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Hyperplasia

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Our next case is of a 24-year-old

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patient who got her pelvic ultrasound

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as part of an infertility workup.

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At the time of this ultrasound, her LMP was

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approximately three and a half weeks earlier,

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which would put her in the secretory phase.

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So when you're thinking about

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what a normal thickness should be,

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we're in the secretory phase here.

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So maybe up to 18 mm or so tops.

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So this is not the prettiest set of

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images, but it's certainly diagnostic.

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And you can see here that this

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endometrium is very thick.

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You can see a nice rim of myometrium around it,

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but no matter how you slice it, this is

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going to be far too thick at 22 mm.

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So this is abnormally thickened,

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but it's homogeneously thickened.

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At this point, I don't see a

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focal echogenic lesion, although

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one certainly could be obscured.

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but just rather complete diffuse thickening.

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Go to the color Doppler images just

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to complete your workup and make sure

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we don't see any abnormal vascularity.

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And again, you almost see the

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endometrium a little bit better here.

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What's interesting is you do see this single

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feeding vessel crossing from the myometrium

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here into the endometrium right here.

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And then maybe if you squint a little

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bit, maybe there is something a little

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bit brighter right here as well.

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Again, the background is thickened straight.

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That's thickened no matter what, but we

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may have a little polyp here as well.

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I'll go backwards a little bit.

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Feeding vessel to this echogenic structure.

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So we have an abnormally diffusely thickened

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endometrium here and probably an underlying polyp.

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43 00:01:28,744 --> 00:01:31,255 Unfortunately, this ended up being

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read at the time, as probably due to her

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late-phase encyclical, could repeat it

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after an LMP if indicated,

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and she hasn't yet had repeat imaging

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to prove what's going on here.

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So putting this all together, this is

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an abnormally thickened, homogeneously thickened

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endometrial stripe and probably

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represents endometrial hyperplasia.

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She probably also has a polyp here on

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the background of this hyperplasia.

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Either way, though, she does need to

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have a biopsy, and that's what you should

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recommend if you see a case like this.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Vascular

Uterus

Ultrasound

Neoplastic

Idiopathic

Gynecologic (GYN)

Body

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