0:01

This is a case of a 59-year-old

0:03

patient who came in for her ultrasound

0:05

for postmenopausal bleeding.

0:07

We're on our sagittal imaging of the

0:09

cervix in this particular case, and you can

0:11

already see there's really not a whole lot

0:13

of normal anatomy as we scroll through this.

0:16

Where exactly the cervix is, the internal

0:18

os, the external os, even the margins,

0:20

through the margins you can see out here,

0:22

but other than that, pretty hard to tell.

0:24

We just have this very heterogeneous structure

0:26

with shadowing at the margins, but no

0:28

definite calcification. Bladder is up here

0:32

and it kind of just fills that whole space.

0:34

So if you're looking just at this, you're

0:35

thinking, is this arising from the cervix to the

0:37

cervical carcinoma, but it is sort of centered.

0:40

Is this an endometrial carcinoma?

0:43

We'll go to color Doppler imaging because

0:45

she is having postmenopausal bleeding.

0:46

What if this is all just blood

0:47

products, always something to consider.

0:49

And you can see immediately.

0:51

There is a ton of flow to this.

0:53

It's obscuring the lesion.

0:54

In fact, there's so much blood flow.

0:56

So we have a hypervascular mass that's

0:58

in the lower uterine segment or cervix.

1:02

You can see there.

1:05

I mentioned in other cases that

1:07

we at our institution always do

1:08

a transabdominal image as well.

1:10

And that's because in a case like

1:12

this, you may not be able to see

1:13

the fundus of the uterus that well.

1:15

And so we have a little bit of imaging

1:16

here, not beautiful imaging, but you can see

1:18

there's a pretty normal endometrial stripe.

1:21

Towards the fundus of the uterus.

1:22

Again, the uterus is going to

1:23

be approximately right here.

1:25

So relatively normal endometrium here, and then

1:28

some sort of ill-defined process down here.

1:31

Can't really see it well via trans

1:32

abdominal ultrasound, but we could

1:34

see it on the transvaginal portion.

1:35

It's trying to put that together.

1:37

We have what is most likely a malignancy

1:39

involving the uterus, whether

1:41

it's cervical or whether it's endometrial.

1:43

Given her age, endometrial cancer,

1:45

she's at higher risk for that,

1:47

but either is certainly possible.

1:49

And what's interesting is about 10

1:51

years before that, she did have a prior,

1:53

and you can see the difference in how

1:54

quickly ultrasound technology changes.

1:58

But just to show you this, she had a

1:59

completely normal-appearing uterus when

2:01

she was premenopausal approximately 10

2:03

plus years before she presented there.

2:08

I should take back not entirely normal.

2:09

We do have a calcified or

2:11

partially calcified fibroid.

2:13

right here.

2:16

And so she did also get additional

2:18

imaging after she was eventually

2:20

diagnosed with an endometrial cancer.

2:22

This was not cervical cancer.

2:23

She got her staging CT.

2:24

And just to show you, you know, what this

2:26

ended up looking like on a CT scan, you

2:28

have this enhancing, very bright mass again,

2:31

centered in the cervix or lower uterine

2:33

segment, probably a fibroid up here, which we

2:35

saw on a prior ultrasound of a fibroid here.

2:39

But again, differential for here, if

2:41

you started with the CT, is going to be a

2:43

cervical cancer versus endometrial cancer.

2:45

Either way, they need a biopsy.

2:47

So it's important to note that most endometrial

2:48

carcinomas are going to be adenocarcinomas.

2:52

Most of these are going to present in a

2:53

postmenopausal population, and they're

2:55

going to present approximately 90 percent

2:57

of them with postmenopausal bleeding.

2:59

And this is the most common gynecologic malignancy.

3:02

So it's important to consider

3:03

first in this patient population.