Interactive Transcript
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Our next case is of a 50-year-old patient who's
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premenopausal and is coming in for evaluation
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of her dysfunctional uterine bleeding.
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She had her LMP or last menstrual
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period approximately one month before.
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In our sagittal imaging here, we can already see
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a classic appearing fibroid up here with areas
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of heterogeneity and shadowing calcification.
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Make this a little bit bigger.
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And then we have our endometrium.
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Our endometrium does look a little bit
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thickened, but there is something focal within
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it right here, and you can kind of see it because
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not only is it a little bit brighter than
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the endometrium around it, but you have these
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tiny cystic spaces within it that we don't
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have anywhere else in the endometrial canal.
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Just this one focal kind of area right here.
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Then, of course, as we go through, you can
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see another large fibroid back here.
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Looking at our color Doppler images.
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You can see some flow out here to the fibroid.
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Endometrium itself is not that
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vascular, nor should it be.
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Might see little dots of flow
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here and there, but it shouldn't
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have that much color Doppler flow.
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But we're already seeing right here
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what looks like it might be a feeding
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vessel and flow within the structure.
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And hard to tell here, is it one feeding
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vessel or multiple feeding vessels?
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But what you can argue is we definitely have
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an echogenic structure with cystic spaces.
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It has color Doppler flow
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leading out to it directly.
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It is within the endometrium.
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It is not a classic appearance for a fibroid.
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So this case would be a differential case.
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She is not postmenopausal; she's considered
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premenopausal with an LMP of one month
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prior, but she's nearing that age where you
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could consider more of a differential than
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you would in, say, a 24-year-old.
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So with her, your differential is going
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to be an atypical polyp because polyps can
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occasionally have internal cystic spaces
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like this one does.
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It could also be hyperplasia or
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it could be a focal malignancy.
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Again, these are going to be hard to diagnose
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or to differentiate on an ultrasound.
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If you weren't sure if this was real or not,
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you could have repeat ultrasound imaging.
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She's in a secretory phase at this
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point, so it's going to be maximal
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thickness of her endometrium.
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You could repeat it, you know, 5 to 7
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or even 10 days after her LMP to try
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and figure out if this is real or not.
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However, in this case, with the internal cystic
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spaces, we knew this was real, and she needed
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to have this biopsy and/or removed.
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So in this case, she did end up going to
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surgery, and this ended up being atypical polyps.
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So it's not hyperplasia or cancer,
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just a polyp, but it was the cause of
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her dysfunctional uterine bleeding.
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