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Pelvic incidentalomas.

Gore RM, Newmark GM, Thakrar KH, Mehta UK, Berlin JW - Cancer Imaging (2010)

Bottom Line: These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists.Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention.In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, North Shore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL 60201, USA. rgore@uchicago.edu

ABSTRACT
Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and non-oncology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented.

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Incidental endometrial hyperplasia is demonstrated on these axial (A) and coronal (B) staging CT scans performed on this 62-year-old woman with breast cancer. (C) The thickened endometrium is confirmed on a follow-up ultrasound examination. She had no pelvic symptoms or bleeding.
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Figure 5: Incidental endometrial hyperplasia is demonstrated on these axial (A) and coronal (B) staging CT scans performed on this 62-year-old woman with breast cancer. (C) The thickened endometrium is confirmed on a follow-up ultrasound examination. She had no pelvic symptoms or bleeding.

Mentions: When evaluating the postmenopausal appearance of the endometrium (Fig. 5), the presence of vaginal bleeding, the presence of hormonal replacement therapy, a history of breast cancer, ovarian cancer, the BRCA gene, polycystic ovarian disease, and other risk factors should also be incorporated into the degree of clinical suspicion. The normal postmenopausal endometrium should appear thin, homogeneous, and echogenic. A double-layer thickness of less than 5 mm without focal thickening excludes significant disease and is consistent with atrophy. Homogeneous, smooth endometria measuring 5 mm or less are considered within the normal range with or without hormonal replacement therapy. The endometrium in a patient undergoing hormonal replacement therapy may vary up to 3 mm if cyclic estrogen and progestin therapy is being used. The endometrium appears thickest before progestin exposure and thinnest after the progestin phase. A patient undergoing unopposed estrogen therapy with endometrial thickening exceeding 8 mm should be considered for biopsy, whereas patients receiving progesterone in addition to estrogen can be rescanned at the beginning or end of the following cycle to determine if there has been a change in endometrial thickness[60–63].Figure 5


Pelvic incidentalomas.

Gore RM, Newmark GM, Thakrar KH, Mehta UK, Berlin JW - Cancer Imaging (2010)

Incidental endometrial hyperplasia is demonstrated on these axial (A) and coronal (B) staging CT scans performed on this 62-year-old woman with breast cancer. (C) The thickened endometrium is confirmed on a follow-up ultrasound examination. She had no pelvic symptoms or bleeding.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2967139&req=5

Figure 5: Incidental endometrial hyperplasia is demonstrated on these axial (A) and coronal (B) staging CT scans performed on this 62-year-old woman with breast cancer. (C) The thickened endometrium is confirmed on a follow-up ultrasound examination. She had no pelvic symptoms or bleeding.
Mentions: When evaluating the postmenopausal appearance of the endometrium (Fig. 5), the presence of vaginal bleeding, the presence of hormonal replacement therapy, a history of breast cancer, ovarian cancer, the BRCA gene, polycystic ovarian disease, and other risk factors should also be incorporated into the degree of clinical suspicion. The normal postmenopausal endometrium should appear thin, homogeneous, and echogenic. A double-layer thickness of less than 5 mm without focal thickening excludes significant disease and is consistent with atrophy. Homogeneous, smooth endometria measuring 5 mm or less are considered within the normal range with or without hormonal replacement therapy. The endometrium in a patient undergoing hormonal replacement therapy may vary up to 3 mm if cyclic estrogen and progestin therapy is being used. The endometrium appears thickest before progestin exposure and thinnest after the progestin phase. A patient undergoing unopposed estrogen therapy with endometrial thickening exceeding 8 mm should be considered for biopsy, whereas patients receiving progesterone in addition to estrogen can be rescanned at the beginning or end of the following cycle to determine if there has been a change in endometrial thickness[60–63].Figure 5

Bottom Line: These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists.Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention.In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, North Shore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL 60201, USA. rgore@uchicago.edu

ABSTRACT
Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and non-oncology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented.

Show MeSH
Related in: MedlinePlus