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What Does This Ultrasound Report Indicate?

Posted on Fri, 8 Jul 2016

Question: I have bulky A.V. Uterus, also thick endometrium =1.8 cm thickness
ultrasonic test say feature of endometrial hyperplasia
Right lateral wall lower segment submucus uterine fibroid (4.4x3.8) cm size with distorted adjacent endometrium
Do these symptoms lead to cancer? And what is the right treatment?

Answered by Dr. Sameer Kumar (1 hour later)

Brief Answer:
possible endometrial cancer...get an endometrial biopsy

Detailed Answer:
Hello,
Thanks for the query to HCM,
The next best step in a case of thickened endometrium ( normal = less than 3 mm in menopausal women) is to find out if its endometrial hyperplasia with or without atypia ( abnormal cells/ cancer cells). The principal feature of endometrial hyperplasia is irregular endometrial shedding in form of bleeding. The bleeding can be due to sub mucous fibroid itself which is also quite large and may be associated with bleeding and pain as well. The bleeding may be heavy as well. The next step would definitely be an endometrial biopsy for histopathology to establish the diagnosis and rule out any endometrial cancer.
oPTION OF TREATMENT:-
1. SIMPLE ENDOMETRIAL HYPERPLASIA without atypia= cyclical progesterones in menstruating women and hysterectomy for menopausal.
2. Simple endometrial hyperplasia with atypia= course of cyclical progesterones 6 months and review for non-menopausal and hysterectomy for menopausal.
3. Complex endometrial hyperplasia without atypia = hysterectomy for both cases.
4. Complex endometrial hyperplasia with atypia= hysterectomy for non menopausal and total abdominal hysterectomy + bilateral slapping-oophorectomy + pelvic lymph node dissection ( if uterine cancer cells are detected as well).
5 endometrial cancer detected= SURGICAL STAGING OF DISEASE + followed by chemoradiotherapy depending on the stage of cancer.

So any how , endometrial biopsy is a must in your case now.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (40 minutes later)

Thanks Doctor for your prompt reply and I can see that hysterectomy is the most possible solution either the way in my case since I am in menopausal stage,so my next question is it safe to do hysterectomy and if there is any common health related complications after surgery for woman in my age (58)? Although I dont have any history of high blood pressure or diabetes but my blood HB is low please see attached test.
Regards

Answered by Dr. Sameer Kumar (5 minutes later)

Brief Answer:
answered

Detailed Answer:
Hello,
The prognosis would be dependent on the endometrial biopsy report as to the extent of surgery that it would involve but if no cancer cells found then still you should undergo TH+BSO for your age and with no co-morbidities, it should work out fine. If no cancer cells then you may even opt for a laparoscopic approach which shall reduce your hospital stay time considerably say 24 hrs only.
Haemoglobin on an average is slightly low for women standards and that needs to be built up.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (2 days later)

Hello again Doctor, My doctor performed D&C Endometrial biopsy but couldn't take sample due to Cervix obstruction , what do you advise as a next step

Answered by Dr. Sameer Kumar (26 minutes later)

Brief Answer:
answered

Detailed Answer:
Hello,
In this case the endometrial biopsy should be taken under a general anaethesia where cervical dilatation has to be performed as endometrial sampling is an important step in diagnosis further.
Regards

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Above answer was peer-reviewed by : Dr. Nagamani Ng