Uterine Pathology Powerpoint

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1

Adenomyosis

A benign disease that can be diffuse or focal that sonographically presents as a bulky enlarged uterus without a focal mass.

2

Adenomyosis

Is ectopic occurrence of endometrial tissue within the myometrium; more common in the posterior aspect.

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Adenomyosis

Is identical to endometriosis with respect to structure and function; patients with ___ are multiparous and older than endometriosis patients. Endometriosis patients have infertility issues and are younger than ___ patients.

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Adenomyosis

___ is sometimes called adenomyoma, referring to isolated implants that typically cause reactive hypertrophy of surrounding myometrium; implants produce diffuse uterine enlargement.

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Adenomyosis

Estimated 60% of women with ___ experience: abnormal uterine bleeding (hypermenorrhea), prolonged/profuse uterine bleeding (menorrhagia), and irregular, acyclic bleeding (metrorrhea). Approximately 25% of patients with ___ also suffer from pelvic pain during menstruation (dysmenorrhea).

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Adenomyosis

Sonographic findings of extensive ___ present: diffuse uterine enlargement, thickening of posterior myometrium, indistinct border between endometrium and myometrium (involved area being slightly more anechoic than normal myometrium); and myometrial cysts.

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Adenomyosis

Images can appear as the Venetian blind sign.

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Arteriovenous Malformation

Rare, usually involves the myometrium; congenital or teratogenic (pelvic trauma, surgery, GTD); women of childbearing age may present with blood loss to anemia; if D&C is performed, it could be catastrophic.

9

Leiomyosarcoma

cancerous growth that occurs in women between 40-60 years of age; has rapid growth.

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Endometrium

Abnormally thick ___ results from a variety of conditions: early intrauterine pregnancy, gestational trophoblastic disease, endometrial hyperplasia, secretory endometrium, estrogen replacement therapy, polyps, and endometrial carcinoma.

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Endometrial

Many ___ pathologies, such as hyperplasia, polyps and carcinoma, can cause abnormal bleeding especially in the postmenopausal patient.

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Endometrium

Disorders of the ___ may also occur in menopausal patients with breast cancer receiving tamoxifen therapy.

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Measuring the endometrium

Perpendicular to the long axis, do not include hypoechoic halo, if fluid is present, do not include in the measurement, measure both walls separately.

14

Sonohysterography

saline infused sonography is valuable for further evaluating abnormally thickened endometrium.

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Sonohysterography

____ in premenopausal women, is performed in mid-menstrual cycle, usually between days 6 and 10. For women with irregular cycles, procedure is performed soon after cessation of bleeding, if possible.

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Sonohysterography

___ will prevent the possibility for disrupting early pregnancy and prevent blood clots artifactually filling some of the endometrial cavity.

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Sonohysterography

___ in postmenopausal women, procedure can be performed at any time shortly after monthly bleeding, if on sequential hormone therapy.

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Sonohysterography

___ is NOT performed in women with acute pelvic inflammatory disease. Prophylactic antibiotics given to women with chronic pelvic inflammatory disease and to women with history of mitral valve prolapse or other cardiac disorders.

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Endometrial Hyperplasia

____ is the most common cause of abnormal uterine bleeding in pre and postmenopausal women. It is unopposed to estrogen stimulation. Pre meno endo greater than 14 mm; post meno endo 8 mm upper limits of normal and if on HRT up to 15 mm in estrogen phase.

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Endometrial Hyperplasia

____ majority of women with postmenopausal uterine bleeding are experiencing endometrial atrophy. If postmenopausal patient has irregular bleeding and thickened endometrium, may warrant sonohysterography procedure and/or endometrial biopsy.

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Endometrial Hyperplasia

____ in the reproductive years - anovulatory cycles, polycystic ovaries, and obese women with elevated estrogens; estrogen producing tumors - granulose cell tumors and thecomas of the ovary.

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Endometrial polyps

Patients with ___ may be asymptomatic or present with uterine bleeding.

Histologically, polyps are overgrowths of endometrial tissue covered by epithelium.

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Endometrial polyps

___ may be pedunculated, broad-based, or have thin stalk. Typically cause diffuse or focal endometrial thickening. They are more frequently seen in perimenopausal and postmenopausal women. In menstruating women, may be associated with menometrorrhagia or infertility.

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Endometrial Polyps

____ sonographic findings - appear in the luteal phase, represented by hyperechoic or isoechoic region within the hyperechoic endometrium, initially may appear as nonspecific echogenic endometrial thickening, and may be diffuse or focal and may also appear as a round echogenic mass within the endometrial cavity.

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Endometritis

___ is inflammation of the endometrium.

Symptoms include: low back pain and fever, lower abdominal pain, dysmenorrhea, menorrhagia, sterility, and constipation.

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Endometritis

____ sonographic findings: appears as prominent or irregular; pus may be seen in the cul-de-sac; enlarged ovaries with multiple cysts secondary to periovarian inflammation, and dilated fallopian tubes.

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Endometritis

____ occurs most often in association with PID, in postpartum state, or following instrumentation of uterus.

Endometrial thickening or fluid may indicate ___.

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Endometritis

Postpartum patients may develop ____ after prolonged labor, vaginitis, premature rupture of the membranes, or retained products of conception.

Clinically, patient has intense pelvic pain.

29

Endometritis

Dilation of fallopian tube shows fluid-filled tubular shapes in folded configuration and well-defined echogenic walls. Thickened tubal wall (5mm or more) indicative of acute disease. As infection worsens, periovarian adhesions may form and fuse inflamed tube and ovary.

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Endometritis

Also called tubo-ovarian complex

Further progression results in tubo-ovarian abscess; appears as complex multiloculated mass with septations, irregular shaggy margins, and scattered internal echoes.

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Synechiae

___ is also known as endometrial adhesions, and Asherman's syndrome. It is found in women with posttraumatic or postsurgical histories, including uterine curettage and may be cause of infertility or recurrent pregnancy loss.

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Synechiae

___ sonographic findings - bright echoes within the endometrial cavity.

Difficult diagnosis unless fluid is distending endometrial cavity.

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Synechiae

___ is best seen during secretory phase when endometrium more hyperechoic. ___ is more easily seen in gravid uterus where they appear as hyperechoic band traversing uterus from anterior to posterior.

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Endometrial Carcinoma

___ is the most common gynecologic malignancy in North America.

Most in postmenopausal patients.

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Endometrial Carcinoma

___ clinical presentation - is uterine bleeding, although only 10% of women with postmenopausal bleeding have ____.

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Endometrial Carcinoma

____ has a strong association with estrogen replacement therapy. In premenopausal women, anovulatory cycles and obesity are considered risk factors.

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Endometrial Carcinoma

___ earliest change is thickened endometrium.

Abnormally thick endometrium is also associated with endometrial hypertrophy and polyps.

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Endometrial Carcinoma

____ sonographic findings - transvaginal is helpful in screening for early changes of endometrial hyperplasia or carcinoma by accurately measuring endometrial thickness.

Sonographically, thickened endometrium (greater than 4-5 mm must be considered cancer until proved otherwise).

39

Endometrial Carcinoma

___ may obstruct endometrial canal, resulting in hydrometra or hematometra. Intactness of subendometrial halo usually indicates superficial invasion. Obliteration of halo indicative of deep invasion.

40

Intrauterine Contraceptive Devices (IUDs)

Sonography of ___ can check for placement, lost device, malpostion, perforation, or incomplete removal. Eccentric position of ___ from midline suggests myometrial penetration. If ___ not seen by sonography, x-ray should be done.

41

Intrauterine Contraceptive Devices (IUDs)

Most commonly shaped ___ are currently t-shaped paraguard, flexible plastic wrapped in copper, and t-shaped mirena, flexible plastic that releases low amounts of progestin. Traditionally medal containing devices appear as highly echogenic linear structures in endometrial cavity with uterine body.