SONO. CASE PRESENTATION 가천의대길병원 초음파실 R2 이현이

초음파실 통계상황 12/8~12/1412/15~12/21 OB7973 GY Target85 Amnio12 Doppler04 BPP00 Aspiration00

CASE I 윤 0 자 (44/F) C.C: Vaginal bleeding P.I : 상기 환자 일 ( 목요일 ) 부터 중형 pad 4 장 /day 정도의 질출혈있어 입 원함

OBHx: P (NFSD x2) Mens Hx Irregular(2~4Mon)-14 일 - Scanty-pain(-) 18 년전 – T/L PHx :DM/HTN/Pul.Tbc/Asthma (-/-/-/-) FHx : none Weight loss : none

Lab : CBC (12.11) 12.6/ / (12.13) 11.6/ / CA SCC(TA-4) 0.2

Sono finding I TVS Uterus AVF 10.7x7.8 x6.6 cm

Sono finding II TVS Tansverse view

Sono finding III TVS Endo- metrium 0.4 cm

Sono finding IV TVS Rt. ovary 2.1x1.3 cm

Sono finding V TVS Lt.ovary 6.5x3.6cm sized septated serouis 양 상의 cyst

Sono finding VI TVS 4.7x2.6 x4.4cm Sized low level echoic mass in endo- metrial cavity

Sono finding VII TVS Transverse view

Sono finding VIII TVS Color flow (+)  hematoma echo 양상 으로 보이 지만 color flow 가 관 찰되는 것 으로 myoma 로 생각됨

Sono finding IX Imp> R/O Uterine myoma (submucosal type) R/O Lt. ovarian serous cyst

A-P CT finding I Pre-enhance view About 6.7cm sized bilobular contoured septated cystic lesion in lt. Adnexal area

A-P CT finding II Pre- enhance view

A-P CT finding III Post- enhance view Fluid filled uterus, but uncertain endo- metrial mass

A-P CT finding IV

A-P CT finding V Imp> R/O Endocervical canal obstruction R/O Lt. ovarian cystic neoplasm

Post OP. specimen

OP date : OP name:TAH, BSO &BPLND Bx: Endometrial Ca.(by frozen Bx)

CASE II 최 0 지 (8/F) C.C:Low abdominal pain P.I : 상기 환자 내원 4 일전 (12.11) 부터 Low abd pain 이 intermitent 하게 있어 local 에서 medication 하였으나 증상 호전없고 본원 ER 경 유, appendicitis R/O 한후 A-P CT 상 Ovary mass 소견보여 입원함

Hx: Delivery - 40 wk NFSD 3.2kg 모유수유 - 모유 + 우유 Scheduled vaccination (+) Mens Hx – Premenarche FHx : none

Lab : B-hcgCA 125CA 19-9a-FPLDH

Sono finding I TAS Uterus AVF 3.6 x 1.6 x 1.2 cm

Sono finding II TAS

Sono finding III TAS Endometriu m -not well visible

Sono finding IV TAS

Sono finding V TAS

Sono finding VI TAS Rt ovary 8.6x6.3x4.8c m 크기의 mass

Sono finding VII TAS Ovarian mass 내에 6.3x4.9 cm sized cystic region 과 hyper- echoic region 이 관찰됨

Sono finding VIII TAS RT ovary 의 cystic region 내 1.9 x1.0 cm echogenic mass Color flow (-)

Sono finding IX TAS Color flow (-)

Sono finding X TAS Color flow (-)

Sono finding XI TAS Uterus 뒤쪽으 로 PCDS 로 추정되며 4.3x2.7cm sized mixed echogenic mass 가 보 이며 hematoma 로 추정됨

Sono finding XII Imp> R/O Rt. Ovarian cystic teratoma (torsion?) R/O Rt. Ovarian cystic tumor

CT finding I 6.2x4.5cm sized well defined cystic mass with enhanced wall thickening, including fat and calcification in pevic cavity

CT finding II

CT finding III Imp> R/O Cystic teratoma R/O Torsion

Op date : OP name: LSO, Appendectomy Bx: Mature cystic teratoma within hemorrhagic infarction

Endometrium Normal thickness 1. proliferative phase -4~8 mm 2. periovulatory period – 6~10 mm 3. secretory phase – 7~14 mm Postmenopausal women < 8 mm Postmenopausal bleeding + ≥5 mm  further evaluation

Differentiation of benign from malignant conditions of the EM Malignant 1.thickend echogenic EM 2.enlarged 3.retroverted 4.lack a subendometrial halo 5.cysic change-24% 6.poorly defined on EM contour

Endometrial hyperplasia

Endometrial Cancer

Differentiation of benign from malignant conditions of the EM Neither TVS nor color Doppler imaging can distinguish benign lesions from malignant counterparts

Endometrial hyperplasia 1.Clinical importance- abnormal bleeding(ES stimulation in the absence of progestin influence) 2. Risk of EM hyperplasia progressing to carcinoma – presence and severity of cytologic atypia

Classification of endometrial hyperplasia Type of HyperplasiaProgression to Cancer (%) Simple(cystic without atypia) 1 Complex(adenomatous without atypia) 3 Atypical simple(cystic with atypia) complex(adenomatous with atypia) 8 29

Endometrial hyperplasia reversing EM hyperplasia without atypia – very effective EM hyperplasia with atypia – less effective

Endometrial Cancer Sx- vaginal bleeding or discharge(90%) asymptomatic (<5%) Dx- EM aspiration Bx Surgical staging – extrafascial hysterectomy,BSO,high common iliac and paraaortic LN dissection,pelvic LN Bx

Endometrial Cancer Tx 1. Surgery – TAH, BSO 2. Radiation therapy Postoperative adjuvant therapy