Endometrial Pathology

A 32 year old female presents with intermenstrual bleeding and a negative pregnancy test. What is the following image consistent with?

Endometrial polyp

-Based on the age and the focal nature of the endometrial thickening, the most likely diagnosis is a polyp

What is the most likely sonographic appearance of the endometrium in a patient complaining of post menopausal bleeding?

Endometrium measuring <4mm

-Most common cause of PMB is endometrial atrophy. So most likely that will be the sonographic finding

A 24 year old patient with a history of PCOS presents with abnormal bleeding. What is the most likely diagnosis?

Endometrial hyperplasia

-The patient history of PCOS predisposes her to endometrial hyperplasia due to chronic anovulation and increased estrogen levels.

Hormone replacement therapy is related to what typical endometrial appearance?

Cystic changes of the endometrium

-Normally we expect to see an endometrium similar to the reproductive age

What is the most likely cause of endometrial thickening in the reproductive age patient?

Endometrial polyp

-It's most likely a polyp since that's more common in this age group. If the patient were to have a history of PCOS, then she would most likely have endometrial hyperplasia

What is suspected in a patient presenting with a history of multiple D&C's and miscarriages?

Asherman Syndrome

-The patient history indicates the likelihood of scarring of the endometrium, which is consistent with Asherman's syndrome

What is the most common gynecological malignancy?

Endometrial adenocarcinoma

What is the normal maximum dimension of the endometrium in the reproductive age group?

16mm

-Since the timing of the menstrual cycle is not mentioned, we will look for the maximum dimension of the normal endo

What is the normal maximum dimension of the endometrium in a patient experiencing post menopausal bleeding?

5mm

-In the symptomatic (bleeding) post-menopausal patient, the upper limit of normal is 5mm

How should this endometrium be properly measured?

Measure anterior and posterior endometrial stripes separately and add the values together

-When fluid is present, it should be included in the measurement. Each side of the endo should be measured separately and then added together

What diagnosis is most consistent with the image below?

Endometrial hyperplasia

-A heterogeneous endo with cystic changes is most likely hyperplasia

What is the typical effect of tamoxifen on the endometrium?

Thickened endometrium with cystic changes

-A common secondary effect of tamoxifen is hyperplasia with cystic changes

What is the upper limit of normal for the endometrium in the asymptomatic post-menopausal patient?

8mm

-Asymptomatic (not bleeding) post-menopausal endo may measure up to 8mm

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

Endometrial atrophy

An elevation in which hormone will increase the likelihood of the patient developing endometrial carcinoma?

Estrogen

-Since estrogen thickens the endometrium, if there is too much, the endo will keep on being stimulated