UTERINE PATHOLOGY
CAUSES ~ Definition
RISK FACTORS
CLINICAL
PRESENTATION
Can cause pregnancy
loss or infertility
Difficult to detect
unless fluid in endo
cavity
INCIDENCE
SONO FINDINGS
TREATMENT or
Complications
Bridging band of tissue distorts
endo cavity; or thin
membrane
Divide adhesions under
Hysteroscopy
Endometrial Adhesions
(Synechiae, Asherman
syndrome)
bands of tissue caused by
trauma, surgery, abortions,
D&C
Endometrial Atrophy
Endometrium gets smaller
postmenopausal
bleeding
2nd most
common
gynecologic
malignancy in
USA & presents
in 3rd & 4th
Abnormal thickening of Endo Estrogen Stimulation:
cavity; Malignant;
Postmenopausal (70progression from atypical
80%); late menopause
endometrial Hyperplasia 25% (52+)
Uterine
bleeding
Heterogeneous echotexture;
3% of women; <
irregular margins; enlarged uterus
1.5% of Cancer
(lobular contour; miixed
deaths
echogenicity)
a thin <5mm endometrium; may
estradiol
demonstrate cystic changes (cystic
supplementation
atrophy)
Endometrial
carcinoma
Hysterectomy,
radiation, progesterone
UTERINE PATHOLOGY
CAUSES ~ Definition
Endometrial Hyperplasia
Overgrowth of
endometrium due to
unopposed estrogen
stimulation (w/out progrestin
influence)
Endometrial Polyps
RISK FACTORS
CLINICAL
PRESENTATION
Peri/Post-menopausal,
unopposed estrogen
HRT; hormone
imbalance (due to
Abnormal uterine
Anovulatory cycles, High bleeding; Abnormal
Endogenous Estrogen
thickening; may not
production from
affect entire endo
obesity), PCOD,
Ovarian masses
secreting excess
Estrogen (Thecomas,
Granulosa cell tumors)
INCIDENCE
SONO FINDINGS
Focal/ diffuse thickening (withw/out cystic changes); Endo > 14
most common
post reproductive mm (premenopausal); Endo > 5
mm (Postmenopausal), Endo >
years
7mm (postmeno w/HRT)
Oral contreception;
D&C; Hysterectomy
Diffuse or Focal Endo thickening;
Focal, round, echogenic mass w/in
D&C; Snare
endo cavity; Isoechoic to Secretory
Polyectomy under
endometrium (via
Hysteroscopic
Hysterosonography); Hyperechoic
guidance
in Periovulatory or Late proliferative
stages
Pedunculated or senile mass
of endometrial tissue covered most asymptomatic;
by endothelium attached to
may cause infertility
Endo cavity
most asymptomatic;
abnormal uterine
bleeding
Benign tumor: smooth
muscle cells & Fibrous conn
tissue in uterus; spindleshaped in whorl-like pattern
↑ size in pregnancy;
Shrinks or stabilize in
menopause; may ↑ size
w/ HRT or Tamoxifen
Asymptomatic, pain
w/ internal bleeding,
Pelvic pressure w/
occurs 20-30% in Variable echogenicity: irregular
enlarged uterus,
age 30+; higher
uterine contour, diffuse uterine
irregular or prolonged in African decent enlargement
(acyclic or profuse0
bleeding
Malignant tumor made of
smooth muscle cells &
fibrous conn tissue of
myometrium
Aggressive cancer w/
poor prognosis
rapid growth in
Peri/Postmenopausal
most common in
peri/postmenopausal
TREATMENT or
Complications
LEIOMYOMA (Fibroid,
Myoma)
Hysterectomy,
myomectomy,
Embolization of Uterine
Artery
LEIOMYOSARCOMA
Rare: 3% of
Uterine Tumors
Hysterectomy; Bi-Laterl
solid & cystic feautures:
salpingoindistinguishable from fast growing
oophoectomy;
or degenerating leiomyomas
peritoneal washings
UTERINE PATHOLOGY
CAUSES ~ Definition
RISK FACTORS
CLINICAL
PRESENTATION
TREATMENT or
Complications
INCIDENCE
SONO FINDINGS
usually in women
who have had
kids; found in
70% of
hysterectomy
specimens
non-specific; enlarged uterus w/
normal contours & intact
endometrial lining; asymetrical
enlarged uterus w/ abnormal
myometrium
Hysterectomy w,w/o
Ovary removal;
endometrial ablasion;
Uterine Artery
embolization; hormone
therapy
middle aged
Round, anechoic
structures (May contain
echoes if infected or if
hemorrhage)
Usually, < 2 cm
May be multiple
No treatment for
asymptomatic;
drainage if enlarged
and malignancy can
Not be ruled out
Normal; Enlarged, bulky cervix;
Solid mass in cervix ;
Obstruction of ureters;
Extension into bladder, pelvic
sidewalls, & rectum
laser surgery, freezing,
or cauterization,
Conization, Radiation,
Hysterectomy
ADENOMYOSIS
uterine condition:
defect in basement
endometrial glands & stroma;
membrane separating
located in uterine
the myometrial &
myometrium proximal to
endometrial layers
basal layer of endo
often undiagnosed:
symptoms similar to
leiomyomas &
endometrial
pathologies
NABOTHIAN CYST
Benign cyst w/in cervix
due to obstructed dilated
transcervical gland
retention of nabothian
gland secretions;
common after
pregnancy or chronic
cervicitis
Vaginal disharge;
Early cancer is
asymptomatic
CERVICAL CARCINOMA
squamous cell cancer or
cancer originating
endocervical glands
HPV; early Sexual
activity; Multiple sex
partners; Smoking; oral
contraceptive
Asymptomatic (early
stage); bleeding
(Intermenstrual,
postcoital);
Malodorous
discharge, Palpable
pelvic mass