Ben Falconer [email protected] Supervisors: Peter Bryanston-Cross, Brenda Timmerman.
Abnormaal vaginaal bloedverlies Dirk Timmerman UZ KU Leuven 2de Master Arts, 28 april 2010.
-
Upload
brittany-makins -
Category
Documents
-
view
220 -
download
0
Transcript of Abnormaal vaginaal bloedverlies Dirk Timmerman UZ KU Leuven 2de Master Arts, 28 april 2010.
Abnormaal vaginaal Abnormaal vaginaal bloedverliesbloedverliesDirk Timmerman Dirk Timmerman
UZ KU LeuvenUZ KU Leuven 2de Master Arts, 28 april 20102de Master Arts, 28 april 2010
Postmenopausal bleeding
Is all postmenopausal bleeding caused by Is all postmenopausal bleeding caused by endometrial cancer?endometrial cancer?
NoNo30%30% exogenous estrogensexogenous estrogens
30%30% atrophic endometritis/vaginitisatrophic endometritis/vaginitis
11%11% endometrial cancerendometrial cancer
10%10% endometrial or cervical polypsendometrial or cervical polyps
5%5% endometrial hyperplasiaendometrial hyperplasia
10-10-15%15%
miscellaneous: cerv. ca., uterine miscellaneous: cerv. ca., uterine sarcoma, urethral caruncle, traumasarcoma, urethral caruncle, trauma
Abnormaal bloedverlies Echografie? EndometriumdikteEndometriumdikte Bijkomende informatie: Bijkomende informatie:
MorfologieMorfologie Hydrosonografie (SIS)Hydrosonografie (SIS) Kleuren DopplerKleuren Doppler
Ambulante hysteroscopieAmbulante hysteroscopie
TVS en endometriumdikte:Is dit alles wat we nodig hebben?
PMB: Endometriumdikte
Prevalentie van endo ca: 11%Prevalentie van endo ca: 11%
< 5mm 15 endo ca/ 1113 (1.4%)< 5mm 15 endo ca/ 1113 (1.4%)
>> 5mm 248 endo ca/ 1247 (20%) 5mm 248 endo ca/ 1247 (20%)
(Meta-analysis by Timmerman &Vergote 1997 : 20 studies)(Meta-analysis by Timmerman &Vergote 1997 : 20 studies)
OOnly a normal nly a normal and thin and thin endometrial endometrial line line is informativeis informative
Endometrial thickness at TVS?
Fibroom
Poliep
Limitations of hydrosonography Cost? Double compared to TVS aloneCost? Double compared to TVS alone Time to perform? Extra 5 minutesTime to perform? Extra 5 minutes Side effects: Side effects:
infection: very rare infection: very rare spilling of malignant cells? Yes. spilling of malignant cells? Yes.
Patient discomfort? MinimalPatient discomfort? Minimal Does it change management? SometimesDoes it change management? Sometimes
Adenomyosis uteri
Common gynecologic disorderCommon gynecologic disorder Heterotopic endometrial glands and stroma Heterotopic endometrial glands and stroma
in the myometrium with adjacent smooth in the myometrium with adjacent smooth muscle hyperplasiamuscle hyperplasia
(Rokitansky, 1860)
Adenomyosis: presenting symptoms
Diffusely enlarged uterus withDiffusely enlarged uterus with menorrhagia (40-50%)menorrhagia (40-50%) dysmenorrhea (10-30%)dysmenorrhea (10-30%) metrorrhagia (10-12%)metrorrhagia (10-12%) dyspareunia dyspareunia (typically 1 wk prior menstruation)(typically 1 wk prior menstruation)
dyschezia dyschezia (typically 1 wk prior menstruation)(typically 1 wk prior menstruation)
Adenomyosis: epidemiology
About 1% of female patientsAbout 1% of female patients 5 - 70% of hysterectomy specimens 5 - 70% of hysterectomy specimens (Azziz 1989)(Azziz 1989)
31% if 3 sections; 61% if 6 sections 31% if 3 sections; 61% if 6 sections (Bird 1972)(Bird 1972)
More often in multiparous women More often in multiparous women Fourth – fifth decade of lifeFourth – fifth decade of life
Adenomyosis: morphology
Asymmetrical uterine enlargement Asymmetrical uterine enlargement
(or globular appearing uterus)(or globular appearing uterus)
Adenomyosis
Asymmetrical uterine enlargementAsymmetrical uterine enlargement Ill defined hyperechoic & hypoechoicIll defined hyperechoic & hypoechoic areasareas Small anechoic cystsSmall anechoic cysts
Adenomyosis
Asymmetrical uterine enlargementAsymmetrical uterine enlargement Ill defined hyperechoic & hypoechoicIll defined hyperechoic & hypoechoic areasareas Small anechoic cystsSmall anechoic cysts Indistinct endometrial-myometrial borderIndistinct endometrial-myometrial border
Differential diagnosis
Concentric, roundConcentric, round Sharply definedSharply defined Mass effectMass effect Often calcificationsOften calcifications Color DopplerColor Doppler
EllipticalElliptical Poorly defined bordersPoorly defined borders Lack of mass effectLack of mass effect No calcificationsNo calcifications Color DopplerColor Doppler
FibroidAdenomyosis
Morphology of flow
Fibroid: circular flowFibroid: circular flow
Polyp: pediclePolyp: pedicle
Endometrial cancer: multiple Endometrial cancer: multiple irregular vessels in junctional areairregular vessels in junctional area
Adenomyosis: no clear changes in Adenomyosis: no clear changes in normal flow pattern normal flow pattern
Differential diagnosis
Size 0 - 5 cmSize 0 - 5 cm Concentric, roundConcentric, round Sharply definedSharply defined Degeneration possibleDegeneration possible Often calcificationsOften calcifications Color DopplerColor Doppler
Size 5 - 18 cmSize 5 - 18 cm Inhomogeneous, ovalInhomogeneous, oval Irregular contourIrregular contour Central necrosis commonCentral necrosis common No calcificationsNo calcifications Color Doppler?Color Doppler?
Leiomyoma Leiomyosarcoma
Abnormal bleedingHistory, clin. exam, PAP, TVS +Doppler (SIS only if indicated)
Thick endometrium
Exclusion of adnexal pathology
BiopsyHysteroscopic resection (polyp / myoma)
Focal pathology
No focal pathology
Thin endometrium
DUB
Medic. R/
Surgery