Malignant diseases of the uterus.
Malignancy of the uterus other than endometrium are rare and include sarcomas & more rarely lymphomas . Sarcoma arising from mesodermal tissue of the uterus or from underlying malignant degeneration of the myoma , the incidence are rare it is of about 1% or less.
Is the most common occurring gynecological cancer in the united state.
Incidence is among the most common female pelvic malignancies the tumor confined to the uterine corpus in 75%
Presentation : uterine bleeding .
Pain during micturation & intercourse .
Late stage pelvic pain & weight loss.
8) Family history – possible genetic link
9) Personal history of breast cancer or ovarian cancer .
Ultrasound findings .
Color flow imaging ( altered vascularity with low PI index ) .
CT & MRI ( cervical extension )
CA - 125 blood test
Cystoscopy & proctoscopy .
Chest X-Ray , IVU
Shape of the ovaries are ellipsoid, Almond in shape .
Ovarian location :
Ovarian volume :
The adult ovary volume measures ( 9,8 +_ 5,8 ml )
Postmenopausal volume ( 6,8 ml )
Dominant follicle .
Mature follicle .Approximately 24 hours before ovulation, the granuloza layer separates from the theca layer, resulting in hypoechoic ring .
Corpus luteum . If pregnancy does not occore the corpus luteum gradually decline and atrophied to corpus albicance which not be identified sonographically .
Definition : - complex endocrinologic disorder associated with chronic anovulation.
Ultrasonographic Appearance :
Adams et al & Fox et al .
menstrual disturbances elevated levels of male hormones (androgen).
Other signs and symptoms of PCOS include:
obesity and weight gain,
elevated insulin levels and insulin resistance
high cholesterol levels,
elevated blood pressure, and
multiple, small cysts in the ovaries.
Any of the above symptoms and signs may be absent in PCOS, with the exception .
No one is quite sure what causes PCOS. 1- Both genetic (inherited) as well as environmental factors.
2-A malfunction of the body's blood sugar control system (insulin system) .
3- Women with PCOS produce excess amounts of male hormones known as androgens.
4- Excessive production of the hormone LH
5- A low level of chronic inflammation in the body and fetal exposure to male hormones
Any mass in the ovary or adnexa may be solid or cyst.
Solid mass in the adnexa may be
1- Pedunculated fibroid ( myoma ) .
2- ovarian solid mass ,ovarian fibromas, adenofibroma, thecoma, burner tumors .
Cystic mass may be benign ( non neoplasm) or neoplasm .
Sign of benign cystic mass .
Sign of neoplasm .
Ovarian Cysts ( non neoplastic )
Functional cysts : most result from abnormalities in the release of anterior pitutarygonadotropins .
1- Physiological Ovarian Cysts .
2- Follicular Cysts, are extremely common .
< 5 cm.
3- Corpus lutea cyst ( 2,5-3 cm ) it cause abnormal menestrual cycle .
4- Theca leutien cyst ( due to ovarian hyperstimulation ) . May be seen .
5- Serous inclusion cyst .( tiny to multiple cm ) , this not cause post manopausal bleeding because it is functionless cyst .
US findings .
sonograms show complex intraovarian cyst (C) surrounded by rim of healthy ovarian tissue. Cyst contains retracting clot. Calipers indicate boundary of ovaries.
Is a germ cell tumor of the ovary .
Contained of the cyst :
Cystic teratomas are probably the most common ovarian neoplasm in patients younger than the age of 50 years.
Cyst , hypoechic , plugs of nodule .
2- CT scan
3- Plain X-ray .
It is better to be removed .
Hemorrhage within the cyst may make the sonographic appearance confusing , hemorrhage is excellent evidence that the mass is benign.
Contrast study of uterus , fallopian tubes .
1- Infertility .2- recurrent abortion .3- monitor the effect of tubal surgery , 4- after ectopic pregnancy .
1- acute pelvic infection .
2- sever renal or cardiac disease .
3- sensitivity to contrast .
4- recent dilatation or curettage .
5- pregnancy .
Week prior & week following menstrual cycle .