The role of MRI in the diagnosis of pelvic cancer

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The role of MRI in the diagnosis of pelvic cancer

Administration of Presidential Affairs Republic of Kazakhstan, Nur-Sultan, Kazakhstan Supervisor: Elshibayeva Elmira Serikkalievna, radiologist of the highest category, RSE "BMC UDP RK", Nur-Sultan, RK. Doctor PhD, Associate Professor of the Department of Radiology named after Academician Zh.Kh. Khamzabaev NJSC "AstanaMedical University".

РОЛЬ МРТ В ДИАГНОСТИКЕ РАКА ОРГАНОВ МАЛОГО ТАЗА

Аубакирова Айша Габдрашитовна,

врач-резидент

врач-резидент diagnosis of uterine carcinosarcoma treatment

РГП «Больница медицинского центра управления делами президента

Республики Казахстан» г. Нур-Султан, Казахстан Научный руководитель: Ельшибаева Эльмира Сериккалиевна - врач радиолог высшей категории РГП «БМЦ УДП РК» г. Нур-Султан, РК. Доктор PhD, доцент кафедры радиологии имени академика Ж.Х. Хамзабаева

Аннотация. В работе произведен анализ диагностических методов диагностики для ранней диагностики карциносаркомы матки, используемых в медицине. Актуальность проблемы обусловлена в ранней диагностике и своевременной подобранной тактики лечения.

Ключевые слова: медицина, радиология, онкопатологии, карциносаркома матки, гинекология.

Abstract. The paper analyzes diagnostic methods for early diagnosis of uterine carcinosarcoma used in medicine. The urgency of the problem is due to early diagnosis and timely selected treatment tactics.

Key words: medicine, radiology, oncopathology, uterine carcinosarcoma, gynecology.

Introduction

According to statistical data in Kazakhstan in recent years, pelvic cancer ranks 5th, and 8th in the structure of mortality. In 2020, 1830 women were diagnosed with cervical cancer, 1100 cases of uterine cancer and 1120 cases of ovarian cancer. Preoperative diagnostics plays an important role in the verification of oncological diseases of the pelvic organs, especially malignant pathologies of the uterus and cervix. One of the most common histological variants of uterine sarcomas is carcinosarcoma (the incidence is 4-9%) [3,5]. Neoplasms are characterized by an aggressive clinical course with a high frequency of local and distant relapses. The most important diagnostic method is curettage of the uterine cavity, but in 25% of cases the diagnosis is established after a hysterectomy. Many research centers are involved in the diagnosis of this disease. The further prognosis and treatment of the patient depends on the time of determining the verification of the diagnosis using MRI of the small pelvis.

Aim

To assess the diagnostic significance of preoperative methods for detecting small pelvic pathologies and the role of MRI in future treatment tactics.

Materials and methods

The data of 54 women with pelvic pathologies of different ages were analyzed. Of these, identified: endometrial carcinoma -3.7%; uterine carcinosarcoma -1.8%; leimiosarcomas - 1.8%; uterine body cancer -14.8%; cervical cancer - 40.7%; endometrial cancer -14.8%; ovarian cancer - 18.5%.

In the course of the analysis, one of the rare pathologies was revealed - uterine carcinosarcoma in a 58-year-old patient, clinically with a predominance of bloody discharge from the genital tract in menopause. She was examined using a complex of methods: ultrasound, CT / MRI, PET CT. During treatment in the hospital, a radical treatment with histological confirmation was performed.

Pelvic ultrasound Figure 1.

CT scan of the pelvis Figure 2. Arterial phase

CT scan of the pelvis Figure 3. Venous phase

The uterus is located anteriorly, there is an expansion of the uterine cavity up to 0.5 cm.

PET CT scan of the pelvis Figure 5.

Results

The presented rare clinical case reflects the complexity of diagnosis and further management of treatment tactics. Conducting MRI at the preoperative stage made it possible to determine the nature of the spread, possible invasion, rather than other instrumental research methods.

Discussion

In the course of the analysis of a rare pathology, uterine carcinosarcoma per 1000 women was 1.8%. Due to its low prevalence in the population, carcinosarcoma plays an important role of verification in diagnostic research methods. In many cases, patients need a radical removal of the body of the uterus or appendages, as well as resection of neighboring organs and regional lymph nodes. But in the early stages of uterine sarcoma, radiation therapy in combination with chemical drugs is more effective [6,7].As a result, early detection of carcinosarcoma eliminates the need for surgical treatment. For early detection of the disease, according to WHO, each woman should be observed by an obstetrician- gynecologist once a year, in the absence of complaints, also undergo screening for cervical cancer from 30 to 70 years of age, which will allow dynamic monitoring of women.One of the clinical symptoms of uterine carcinosarcomas is a symptom of irregular spotting, this symptom is pathogonomic for uterine carcinosarcomas, which women often do not pay attention to. What is already a wake-up call, the same complaints were encountered in this patient [1,2,4].

Conclusion

The diagnostic significance of preoperative methods for detecting pathologies of the small pelvis is one of the most important points in the examination. Ultrasound OMT allows you to determine at the initial stages of diagnosis changes in the structure of the uterine cavity and ovarian function, while CT / MRI determines the exact localization of the spread, while PET CT determines the spread of metastases and metabolic activity not only in the affected organ, but also the likelihood of changes throughout the body.Despite the quality of the above instrumental diagnostic methods, OMT MRI is the most informative and safe research method. With the help of MRI, a huge number of pathologies can be detected, such as uterine sarcomas. MRI in sarcoma allows you to determine the exact size, nature, number of neoplasms and track their growth rate. It is also possible to obtain data on the state of the pelvic floor muscles, bones, lymph nodes, bladder and rectum. The conclusion obtained with the help of MRI OMT helps the attending physician with the determination of further treatment tactics and the stage of the neoplasm process. Reliable staging of the disease is essential because only stage 1 of the disease is treated with chemotherapy, while the remaining stages are treated with surgery.

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