Transcript Malignant Diseases Of The uterus

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.
Endometerial carcinoma
Is the most common occurring gynecological cancer
in the united state.
Endometrial Carcinoma
Incidence is among the most common female
pelvic malignancies the tumor confined to the
uterine corpus in 75%
Presentation :
uterine bleeding .
Discharge
Pain during micturation & intercourse .
Late stage pelvic pain & weight loss.
E. Risk Factors
1)
2)
3)
4)
5)
obesity -type 2 diabetes early menstruation & late menopause .
nulliparity or a history of infertility .
polycystic ovaries.
6)
patients with estrogen producing tumors of the ovaries such as
granulosa cell tumors .
7) Estrogen –only replacement therapy (ERT).
8)
Family history – possible genetic link
– Hereditary nonpolyposis colorectal cancer (HNPCC). Inherited disease
caused by an abnormality in a gene important for DNA repair.
9) Personal history of breast cancer or ovarian cancer .
10) Tamoxifin
11) Stress
Endometrial carcinoma
Diagnosis
Ultrasound findings .
Color flow imaging ( altered vascularity with
low PI index ) .
CT & MRI ( cervical extension )
Additional test
CA - 125 blood test
Cystoscopy & proctoscopy .
Chest X-Ray , IVU
Endometrial Carcinoma
Cervical carcinoma
CT Endometrial Carcinoma
MRI Endometrial Carcinoma
C. Prevalence & Incidence
• Although this cancer is 40% more common in white
women, black women are nearly twice as likely to die
from it.
The ovaries
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 hemorrhagicum
Corpus luteum . If pregnancy does not occore the corpus luteum
gradually decline and atrophied to corpus albicance which not
be identified sonographically .
Normal ovary
Polycystic ovaries
Definition : - complex endocrinologic
disorder associated with chronic
anovulation.
Clinically :
Ultrasonographic Appearance :
Adams et al & Fox et al .
What are the symptoms of polycystic ovarian syndrome (PCOS)?
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
oily skin,
dandruff,
infertility,
skin discolorations,
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 .
What causes polycystic ovarian syndrome
(PCOS)?
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
Polycystic ovary
Sonographic appearance of
ovarian mass
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 masses
Ovarian Cysts ( non neoplastic )
Functional cysts : most result from abnormalities in the release
of anterior pitutary gonadotropins .
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 .
Ovarian cyst ( CT scan )
MRI ovarian cyst
Lu cyst
• endometrial cyst ( endometrioma ) it is
nonneoplastic cyst .
• The ovary is involved in 80% of all cases of
endometriosis. These masses may be large
(15-20cm) and are filled with old blood .
• US
• Hemorrhagic cysts .
• US
Hemorrhagic cyst
sonograms show complex intraovarian cyst (C) surrounded
by rim of healthy ovarian tissue. Cyst contains retracting
clot. Calipers indicate boundary of ovaries.
Hemorrhagic cyst color US
Ruptured hemorrhagic cyst
Chocilate cyst
Dermoid cyst ( teratomas )
Is a germ cell tumor of the ovary .
Contained of the cyst :
1-Sonography
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 .
Dermoid cyst ( plain X-ray
Ultrasound Dermoid cyst
CT Dermoid cyst
Female genital tract
•
•
•
•
•
•
•
•
•
•
•
•
Ovarian tumours
The commonest is cystadenoma & cystadenocarcinima.
Ultrasonography
Diagnosis by US, CT & MRI
US, CT& MRI may show
Hydronephrosis from ureteric obstruction .
Enlarges lymph nodes .
Liver metastasis .
Ascitis.
Omental & peritoneal metastases are difficult to be visible because of there small
size .
Treatment is surgical removal but staging should be carried out befor surg.
The main role of post operative imaging is for follow up
• Hemorrhage within the cyst may make the
sonographic appearance confusing , hemorrhage
is excellent evidence that the mass is benign.
• Often called the “silent cancer”
• Tumor size in post menopausal is important the
larger the size of the lesion, the higher the
likelihood of malignancy. Large size also indicate
that the mass has persistent for some time .
• It is important to realize that the ovary is
relatively common site for metastasis . The
primary is from colon, stomach & breast.
II. Ovarian Cancer
• For most pre-menopausal women, a
growth on the ovary is benign (90%) – for
post-menopausal women there is a 70%
chance of it being benign
– Tumor growth that begins in the egg-producing
cells (germ cell tumors) –
– Tumor growth that begins on the surface of the
ovary (epithelial cell tumors)
1)
2)
3)
4)
5)
6)
7)
A.
Risk
Factors
Continuous egg production (never pregnant, never used birth control,
or first birth after age 30)
Early menstruation & late menopause .
Obesity
Diet
Fertility drugs
Estrogen replacement therapy .
Genetics.
– <10% of women found to have ovarian cancer have inherited the
disease
– BRCA1 and BRCA2 are implicated in ovarian cancer too
– Family history breast cancer
CT. Detection
Rudimentary uterus
Conganital anomalies of the
uterus
3D ultrasound image of
didelphys uterus
IUCD
3 D US
Hysterosalpingography ( HSG )
Contrast study of uterus , fallopian tubes .
Indications
1- Infertility .2- recurrent abortion .3- monitor the effect of tubal
surgery , 4- after ectopic pregnancy .
Contraindication
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 .
HSG
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Complications :
1- pain .
2- Intravasation .
3- exacerbation of infection .
Normal HSG .
Congenital anomalies :
1- uterus didelphys .
2- uterus bicornis bicollis .
3- uterus bicornuate unicollis .
4- septate uterus , ( arcuate uterus ) , subseptet & complete septation ..
5- infantile uterus .
6- Unicornis unicollis uterus .
Fibroid can be detected by HSG .
Abnormalities in the fallopian tubes 1- hydrosalpinx 2- TB.