Computer-tomographic evaluation of gynecologic tumors

Small cell carcinoma of the uterine corpus: CT appearance

We report a rare case of small-cell carcinoma of the uterine corpus. To our knowledge, this is the first radiological report. Computed tomography (CT) demonstrates a hypodense lesion within the endometrial cavity with nonhomogeneous contrast enhancement.

CT and MRI of ovarian cancer

Among the gynecologic malignancies, ovarian cancer is second most common in incidence. However, unlike the other gynecologic cancers, its mortality has decreased only minimally during the last two decades [1]. Only recently, preliminary studies suggest promising results for ovarian cancer screening using transvaginal ultrasound in combination with serum Ca 125 levels [22,23]. Exploratory laparotomy has been the mainstay in the management of ovarian cancer, as it offers histopathological evaluation as well as cytoreduction. However, it is limited by its inaccuracy with understaging in 30-40% at initial presentation. Cross-sectional imaging contributes valuable information toward preoperative surgical and management planning. The proper surgical approach can be selected, the need for preoperative chemotherapeutic debulking can be assessed, and the surgeon will be forewarned of the need for assistance from a gynecologic oncologic surgeon or gastrointestinal oncologic surgeon if a complicated surgical procedure or bowel resection is indicated. CT is established as the primary imaging modality for characterization of ovarian tumors and ovarian cancer staging, while MR is emerging as a problem-solving modality. MR seems to be superior to CT in lesion characterization, in evaluation of local extent of tumor, and in tumor implants involving the hemidiaphragm and liver surface. The role of spiral CT has yet to be explored.

Use of angio computed tomography to evaluate extent of endometrial carcinoma

Patients with endometrial carcinoma underwent angio computed tomography (CT) prior to surgery to evaluate the extent of the carcinoma. The subjects of the study were 87 patients operated on at the Cancer Institute Hospital during the period 1983 to 1986. After preoperative bilateral internal iliac angiography, angio CT was performed using the already inserted catheters. Although the intact uterine wall was enhanced by the angio CT, the cancerous lesion was not, which permitted easy recognition of the cancerous lesion as a low-density area. To evaluate the degree of myometrial invasion, the minimal thickness of intact uterine wall was measured in the CT image, and was compared later with findings from the operative materials. The comparison showed that for all the patients, the minimal thickness of the intact uterine wall as shown in the CT image was comparable to the actual minimal thickness of the operative materials. Because depth of myometrial invasion is known as an important prognostic factor, measurement of the minimal thickness of the intact uterine wall as shown in the CT image is useful as an objective prognostic factor. Angio CT facilitates recognition of myometrial invasion preoperatively.