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Tamoxifen Polyp

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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.

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)

Drug related

Body

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