EP15.20: Ultrasound evaluation of complex endometrial disorders: case report

Patient was a 37 year old Chinese female, follow up in our department for menorrhagia with symptomatic anemia. Medical history include (i) D+C for endometrial polyp 7 years ago; (ii)4 years ago simple hyperplasia noted on uterine curetting; (iii)a year earlier Nil hyperplasia on uterine curetting. Recent review, she was keen for conservative treatment with NorE. A month later she presented to Emergency Department with menorrhagia. Given IM progesterone and NorE. She had heavy withdrawal bleed despite 2 cycle of NorE. U/S evaluation (i) Enlarged uterus, endometrial outline appears vague. A heterogeneous ‘mass’ composing of echogenic and hypoechoic areas is demonstrated encompassing the endometrium. Its measurements are 6.9x6.4x6.3cm. Colour and power Doppler detected some intratumoral flow including large venous flow; (ii) Uterus: Adenomyotic, a 6.6x4.7x5.5cm ill-defined heterogeneous mass noted occupying the mid and upper corpus. Colour and power Doppler detected moderate intratumoural flow. In addition, a 2.9x0.5x1.4cm avascular echogenic area seen in upper and mid endometrial cavity, and appears inseparable from the above mentioned “mass”. MRI demonstrated the endometrial lining has a heterogeneous and nodular appearance without a discrete endometrium mass. The junctional zone is thickened and irregular with ill-defined margins, most likely representing adenomyosis. No adnexal mass seen. Underwent hysteroscopy, D+C. Operative findings: Uterus 12/52 bulky, Cavity length 10cm. Very poor visualisation of the cavity as was filled with large old blood clots and patient was menstruating. There appeared to be a degenerated fibropolyp arising from 5 o'clock of cavity. Bilateral ostia were seen after curettage done. Histopathological findings: Inactive endometrium with pseudodecidualised stroma, in keeping with progestogen effect. Fragments of submucosal smooth muscle, consistent with submucosal leiomyoma. There was no endometritis, endometrial hyperplasia or malignancy.