vaginal bleeding is the measurement of the endometrial thickness with transvaginal ultrasound. If endometrial thickening or heterogeneity is confirmed, a biopsy should be performed to establish a definite histopathological diagnosis. Magnetic resonance imaging is not considered in the International Federation of Gynaecology and Obstetrics staging system. Nonetheless it plays a relevant role in the preoperative staging of endometrial carcinoma, helping to define the best therapeutic management. Moreover, it is important in the diagnosis of treatment complications, in the surveillance of therapy response, and in the assessment of recurrent disease.
- Estratificação pré-terapêutica do carcinoma do endométrio por ressonância magnética - papel do estudo dinâmico após administração de contraste endovenoso e do estudo ponderado em difusãoPublication . Horta, Mariana; Cunha, Teresa MargaridaO carcinoma do endométrio apresenta uma taxa de incidência em Portugal de cerca de 7.2%, sendo a 5ª neoplasia mais comum na mulher. Apesar de apresentar uma prevalência relativamente elevada, o seu prognóstico global é favorável, uma vez que 75% dos casos são diagnosticados em estádio precoce. O estudo por ressonância magnética é geralmente efectuado após a realização de uma ecografia para avaliação de uma hemorragia uterina anormal e após o diagnóstico histológico por histeroscopia ou ressecção. Contudo, a ressonância magnética pode apresentar um papel determinante no diagnóstico em casos de impossibilidade de biópsia e nos quais a biópsia é inconclusiva. Além do mais, apesar de esta técnica não ser contemplada na classificação para o estadiamento do carcinoma do endométrio da International Federation of Gynecology and Obstetrics de 2009, apresenta uma função fundamental no estadiamento pré-operatório destas doentes, sendo crucial para definir a abordagem cirúrgica e terapêutica. No presente artigo, as autoras descrevem o estado da arte da ressonância magnética funcional no diagnóstico e no estadiamento do carcinoma do endométrio, chamando a atenção para o papel do estudo dinâmico após administração de contraste endovenoso e do estudo ponderado em difusão nestes cenários através da revisão da literatura mais recente sobre este tópico.
- Hydropic leiomyoma of the uterus presenting as a giant abdominal massPublication . Horta, Mariana; Cunha, Teresa Margarida; Oliveira, Rita; Magro, PaulaWe describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. Magnetic resonance imaging (MRI) was performed to further characterise and revealed a myometrial pedunculated tumour. Despite its marked T2-signal heterogeneity and volume, there were no other suspicious findings to suggest a malignant nature; therefore, fertility-sparing myomectomy was performed. Leiomyomas frequently undergo degenerative changes altering their imaging appearances. Leiomyomas with uncommon degenerative changes may be difficult to differentiate from malignant myometrial tumours, based solely on imaging. To the best of our knowledge, a diffuse hydropic degeneration imaging appearance has only been described twice in the literature. We describe the imaging appearance of this rare form of leio
- Mistakes in assessment of endometrial cancerPublication . Cunha, Teresa Margarida; Horta, MarianaPelvic MR imaging allows to avoid most of the mistakes in the assessment of ovarian masses made using transvaginal ultrasonography or CT scan. However, even using pelvic MR imaging, there are some pathologies that may mimic primitive ovarian cancer including pelvic inflammatory disease, uterine myoma, digestive tumour or ovarian metastases. Preoperative diagnosis of these pathologies is crucial because the therapeutic strategy is completely different and the absence of a diagnosis may impact the prognosis. Thus, this lecture will present three clinical situations where the radiologist needs to accurately analyse MR images to not misdiagnose a wide variety of pelvic pathologies as ovarian cancer. Learning Objectives: 1. To become familiar with benign masses mimicking ovarian cancer. 2. To demonstrate benign and malignant diseases mimicking peritoneal carcinomatosis. 3. To learn about imaging strategies for avoiding these pitfalls.
- Ovarian sertoli-leydig cell tumour with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature reviewPublication . Horta, Mariana; Cunha, Teresa Margarida; Marques, Rita Canas; Félix, AnaHere we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alphafetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrineinactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker.
- Pitfalls in imaging of female pelvic massesPublication . Horta, Mariana; Cunha, Teresa MargaridaPurpose of Review The purpose of this review is to highlight potential magnetic resonance (MR) imaging pitfalls that may mask and simulate ovarian cancer. Recent Findings MR imaging is the standard method for evaluating female pelvic masses of indeterminate origin, especially sonographically indeterminate adnexal masses. To define the correct origin and nature of a pelvic mass has an enormous clinical impact, namely in females of child-bearing age. This is particularly true in adnexal lesions. Ovarian cancer usually requires a cytoreductive surgery in a specialized oncological centre. In contrast, a benign ovarian lesion may be treated by simple resection in a general hospital. To help preventing diagnostic errors and in order to guide appropriate therapeutic management, radiologists should be aware of potential MR pitfalls that may mask and simulate ovarian cancer. Summary The first section of this article will describe the MR imaging protocol that authors perform in their oncological centre, highlighting how imaging techniques can be optimized in order to reduce pitfalls in the characterization of an indeterminate pelvic mass. In the next section, authors will revise the main anatomic and organ-specific signs that may allow the radiologist to determine the ovarian origin of a pelvic mass. Finally, benign gynaecological masses that may simulate ovarian cancer in a non-emergency setting will be discussed, with emphasis on features that may provide important clues to their diagnosis.
- Sex cord-stromal tumours of the ovary: a comprehensive update reviewPublication . Horta, Mariana; Cunha, Teresa MargaridaOvarian sex cord-stromal tumors are infrequent and represent approximately 7% of all primary ovarian tumors. This histopathologic ovarian tumor group differs considerably from the more prevalent epithelial ovarian tumors. Although sex cord-stromal tumors present in a broad age group, the majority tend to present as a low-grade disease that usually follows a nonaggressive clinical course in younger patients. Furthermore, because the constituent cells of these tumors are engaged in ovarian steroid hormone production (e.g., androgens, estrogens, and corticoids), sex cord-stromal tumors are commonly associated with various hormone-mediated syndromes and exhibit a wide spectrum of clinical features ranging from hyperandrogenic virilizing states to hyperestrogenic manifestations. The World Health Organization sex cord-stromal tumor classification has recently been revised, and currently these tumors have been regrouped into the following clinicopathologic entities: pure stromal tumors, pure sex cord tumors, and mixed sex cord-stromal tumors. Moreover, some entities considered in the former classification (e.g., stromal luteoma, stromal tumor with minor sex cord elements, and gynandroblastoma) are no longer considered separate tumors in the current classification. Herein, we discuss and revise the ultrasonography, computed tomography, and magnetic resonance imaging characteristics of the different histopathologic types and clinicopathologic features of sex cord-stromal tumors to allow radiologists to narrow the differential diagnosis when facing ovarian tumors.
- The added value of diffusion-weighted imaging in the preoperative assessment of endometrial cancerPublication . Gil, Rui Tiago; Cunha, Teresa Margarida; Horta, Mariana; Alves, InesTo evaluate the added value of diffusion-weighted imaging (DWI) in the preoperative assessment of myometrial invasion in endometrial cancer, in comparison with T2-weighted imaging (T2WI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).