Lesson 5 (Part 2)

Question 1

What are 3 differential diagnosis for polyps?

Answer 1

1. Hyperplasia
2. Endometrial cancer
   - bleeding –> symptomatic ***
3. Submucosal fibroid

Question 2

Stalk

Answer 2

Pedicle artery sign

Question 3

SHG

Answer 3

Sonohysterogram

Question 4

What does it mean if you see a pedicle artery sign on colour doppler for polyps?

Answer 4

You dont need a sonohysterogram if you can see it with regular US

Question 5

PMB

Answer 5

Post menopausal bleeding

Question 6

What is SHG good at?

Answer 6

Differentiating polyps and fibroids

Question 7

What can you see with a SHG? (2)

Answer 7

1. Polyp seen arising from the endometrial

2. Submucosal fibroid normal layer from the endometrial is seen overlying

Question 8

What is a treatment for polyps?

Answer 8

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

Question 9

What is the most common gynecologic malignancy in North America?

Answer 9

Endometrial Carcinoma

Question 10

Is endometrial carcinoma highly curable?

Answer 10

Yes

Question 11

Were do you see most endometrial carcinoma located?

Answer 11

Confined to the uterus

- 75%

Question 12

Who do you see most endometrial carcinoma with?

Answer 12

Postmenopausal women

- 75-80%

Question 13

What is the most common clinical presentation of endometrial carcinoma?

Answer 13

Uterine bleeding

Question 14

What percentage of women with PMB have endometrial carcinoma?

Answer 14

10%

Question 15

What is the sonographic appearance of endometrial carcinoma? (4)

Answer 15

1. Thickened endometrium
2. Heterogeneous echotexture
3. Irregular or poorly defined margins
4. Can cause obstruction blocks the cervix
   - hydrometra or hematometra

Question 16

Why can endometrial carcinoma be tricky? (2)

Answer 16

1. Well defined and uniformly echogenic

2. Can have the same appearance as endometrial hyperplasia or polyps

Question 17

What is 3 differential diagnosis of a thicken endometrium for a women in her peri or post menopausal years?

Answer 17

1. Hyperplasia
2. Polyps
3. Cancer

Question 18

What is needed to confirm the differential diagnosis of a thicken endometrium for a women in her peri or post menopausal years?

Answer 18

A biopsy

Question 19

What was the first thought with endometrial cancer when using colour and spectral doppler?

Answer 19

That low resistance flow in the uterine arteries distinguish normal postmenopausal endometriums from cancer
- found to not be significant

Question 20

What is the best way to measure postmenopausal endometriums from cancer?

Answer 20

Measure the endometrial thickness

Question 21

What is the role of sonographers in pre-op for endometrial cancer? (2)

Answer 21

1. To determine if there is a myometrial invasion
2. If there is an intact subendometrial Halo
   - superficial invasion

Question 22

What layer of the uterus is involved with the subendometrial halo?

Answer 22

The inner layer of the myometrium

Question 23

What is contrast enhanced MRI a superior method for in staging and pre-op? (3)

Answer 23

1. Myometrial invasion
2. Cervical extension
   - stage 2
3. Extrauterine extension
   - stage 3 & 4

Question 24

What is an example of a rare uterine sarcoma?

Answer 24

Leiomyosarcomas

Question 25

What sarcomas arise from the endometrium? (4)

Answer 25

1. Carinosarcomas 2. Endometrial stromal sarcoma 3. Adenosarcomas 4. Undifferentiated sarcomas

Question 26

What does the endometrial stomal involve?

Answer 26

Myometrium | - diffuse or focal

Question 27

What can endometrial stromal be mistaken for?

Answer 27

Leiomyoma

Question 28

What occurs in the majority of women with PMB?

Answer 28

Endometrial atrophy

Question 29

How does Endometrial atrophy appear on US? (3)

Answer 29

1. Usually thin - <5mm 2. Homogeneous 3. Can have cystic changes and be thick - therefore it can look like cystic hyperplasia