Image 1: Sag Ut Mid
Image 2: Sag Ut Mid
Image 3: Sag Ut Mid
Image 4: 3 D
During transvaginal exam a thickened endometrial lining was documented (1.78cm).
Later on a sonohysterogram was performed, it revealed hyperechoic vascular ( 2.80 x 1.17 x 1.62 cm) mass, a single vessel was seen.
32 comments:
The patient had abnormally prolonged and heavy bleeding that is related to endometrial pathology. It looks normal to me when I look through 3 images. However, as given clue, hyperechoic mass with single vascular in the mass, which indicate polyps.
The patient is on Tamoxifen for breast cancer, which increases the risk of endometrial carcinoma. She is having uterine bleeding and has an abnormally thick endometrium-- both are associated with endometrial cancer. There also appears to be some fluid present, which could be caused by mass obstructing the endometrial canal. Increased vascularity, as seen, is another sign. Sonohysterography was able to nicely distinguish the borders for us. I think that this may be a later stage of endometrial cancer, because the patient is experiencing abdominal pain and bleeding. An endometrial biopsy should be taken to diagnose it. In addition, a CT &/or MRI with and without contrast should be ordered for staging and to examine possible extension.
Do you agree?
Leah
I agree with your impressions,this is clearly an endometrial polyp as seen on the sonohysterogram and even in the 2D image as outlined by the endometrial cavity fluid. It has a broad base. As Leah suggested, benign polyps and endometrial cancer are not distinguishable by ultrasound. A D&C is required to determine the cellular composition of the polyp. Patient history should increase suspicion for endometrial cancer.
This case is clearly endometrial carcinoma/cancer as established by the previous comments. Therefore, I will comment regarding possible treatment options. Usually, with uterine cancer, a hysterectomy is performed (removal of the uterus). The removal of the ovaries and fallopian tubes may occur as well (bilateral salpingo-ooophorectomy). In addition, lymph nodes near the tumor may be removed to see if they contain cancer. If the lymph nodes have cancer cells, then cancer may have spread to other parts of the body. If cancer cells have not spread beyond the endometrium, then treatment may be complete. (www.cancer.gov)
This is a clear cut image of endometrial cancer. Looking at the image,with the help of a little research i'll say it is a stage IA endometrial cancer because the mass is within the endometrial cavity and does not spread to the myometrium, cervix or vagina. Fortunately endometrial cancer is detected early and treated so it has a good prognosis. Also endometrial cancer has a low chance of coming back after complete removal.http://www.oncologychannel.com/endometrialcancer/staging.shtml
I feel very badly for this patient. It is clear that there is unilateral thickening of the endometruim. I agree with everyone aboout the fact that a person who has or had breast cancer is much more at risk for endometrial cancer. Do you think the additional cancers that breast cancer patients are more prone to get are a result of the radiation, kimo, or the medications they are required to take long after their breast cancer treatments?
That is a possibility, but usually the effects of radiation therapy aren't seen until well into the future. The dosimetrist and doctor will develop a plan of attack for every individual case and monitor it. I guess the outcome has to outweigh the risks.
Zouliath Said
According to what I am seeing through the pictures I think it a n endometrial polyp. An endometrial polyp or uterine polyp is a sessile mass in the inner lining of the uterus. They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated). Pedunculated polyps are more common than sessile ones. Endometrial polyps are usually benign although some may be precancerous or cancerous. This is why I will recommend a curettage and cytology of the polyp because of the patient history.
Because there is a hysterogram performed, I think it is a polyp inside the endometrial cavity.
Kermen,what's the indication?
It is an endometrial polyp,
but because of the patient history of breast cancer, further evaluation of the polyp is recommended.
Thank you for the comments.
Everybody did a great job!
according to the indication that the patient is on tamoxifen for breast cancer and has abnormal thick endometrium i think this patient has an endometrial cancer
Endometrial polyps are overgrowths of endometrial tissue. Women with endometrial polyps do not usually have symptoms. , but they appear more frequently in postmenopausal women. They vary in appearance and may be pedunculated, broad based, or have a thin stalk. A sonohysterogram will help differentiate endometrial abnormalities.
Sorry I am sooo late to this discussion. Considering that the patient was previously on Tamoxifen for breast cancer, now presents with pain, bleeding and a hypervascular endometrial mass, I think the patient has endometrial cancer. I was hoping with the sx and history that it would just be benign endometrial hyperplasia, but it does look much like endometrial cancer. :(
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