Uterine & Endometrial Pathology

What is the uterine pathology where there is an invasion of endometrial tissue into the myometrium that is usually noted by thickening of the posterior uterus?

adenomyosis

What patients are at increased risk for adenomyosis?

patients with fibroids

What is the signature sonographic appearance of adenomyosis?

linear striations in uterus/venetian blinds

What is the most common benign gyn tumor and leading cause of hysterectomy and gyn surgery?

leiomyoma (fibroid/myoma)

What stimulates the growth of a fibroid?

estrogen

What is the most common type of fibroid?

intramural

What is the type of fibroid that is located within the muscle wall of the uterus and does not directly change the uterine contour?

intramural

What is the type of fibroid that grows under the serosal layer and distorts the outer contour of the uterus?

subserosal

What is the type of fibroid that is adjacent to endo and distorts the endo contour?

submucosal

What type of fibroid is most likely to cause bleeding issues?

submucosal

What is the type of fibroid that grows out and attaches by a stalk?

pedunculated

What type of fibroid may resemble adnexal masses and is most likely to cause abdominal distention or pelvic pressure?

pedunculated

What is the malignant form of fibroids?

leiomyosarcoma

What population are leiomyosarcomas commonly found in?

perimenopausal and postmenopausal women

How do leiomyomas and leiomyosarcomas compare sonographically?

same clinical and sonographic findings except leiomyosarcomas exhibit rapid growth

What is the most common female malignancy under the age of 50?

cervical carcinoma

What is an asymptomatic, benign retention cyst within the cervix?

Nabothian cyst

What is a small, asymptomatic cyst located along the vaginal wall?

Gardner duct cyst

What is the normal sonographic appearance of a c-section scar?

a slight indentation of the isthmus

What is a c-section scar defect?

when fluid or separation occurs

What is a c-section dehiscence?

when the myometrial walls are separating

What is the normal sonographic appearance of a correctly placed IUD?

echogenic linear echo with posterior shadowing or reverberation artifact noted centrally within endometrial cavity

What is the type of IUD which appears as 5 equally spaced dots with posterior shadowing?

Lippes loop

What is endometrial hyperplasia?

thickening of the endo

What does endometrial hyperplasia result from?

unopposed estrogen stimulation

What conditions can endometrial hyperplasia be secondary to?

PCOS, tamoxifen treatment, estrogen only HRT, or estrogen producing ovarian tumors

What is the most likely diagnosis in a post-menopausal patient with a thickened endometrium?

endometrial hyperplasia

What is the normal endometrial thickness in a postmenopausal woman with no bleeding?

≤8mm

What is the normal endometrial thickness in a postmenopausal woman with bleeding?

≤5mm

What is the normal endometrial thickness in a postmenopausal woman taking HRT?

a variable premenopausal appearance

What is the normal endometrial thickness in the early proliferative phase?

4-6 mm

What is the normal endometrial thickness in the late proliferative phase?

6-10 mm

What is the normal endometrial thickness in the secretory phase?

≤16 mm

What is the most common gyn malignancy?

endometrial carcinoma

What is a clinical marker of endometrial carcinoma?

elevated CA-125

What is the most likely reason for abnormal bleeding/thick endo in reproductive age patients (excluding PCOS)?

endometrial polyps

What is the best way to visualize endometrial polyps?

saline infused sonohysterography (SIS)

What is the most common cause of post-menopausal bleeding?

endometrial atrophy

What appears as adhesions or synechiae within the uterine cavity as a result of scar formation after surgery or D&C?

Asherman syndrome

How does Asherman syndrome appear on SIS?

webb-like or stringy appearance and visualization of the synchiae