REPRODUCTIVE SYSTEM

PATHOLOGY-IMAGING MRT 1202

MODALITIES
RADIOGRAPHY-
FLUOROSCOPY
The reproductive organs are highly radiosensitive, so radiation
exposure of persons of reproductive potential is limited as much as
possible.
The benefits of the procedure must far outweigh the risks of
radiation exposure, and the procedures are performed with
emphasis on minimizing exposure.
The radiographic procedures of the reproductive system require
contrast administration, and the side effects of this must also be
considered.
RADIOGRAPH
Y-
FLUOROSCOP
YThe most common radiographic

procedure of the reproductive system is
hysterosalpingography.
Hysterosalpingograms will demonstrate
uterine size, shape and position, and the
patency of the fallopian (uterine) tubes.
Why are these tests usually done?
Who performs these tests?
What is the “rule” regarding elective
procedures that will administer radiation
to the reproductive organs?
HYSTEROSALPINGOGRAPHY
Patent fallopian tubes Blocked right fallopian tube
MAMMOGRAPHY
Mammography is the specialized radiographic examination of the breast.
The equipment and image receptors are designed to provide the highest quality
images with the lowest radiation exposure.
Screening mammography is recommended for women over age 50 (younger for
those with known risk factors) to increase the chances of early detection of breast
cancer
CAR guidelines for breast screening
MAMMOGRAPHY
Male breasts are also imaged with mammography to check
masses and other conditions.
Mammography is also used for biopsy procedures.
MRI and sonography are also used for breast imaging-benefit of
no ionizing radiation
MAMMOGRAPHY
Cranio-caudal view MLO view
BREAST SONOGRAPHY

 DMS of the breast is also used

extensively for the differentiation
of cystic versus solid masses.
 DMS is not practical for breast
screening, so it commonly follows
mammography in cases where a
specific area of interest has been
identified.
 DMS is also used for image
guidance during biopsy
procedures.
SONOGRAPHY-DMS
Diagnostic medical sonography (DMS) is the modality of choice for imaging the
male and female reproductive systems.
Safety is the biggest advantage, since there is no radiation exposure. Another
advantage is the specificity of the images.
DMS can demonstrate inflammatory diseases, cystic and solid lesions, as well as
congenital anomalies.
Color-flow Doppler is used to determine blood flow to structures and masses,
which can be used to detect testicular torsion and inflammatory processes of the
scrotum.
DMS is also widely utilized for prenatal imaging, with many congenital conditions
diagnosed during fetal development.
DMS
Female-uterus ultrasound Male-scrotal ultrasound
BREAST MRI
MRI is useful in imaging of the breast,
particularly in women with dense
breasts and implants.
MRI is used as a correlation with
mammography and/or ultrasound and is
malignancy not currently recommended to replace
either modality.
The primary disadvantage of MRI
breast screening is the cost, which is
much greater than both mammography
and sonography.
 CT
Computed tomography (CT) has limited use for
diagnostic imaging of the reproductive systems.

Many of the pathologies of the reproductive system

occur during the reproductive years.

Since the radiation dose of CT scans is known to be

higher than other imaging modalities, it is not the
safest modality, despite the image quality provided.

The primary application is for staging of known

malignancies of the reproductive system.

CT/PET fusion imaging may also be utilized to check Ovarian Cyst

for metastatic disease and the efficacy of treatments.
PET CT-ENDOMETRIAL
CARCINOMA
STAGING
MRI
Magnetic resonance imaging
(MRI) is widely utilized for imaging of
the reproductive system and the breast.
The primary advantage is there is no
radiation exposure, with the exceptional
image quality ranking a close second to
safety.
MRI can accurately detect
inflammatory disease and cystic and
solid masses in both male and female
reproductive systems.
MRI is useful in demonstrating the
extent of these conditions as well. Normal MRI anatomy
MRI PELVIS
Male Female
NUCLEAR MEDICINE
Nuclear medicine (NM) is used primarily in imaging of the male reproductive system.
Specifically, nuclear medicine can demonstrate testicular torsion and inflammation of the
ducts and testes.
Torsion will demonstrate with a decreased or absence of uptake, whereas inflammation
shows increased uptake in the affected scrotum.
Both conditions require immediate attention, particularly testicular torsion, so imaging
must be expedited for the patient's health.
REQUIRED PATHOLOGIES
Adenocarcinoma of the breast
Adenocarcinoma of the prostate
Carcinoma in situ of the breast
Fibroadenoma of the breast
Fibrocystic breast
Uterine Fibroids (Leiomyomas)
ADENOCARCINOM
A OF THE BREAST

Nearly all breast cancers are carcinomas. Most

of these are a type of carcinoma that starts in
glandular tissue, which is called an
adenocarcinoma.
When carcinomas form in the breast, they are
usually a more specific type called
adenocarcinoma, which starts in cells in the
ducts (the milk ducts) or the lobules (glands in
the breast that make milk).
Treatment of breast carcinoma depends on the
extent of the disease. Once the carcinoma is
confirmed through biopsy, an axillary lymph
node resection is performed to assist in the
management of the disease. The 5-year survival
rate for individuals with localized breast cancer
is 98.6%, dropping to 84.9% if the cancer is
regional (spread to regional lymph nodes), and
25.9% if it is found to be distant (metastasized).
 ADENOCARCINOMA OF THE
PROSTATE
Adenocarcinoma of the prostate is a common cancer in males; it is
estimated that 1 in 7 will be diagnosed with the disease during his
lifetime.
It is the second leading cause of cancer death in American males,
behind lung cancer.
Prostate cancer most frequently affects older males, with the chance
of developing prostate cancer rising rapidly after 50 years of age,
with 6 in 10 cases occurring in males over the age of 65 years.
The cause of prostate cancer is unknown, but there is evidence of a
potential inherited or genetic link. This disease is most often
diagnosed during blood tests screening or digital rectal
examinations. If test results come back abnormal, a transrectal
ultrasound (TRUS) or MRI may be performed to determine the
location and extent of the disease. However, a prostate biopsy is
necessary for disease confirmation. Common signs and symptoms
associated with prostate cancer include urinary tract obstructions; a
hard, enlarged prostate on rectal palpation; and low-back pain,
which is often caused by metastatic spread to the pelvis and lumbar
spine.
 CARCINOMA IN SITU OF THE
BREAST
Breast carcinoma is a very common malignancy among females in the United States and
the second leading cause of cancer deaths in females, behind only lung cancer. Current
literature suggests that 1 of every 8 females in the United States will develop invasive
breast cancer during her lifetime, with an increased incidence between ages 30 and 50
years. The incidence continues to rise throughout the postmenopausal years because of
changes in estrogen levels, with the mean age for breast cancer being age 60 years.
Approximately 60% of all palpable lesions occur in the upper outer quadrant of the
breast.
Although the exact cause of breast cancer is unknown, it is believed to be a multifactorial
disorder. Heredity, endocrine influence, oncogenic factors (such as viruses), and
environmental factors (such as chemical carcinogens) appear to play a role in the
development of this disease. Those individuals with an early onset of menstruation
(menarche) or late menopause and females with a first pregnancy after age 30 years are
at a higher risk for developing breast cancer. Family history also plays a role.
Breast cancers may be classified as in situ carcinoma, ductal carcinoma in situ, lobular
carcinoma in situ, invasive ductal or lobular carcinoma, or inflammatory carcinoma.
Breast cancers are generally discovered as a lump in the breast by the individual.
Mammography plays a very important role in the diagnosis and management of breast
cancer. Routine screening mammography in asymptomatic females may lead to early
detection and thus reduce breast cancer mortality by up to 30%. It has also been reported
that breast cancer mortality could be reduced by as much as 50% if all females older than
age 40 years received annual screening mammography. However, annual screening of
females between the ages of 40 and 50 years remains controversial.
 FIBROADENOMA OF THE
BREAST
A fibroadenoma is a common benign breast tumor.
It is estimated that 10% of all females will experience a
fibroadenoma in their lifetime.
They are usually unilateral, consisting of a solid, well-defined mass
that does not invade surrounding tissue.
The neoplasm is formed by an overgrowth of fibrous and glandular
tissues and is commonly located in the upper, outer quadrant of the
breast. Fibroadenomas almost always occur in females under 30
years of age and most frequently in those 21 to 25 years of age.
Fibroadenomas appear to be estrogen dependent and may grow
rapidly during pregnancy. These lesions are often painless and can
usually be moved about within the breast. Mammography, in
conjunction with physical breast examination and sonography, plays
a vital role in the detection of fibroadenomas
FIBROCYSTIC BREAST
An overgrowth of fibrous tissue or cystic hyperplasia results in
fibrocystic breasts.
This is the most common disorder of the female breast and occurs
to some degree in 60% to 75% of all females.
This condition is most frequently bilateral.
The severity of this disorder varies greatly, and it is believed to
result from fluctuations in hormone levels. The most common
sign or symptom associated with fibrocystic breasts is a mass or
masses that increase in size and tenderness immediately before
the onset of the menstrual period. The texture of the breast tissue
is ropy and thick, especially in the upper outer quadrant of the
breast.
Sonography is extremely useful as a follow-up to mammography
in differentiating solid masses from cystic masses in females with
fibrocystic breasts.
Large cysts are commonly aspirated for cytologic evaluation of
the fluid. If this evaluation does not yield definitive results,
surgical biopsy is often performed.
A fibrocystic condition may mask a coexistent cancer.
 Leiomyomas are benign, solid masses of the uterus,
they are an overgrowth of the uterine smooth muscle
tissue.

Prevalence is at least 70% in white females and

slightly more common in African American females.

Most common benign tumour of the female

reproductive system

Mostly asymptomatic, but in severe cases can cause

pressure on bowel and bladder and may cause
bleeding and acute pain.

Diagnosed usually during a pelvic exam can be

correlated with HSG, US, CT and MRI

Presents as a sharply circumscribed encapsulated

lesion and rarely transforms into a malignancy.

Treatment ranges from nothing to a complete

hysterectomy.

UTERINE FIBROIDS Uterine artery embolization is a treatment option as

well as ablation.

(LEIOMYOMAS)