· Leiomyomas (fibroids)- Common benign smooth muscle tumors, found in 20% women >35 years. Classically appear as hypoechoic, homogeneous masses. They may distort the shape of the uterus. They may undergo extensive cystic degeneration. Calcification present, high level echoes with shadowing. Fat deposition may also cause high level echoes, and may simulate uterine malignancy. Subserosal fibroids may simulate adnexal or ovarian masses. More common in Afrocaribbeans.
· Endometrial carcinoma- Over 70% occur at >50 years, with peak incidence at age 62
Sonographic diagnosis remains difficult because early lesions may be confined to the corpus (stage I) or extend into the cervix (stage II and may not alter the uterine echo pattern. The presence of pronxnent endometrial echo complex >4 mm in a woman with postmenopausal bleeding and irregularity or loss of the normal endometrial/myometrial junction is suggestive of this diagnosis Endometrial carcinomas may obstruct the uterine cavity causing hydrometra, pyometra or hematometra. A fluid/debris level may be identified. Occasionally, spread to other organs in the pelvis may be identified on US.
· Endometrial polyp- May occur in all ages, but are more common at menopause. Sonography may reveal discrete mass(es) within the uterine cavity. enlargement of the uterus and prominent endometrial echo complex.
· Adenomyosis- Characteristically affect parous women after the age of 40. Invasion by nests of endometrial tissue causes uterine enlargement. The myometrial echo pattern, central echo complex and uterine contour may be normal. Occasionally, adenomyosis is focal, which may result in contour abnormality, although the central echo complex is normal. Rarely a honeycomb appearance caused by cystic spaces is encountered. Pelvic endometriosis and adenomyosis may coexist in 30% of patients.
· Ervical carcinoma- Sonographically there may be a solid retrovesical mass indistinguishable from a cervical leiomyoma. Clinical and magnetic resonance staging are more accurate than US.
· Uterine sarcoma- Rare tumors (3% of all uterinc tumors). All age groups are affected, but the majority is approximately 60 years. Leiomyosarcomas are believed to arise from preexisting leiomyomas. Uterine sarcomas may be indistinguishable from large leiomyomas. Commonly, large tumors present with areas of hemorrhage and/or necrosis, with bizarre areas of high intensity echoes; invasion into the other pelvic organs may be seen as an extrauterine mass. Metastases to the liver suggest leiomyosarcoma. A malignant mixed Mullerian tumor often presents as a bulky uterus with polypoid tumors filling the endometrial cavity and protruding from the cervical os.
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