Interactive Transcript
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This is a case of a 59-year-old
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patient who came in for her ultrasound
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for postmenopausal bleeding.
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We're on our sagittal imaging of the
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cervix in this particular case, and you can
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already see there's really not a whole lot
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of normal anatomy as we scroll through this.
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Where exactly the cervix is, the internal
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os, the external os, even the margins,
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through the margins you can see out here,
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but other than that, pretty hard to tell.
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We just have this very heterogeneous structure
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with shadowing at the margins, but no
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definite calcification. Bladder is up here
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and it kind of just fills that whole space.
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So if you're looking just at this, you're
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thinking, is this arising from the cervix to the
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cervical carcinoma, but it is sort of centered.
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Is this an endometrial carcinoma?
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We'll go to color Doppler imaging because
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she is having postmenopausal bleeding.
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What if this is all just blood
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products, always something to consider.
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And you can see immediately.
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There is a ton of flow to this.
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It's obscuring the lesion.
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In fact, there's so much blood flow.
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So we have a hypervascular mass that's
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in the lower uterine segment or cervix.
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You can see there.
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I mentioned in other cases that
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we at our institution always do
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a transabdominal image as well.
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And that's because in a case like
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this, you may not be able to see
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the fundus of the uterus that well.
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And so we have a little bit of imaging
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here, not beautiful imaging, but you can see
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there's a pretty normal endometrial stripe.
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Towards the fundus of the uterus.
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Again, the uterus is going to
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be approximately right here.
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So relatively normal endometrium here, and then
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some sort of ill-defined process down here.
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Can't really see it well via trans
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abdominal ultrasound, but we could
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see it on the transvaginal portion.
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It's trying to put that together.
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We have what is most likely a malignancy
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involving the uterus, whether
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it's cervical or whether it's endometrial.
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Given her age, endometrial cancer,
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she's at higher risk for that,
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but either is certainly possible.
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And what's interesting is about 10
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years before that, she did have a prior,
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and you can see the difference in how
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quickly ultrasound technology changes.
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But just to show you this, she had a
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completely normal-appearing uterus when
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she was premenopausal approximately 10
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plus years before she presented there.
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I should take back not entirely normal.
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We do have a calcified or
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partially calcified fibroid.
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right here.
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And so she did also get additional
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imaging after she was eventually
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diagnosed with an endometrial cancer.
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This was not cervical cancer.
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She got her staging CT.
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And just to show you, you know, what this
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ended up looking like on a CT scan, you
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have this enhancing, very bright mass again,
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centered in the cervix or lower uterine
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segment, probably a fibroid up here, which we
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saw on a prior ultrasound of a fibroid here.
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But again, differential for here, if
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you started with the CT, is going to be a
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cervical cancer versus endometrial cancer.
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Either way, they need a biopsy.
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So it's important to note that most endometrial
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carcinomas are going to be adenocarcinomas.
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Most of these are going to present in a
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postmenopausal population, and they're
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going to present approximately 90 percent
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of them with postmenopausal bleeding.
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And this is the most common gynecologic malignancy.
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So it's important to consider
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first in this patient population.
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