Interactive Transcript
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Our next case is of a 63-year-old
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patient who has a history of breast cancer
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and is known to be on Tamoxifen.
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So she gets her ultrasound,
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and again, sagittal uterus, cine clip.
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We can see her endometrium is too thick.
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You can stop somewhere around halfway in
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between, put some measurements on there.
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We're going to get at least 21
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millimeters, if not a little bit more,
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depending on how you measure it.
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We also have abnormal morphology in
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that we have multiple cystic spaces.
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Figure out her endometrium right here.
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So this is abnormal.
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She is, however, on Tamoxifen, and some
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literature says you can let a person who's
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on Tamoxifen let that stripe get a little
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thicker, up to about 8 mm.
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However, this is certainly far beyond that.
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We'll go to the color Doppler imaging next.
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And here is our sagittal color Doppler.
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And you can see there's certainly
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blood flow within this structure.
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So on Tamoxifen, they are at increased
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risk of developing polyps, but she actually
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has a history of polyps on her Tamoxifen.
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They are at a higher risk of hyperplasia
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of the endometrium, and they are
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at a higher risk of carcinoma.
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So again, in this kind of case, you can't
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tell which this is. Is this an atypical
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polyp with cystic spaces? Is this endometrial
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hyperplasia? Is this a carcinoma?
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And so you'd have to have this biopsy.
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Even if you have this biopsy once or
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removed, if you stay on Tamoxifen,
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you're at risk of recurrence of whatever the
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structure is or developing something
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else such as hyperplasia or carcinoma.
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So oftentimes, they have to
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come off of the Tamoxifen.
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In her case, she didn't, but she did have
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recurrent abnormalities in her endometrium.
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We did do 3D imaging on her as well.
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So here's just a clip from that.
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Again, this is going to be
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your fundal contour out here.
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This brighter part centrally is
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going to be your endometrium.
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And you can see all these
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sort of like almost divots.
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These are the cystic spaces because
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they're not going to be as bright
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as the rest of the endometrium.
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So that's what this can
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look like on a 3D imaging.
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So this is a patient you need to report for
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biopsy and then they may have to come off
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of the Tamoxifen for the rest of their life.
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So it's an important thing to be able
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to diagnose this appropriately and
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not to overcall this necessarily.
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