Malignant diseases of the uterus

1. Malignant diseases of the uterus Malignancy of the uterus other than endometrium are rare and include sarcomas & more rarely lymphomas . Sarcoma arising from mesodermal tissue of the uterus or from underlying malignant degeneration of the myoma , the incidence are rare it is of about 1% or less. Endometerial carcinoma Is the most common occurring gynecological cancer in the united state.

2. Endometrial Carcinoma Incidence is among the most common female pelvic malignancies the tumor confined to the uterine corpus in 75% Presentation : uterine bleeding . Discharge Pain during micturation & intercourse . Late stage pelvic pain & weight loss.

3. E. Risk Factors • obesity -- • type 2 diabetes - • early menstruation & late menopause . • nulliparity or a history of infertility . • polycystic ovaries. • patients with estrogen producing tumors of the ovaries such as granulosa cell tumors . • Estrogen –only replacement therapy (ERT). 8) Family history – possible genetic link • Hereditary nonpolyposis colorectal cancer (HNPCC). Inherited disease caused by an abnormality in a gene important for DNA repair. 9) Personal history of breast cancer or ovarian cancer . 10) Tamoxifin 11) Stress

4. Endometrial carcinoma Diagnosis Ultrasound findings . Color flow imaging ( altered vascularity with low PI index ) . CT & MRI ( cervical extension ) Additional test CA - 125 blood test Cystoscopy & proctoscopy . Chest X-Ray , IVU

5. Endometrial Carcinoma

7. Cervical carcinoma

8. CT Endometrial Carcinoma

9. MRI Endometrial Carcinoma

10. C. Prevalence & Incidence • Although this cancer is 40% more common in white women, black women are nearly twice as likely to die from it.

11. The ovaries Shape of the ovaries are ellipsoid, Almond in shape . Ovarian location : Ovarian volume : The adult ovary volume measures ( 9,8 +_ 5,8 ml ) Postmenopausal volume ( 6,8 ml ) Dominant follicle . Mature follicle .Approximately 24 hours before ovulation, the granuloza layer separates from the theca layer, resulting in hypoechoic ring . Corpus hemorrhagicum Corpus luteum . If pregnancy does not occore the corpus luteum gradually decline and atrophied to corpus albicance which not be identified sonographically .

13. Normal ovary

14. Polycystic ovaries Definition : - complex endocrinologic disorder associated with chronic anovulation. Clinically : Ultrasonographic Appearance : Adams et al & Fox et al .

15. What are the symptoms of polycystic ovarian syndrome (PCOS)? menstrual disturbances elevated levels of male hormones (androgen). Other signs and symptoms of PCOS include: obesity and weight gain, elevated insulin levels and insulin resistance oily skin, dandruff, infertility, skin discolorations, high cholesterol levels, elevated blood pressure, and multiple, small cysts in the ovaries. Any of the above symptoms and signs may be absent in PCOS, with the exception .

16. What causes polycystic ovarian syndrome (PCOS)? No one is quite sure what causes PCOS. 1- Both genetic (inherited) as well as environmental factors. 2-A malfunction of the body's blood sugar control system (insulin system) . 3- Women with PCOS produce excess amounts of male hormones known as androgens. 4- Excessive production of the hormone LH 5- A low level of chronic inflammation in the body and fetal exposure to male hormones

17. Polycystic ovary

19. Sonographic appearance of ovarian mass Any mass in the ovary or adnexa may be solid or cyst. Solid mass in the adnexa may be 1- Pedunculated fibroid ( myoma ) . 2- ovarian solid mass ,ovarian fibromas, adenofibroma, thecoma, burner tumors . Cystic mass may be benign ( non neoplasm) or neoplasm . Sign of benign cystic mass . Sign of neoplasm .

20. Ovarian masses Ovarian Cysts ( non neoplastic ) Functional cysts : most result from abnormalities in the release of anterior pitutarygonadotropins . 1- Physiological Ovarian Cysts . 2- Follicular Cysts, are extremely common . < 5 cm. 3- Corpus lutea cyst ( 2,5-3 cm ) it cause abnormal menestrual cycle . 4- Theca leutien cyst ( due to ovarian hyperstimulation ) . May be seen . 5- Serous inclusion cyst .( tiny to multiple cm ) , this not cause post manopausal bleeding because it is functionless cyst . US findings .

22. Ovarian cyst ( CT scan )

23. MRI ovarian cyst

24. Lu cyst

25. endometrial cyst ( endometrioma ) it is nonneoplastic cyst . • The ovary is involved in 80% of all cases of endometriosis. These masses may be large (15-20cm) and are filled with old blood . • US • Hemorrhagic cysts . • US

26. Hemorrhagic cyst sonograms show complex intraovarian cyst (C) surrounded by rim of healthy ovarian tissue. Cyst contains retracting clot. Calipers indicate boundary of ovaries.

27. Hemorrhagic cyst color US

28. Ruptured hemorrhagic cyst

29. Chocilate cyst

30. Dermoid cyst ( teratomas ) Is a germ cell tumor of the ovary . Contained of the cyst : 1-Sonography Cystic teratomas are probably the most common ovarian neoplasm in patients younger than the age of 50 years. Cyst , hypoechic , plugs of nodule . 2- CT scan 3- Plain X-ray . It is better to be removed .

32. Dermoid cyst ( plain X-ray

33. Ultrasound Dermoid cyst

34. CT Dermoid cyst

35. Female genital tract • Ovarian tumours • The commonest is cystadenoma & cystadenocarcinima. • Ultrasonography • Diagnosis by US, CT & MRI • US, CT& MRI may show • Hydronephrosis from ureteric obstruction . • Enlarges lymph nodes . • Liver metastasis . • Ascitis. • Omental & peritoneal metastases are difficult to be visible because of there small size . • Treatment is surgical removal but staging should be carried out befor surg. • The main role of post operative imaging is for follow up

36. Hemorrhage within the cyst may make the sonographic appearance confusing , hemorrhage is excellent evidence that the mass is benign. • Often called the “silent cancer” • Tumor size in post menopausal is important the larger the size of the lesion, the higher the likelihood of malignancy. Large size also indicate that the mass has persistent for some time . • It is important to realize that the ovary is relatively common site for metastasis . The primary is from colon, stomach & breast.

37. II. Ovarian Cancer • For most pre-menopausal women, a growth on the ovary is benign (90%) – for post-menopausal women there is a 70% chance of it being benign • Tumor growth that begins in the egg-producing cells (germ cell tumors) – • Tumor growth that begins on the surface of the ovary (epithelial cell tumors)

38. A. Risk Factors • Continuous egg production (never pregnant, never used birth control, or first birth after age 30) • Early menstruation & late menopause . • Obesity • Diet • Fertility drugs • Estrogen replacement therapy . • Genetics. • <10% of women found to have ovarian cancer have inherited the disease • BRCA1 and BRCA2 are implicated in ovarian cancer too • Family history breast cancer

39. CT. Detection

40. Rudimentary uterus

43. Conganital anomalies of the uterus

44. 3D ultrasound image of didelphys uterus

45. IUCD

46. 3 D US

49. Hysterosalpingography ( HSG ) Contrast study of uterus , fallopian tubes . Indications 1- Infertility .2- recurrent abortion .3- monitor the effect of tubal surgery , 4- after ectopic pregnancy . Contraindication 1- acute pelvic infection . 2- sever renal or cardiac disease . 3- sensitivity to contrast . 4- recent dilatation or curettage . 5- pregnancy . Week prior & week following menstrual cycle .

50. HSG • Complications : • 1- pain . • 2- Intravasation . • 3- exacerbation of infection . • Normal HSG . • Congenital anomalies : • 1- uterus didelphys . • 2- uterus bicornisbicollis . • 3- uterus bicornuateunicollis . • 4- septate uterus , ( arcuate uterus ) , subseptet& complete septation .. • 5- infantile uterus . • 6- Unicornisunicollis uterus . • Fibroid can be detected by HSG . • Abnormalities in the fallopian tubes 1- hydrosalpinx 2- TB.