Diagnostic ultrasound ( PDFDrive )

CHAPTER 15 The Uterus 547
A
B
FIG. 15.17 Hematometra in Patient With Cervical Stenosis Due to Cervical Carcinoma. (A) TAS and (B) TVS show distended endometrial
cavity illed with moderately echogenic material due to blood. The cancer was obstructing at the level of the cervix and is not shown on these
images.
hus there were only two concerning endometrial lesions in the
131 patients (1.5%) in whom biopsy was attempted.
FIG. 15.18 Normal Postmenopausal Endometrium. Sagittal TVS
shows a small amount of luid in the endometrial cavity.
patients 146 (Fig. 15.18). Larger amounts of luid may be associated
with benign conditions, most oten related to cervical
stenosis. 143,147
In a study of 1074 asymptomatic postmenopausal women,
endometrial luid was found in 134 (12%). 148 Biopsy was attempted
in 131. Cervical stenosis precluded sampling in 12 and an
additional 32 women had some degree of cervical stenosis (44/131
= 34%). Pathology included two polyps, and one case each of
cystic hyperplasia, adenomatous hyperplasia, and carcinoma.
Endometrial Hyperplasia
Hyperplasia of the endometrium is deined as a proliferation of
glands of irregular size and shape, with an increase in the glandto-stroma
ratio compared with the normal proliferative endometrium.
149 he process is typically difuse but at times may
simulate a broad-based polypoid lesion. Histologically, endometrial
hyperplasia can be divided into hyperplasia without
cellular atypia and hyperplasia with cellular atypia (atypical
hyperplasia). Long-term follow-up studies have shown that about
25% of atypical hyperplasia will progress to carcinoma, versus
less than 2% of hyperplasia without cellular atypia. 149 Each of
these types may be further subdivided into simple or complex
hyperplasia, depending on the amount of glandular complexity
and crowding. In simple (cystic) hyperplasia, the glands are
cystically dilated and surrounded by abundant cellular stroma,
whereas in complex (adenomatous) hyperplasia, the glands are
crowded together with little intervening stroma.
Endometrial hyperplasia is a common cause of abnormal
uterine bleeding. Hyperplasia develops from unopposed estrogen
stimulation which could be due to use of unopposed estrogen
HRT, persistent anovulatory cycles (such as with polycystic ovarian
syndrome) and in obese women with increased production of
endogenous estrogens. Hyperplasia may also be seen in women
with estrogen-producing tumors, such as ovarian granulosa cell
tumors and thecomas.
Sonographically, the endometrium is usually difusely thick
and echogenic, with well-deined margins (Fig. 15.19). Focal
or asymmetrical thickening can also occur. Small cysts may be