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Carcinoma

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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.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Uterus

Ultrasound

Neoplastic

Idiopathic

Gynecologic (GYN)

Body

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