0:01

Our next case is of a 63-year-old

0:02

patient who has a history of breast cancer

0:04

and is known to be on Tamoxifen.

0:07

So she gets her ultrasound,

0:09

and again, sagittal uterus, cine clip.

0:12

We can see her endometrium is too thick.

0:16

You can stop somewhere around halfway in

0:17

between, put some measurements on there.

0:19

We're going to get at least 21

0:21

millimeters, if not a little bit more,

0:23

depending on how you measure it.

0:25

We also have abnormal morphology in

0:27

that we have multiple cystic spaces.

0:30

Figure out her endometrium right here.

0:31

So this is abnormal.

0:33

She is, however, on Tamoxifen, and some

0:35

literature says you can let a person who's

0:36

on Tamoxifen let that stripe get a little

0:38

thicker, up to about 8 mm.

0:40

However, this is certainly far beyond that.

0:42

We'll go to the color Doppler imaging next.

0:45

And here is our sagittal color Doppler.

0:48

And you can see there's certainly

0:50

blood flow within this structure.

0:53

So on Tamoxifen, they are at increased

0:55

risk of developing polyps, but she actually

0:57

has a history of polyps on her Tamoxifen.

1:00

They are at a higher risk of hyperplasia

1:02

of the endometrium, and they are

1:05

at a higher risk of carcinoma.

1:07

So again, in this kind of case, you can't

1:09

tell which this is. Is this an atypical

1:11

polyp with cystic spaces? Is this endometrial

1:13

hyperplasia? Is this a carcinoma?

1:15

And so you'd have to have this biopsy.

1:18

Even if you have this biopsy once or

1:20

removed, if you stay on Tamoxifen,

1:22

you're at risk of recurrence of whatever the

1:24

structure is or developing something

1:26

else such as hyperplasia or carcinoma.

1:28

So oftentimes, they have to

1:29

come off of the Tamoxifen.

1:31

In her case, she didn't, but she did have

1:33

recurrent abnormalities in her endometrium.

1:36

We did do 3D imaging on her as well.

1:38

So here's just a clip from that.

1:39

Again, this is going to be

1:40

your fundal contour out here.

1:42

This brighter part centrally is

1:43

going to be your endometrium.

1:45

And you can see all these

1:46

sort of like almost divots.

1:47

These are the cystic spaces because

1:48

they're not going to be as bright

1:49

as the rest of the endometrium.

1:52

So that's what this can

1:52

look like on a 3D imaging.

1:56

So this is a patient you need to report for

1:57

biopsy and then they may have to come off

1:59

of the Tamoxifen for the rest of their life.

2:02

So it's an important thing to be able

2:03

to diagnose this appropriately and

2:05

not to overcall this necessarily.