Lesson 5 (Part 2) Flashcards
What are 3 differential diagnosis for polyps?
- Hyperplasia
- Endometrial cancer
- bleeding –> symptomatic *** - Submucosal fibroid
Stalk
Pedicle artery sign
SHG
Sonohysterogram
What does it mean if you see a pedicle artery sign on colour doppler for polyps?
You dont need a sonohysterogram if you can see it with regular US
PMB
Post menopausal bleeding
What is SHG good at?
Differentiating polyps and fibroids
What can you see with a SHG? (2)
- Polyp seen arising from the endometrial
2. Submucosal fibroid normal layer from the endometrial is seen overlying
What is a treatment for polyps?
Dilation and Curettage on woman with polyps
- PMB
- polyps can be missed with D/C so a hysteroscopy is recommended if still bleeding and the endometirum is >8mm
What is the most common gynecologic malignancy in North America?
Endometrial Carcinoma
Is endometrial carcinoma highly curable?
Yes
Were do you see most endometrial carcinoma located?
Confined to the uterus
- 75%
Who do you see most endometrial carcinoma with?
Postmenopausal women
- 75-80%
What is the most common clinical presentation of endometrial carcinoma?
Uterine bleeding
What percentage of women with PMB have endometrial carcinoma?
10%
What is the sonographic appearance of endometrial carcinoma? (4)
- Thickened endometrium
- Heterogeneous echotexture
- Irregular or poorly defined margins
- Can cause obstruction blocks the cervix
- hydrometra or hematometra
Why can endometrial carcinoma be tricky? (2)
- Well defined and uniformly echogenic
2. Can have the same appearance as endometrial hyperplasia or polyps
What is 3 differential diagnosis of a thicken endometrium for a women in her peri or post menopausal years?
- Hyperplasia
- Polyps
- Cancer
What is needed to confirm the differential diagnosis of a thicken endometrium for a women in her peri or post menopausal years?
A biopsy
What was the first thought with endometrial cancer when using colour and spectral doppler?
That low resistance flow in the uterine arteries distinguish normal postmenopausal endometriums from cancer
- found to not be significant
What is the best way to measure postmenopausal endometriums from cancer?
Measure the endometrial thickness
What is the role of sonographers in pre-op for endometrial cancer? (2)
- To determine if there is a myometrial invasion
- If there is an intact subendometrial Halo
- superficial invasion
What layer of the uterus is involved with the subendometrial halo?
The inner layer of the myometrium
What is contrast enhanced MRI a superior method for in staging and pre-op? (3)
- Myometrial invasion
- Cervical extension
- stage 2 - Extrauterine extension
- stage 3 & 4
What is an example of a rare uterine sarcoma?
Leiomyosarcomas
What sarcomas arise from the endometrium? (4)
- Carinosarcomas
- Endometrial stromal sarcoma
- Adenosarcomas
- Undifferentiated sarcomas
What does the endometrial stomal involve?
Myometrium
- diffuse or focal
What can endometrial stromal be mistaken for?
Leiomyoma
What occurs in the majority of women with PMB?
Endometrial atrophy
How does Endometrial atrophy appear on US? (3)
- Usually thin
- <5mm - Homogeneous
- Can have cystic changes and be thick
- therefore it can look like cystic hyperplasia
