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Calcified Liver Masses

Ovarian Neoplasms

Calcified Liver Masses - Causes

 

  • Inflammatory hepatic lesions

    • Most common cause of calcified hepatic lesions
      • Inflammatory conditions
        • For example, granulomatous diseases (tuberculosis).
        • Calcification involves entire lesion
        • Appears as a dense mass
      • May produce artifacts on CT scans
    • Echinococcus cysts have curvilinear or ring calcification
      • Central water density in cyst

 

  • Benign neoplasms

    • Hemangiomas, especially large ones, may contain large, coarse calcifications; may be seen at CT  in 20% of cases or radiography in 10%

 

  • Malignant liver neoplasms

    •  Hepatocellular adenoma
      • Calcifications may be solitary or multiple
      • Usually located eccentrically within complex heterogeneous mass.
    • Fibrolamellar carcinoma
      • Calcifications reported in 15%-25% of cases at CT
      • Occurs in many patterns
    • Intrahepatic cholangiocarcinoma
      • Calcifications are typically accompanied by a desmoplastic reaction
      • Visible at CT in about 18% of cases.
    • Calcified hepatic metastases
      • Most frequently associated with mucin-producing neoplasms such as colon, or less likely ovarian, carcinoma

 

Calcified Liver Masses - DDX

·                  Granulomas, as in TB

·                  Hydatid cysts

·                  Hemangiomas

·                  Hepatocellular adenoma

·                  Fibrolamellar carcinoma

·                  Intrahepatic cholangiocarcinoma

·                  Mucin-producing metastases

 

 

 

Calcified liver and peritoneal metastases from ovarian carcinoma

 

 

Ovarian Neoplasms

 

  • Tumors of Surface Epithelium form 90% of ovarian tumors
  • Mucinous Tumors

-         Incidence – 30% of ovarian neoplasms

§         Mucinous cyst adenoma

·        Commonest tumor

·        Age group: 30-50 yrs

·        Bilateral in 10%

§         Mucinous cystadenocarcinoma

·        Age group: 40-60 yrs

·        Bilateral in 10 %

-         Features

§         Large multilocular pedunculated cyst

§         Rare complication  may occur with involvement of the peritoneum

·        Psedomyxoma peritonei (jelly belly)

§         May produce coarse calcifications in primary or metastases

  • Serous Tumors

-         Incidence  –  50% of ovarian neoplasms

§         Serous cystadenoma:

·        Age group: 20 – 30 yrs

·        Bilateral in 15%

·        Malignant transformation in 20 – 30 %

§         Serous cystadenocarcinoma:

·        Age group: 40 – 60 yrs

·        Bilateral in 30%

·        5 year survival rate: 30 – 50 %

-         Features:

§         Contain fibrous walled cysts with papillary excrescences

§         Locules contain straw-colored fluid

§         Psammoma bodies=concentric calcification in papillary process

·        Usually fine sand-like calcification frequently difficult to see on plain radiographs

  • Endometrial tumors

-         Incidence  –  20% of ovarian tumors

-         Morphology:

§         Tumors containing solid and cystic areas

§         Filled with hemorrhagic fluid

§         Lined by glandular epithelium

  • Clear Cell (mesonephroid tumor)

-         Incidence: uncommon

-         Age group: 50 – 60 yrs

-         Morphology:

§         Unilocular cysts with small cystic spaces

  • Brenner tumor:

§         Incidence: 1- 2%

§         Occur commonly in perimenopausal women

  • Germ Cell Tumors

-         Origin : cells derived form oocytes

-         Incidence: 15- 20% of all ovarian tumors, 5% malignant

§         Age: young age

  • Dysgerminoma

-         Incidence : very common

§         Age : 20 – 20 yrs

-         Bilateral : 10 – 15 %

-         Macroscopic features :

§         Solid tumors, elastic rubbery consistency having smooth, firm capsule

  • Teratoma

-         Derived from cells of all three germ layers

-         Types:

§         Mature or benign type (e.g. Dermoid cysts)

§         Immature or malignant type (e.g. Solid Teratoma)

§         Monodermal or highly specialized (e.g. Struma ovarii)

  • Choriocarcinoma and Embryonal Cell Carcinoma

-         Choriocarcinoma mostly of placental origin occurs in prepubertal girls. Highly malignant

§         Contains syncytiotrophoblasts and cytotrophoblasts

§         Secretes large quantities of the tumor marker - HCG

-         Embryonal cell carcinoma

§         Incidence : rare

-         Highly malignant

  • Ovarian Fibroma:

-         Meig’s syndrome

§         Ascites

§         Right sided effusion

  • Krukenberg tumor

-         Primary : 15% - small & large bowel , 20% - stomach, 6% - breast

-         Bilateral smooth surface

-         Histologically cellular or myxomatous stroma with scattered large signet ring cells

 

·        Routes of Peritoneal Spread

o       Right subphrenic space

o       The greater omentum

o       The Pouch of Douglas

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