DOI: 10.1148/rg.231025048
Transvaginal US and Hysterosonography in Postmenopausal Women with Breast Cancer Receiving Tamoxifen: Correlation with Hysteroscopy and Pathologic Study1
Katherine Fong, MB, BS, FRCPC,
Petrina Causer, MD, FRCPC,
Mostafa Atri, MD, FRCPC,
Alice Lytwyn, MD, MSc, FRCPC and
Rose Kung, MD, MSc, FRCSC
1 From the Departments of Medical Imaging (K.F., P.C., M.A.), Pathology (A.L.), and Obstetrics and Gynecology (R.K.), Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Ontario, Canada. Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. K.F. supported in part by an RSNA Research and Education Foundation Seed Grant. Received March 5, 2002; revision requested April 29 and received June 6; accepted June 10. Address correspondence to K.F., Department of Medical Imaging, Toronto General Hospital, 200 Elizabeth St, Eaton South 1-401C, Toronto, Ontario, Canada M5G 2C4 (e-mail: katherine.fong@uhn.on.ca).
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Figure 1a. Atrophic endometrium in a 58-year-old asymptomatic woman who had undergone tamoxifen therapy for 10 months. (a) Sagittal transvaginal US image shows a thin endometrium (calipers). (b) Sagittal hysterosonogram shows fluid (*) in the endometrial cavity, with thin anterior (solid arrows) and posterior walls. A catheter (open arrow) is in the lower portion of the uterus. Hysteroscopic and histopathologic findings confirmed atrophic endometrium.
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Figure 1b. Atrophic endometrium in a 58-year-old asymptomatic woman who had undergone tamoxifen therapy for 10 months. (a) Sagittal transvaginal US image shows a thin endometrium (calipers). (b) Sagittal hysterosonogram shows fluid (*) in the endometrial cavity, with thin anterior (solid arrows) and posterior walls. A catheter (open arrow) is in the lower portion of the uterus. Hysteroscopic and histopathologic findings confirmed atrophic endometrium.
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Figure 2. Fluid in the endometrial cavity due to cervical stenosis in a 59-year-old asymptomatic woman who had undergone tamoxifen therapy for 7 months. Sagittal transvaginal US image shows fluid (*) in the endometrial cavity, with thin anterior (arrows) and posterior walls. Hysteroscopic and histopathologic findings confirmed atrophic endometrium.
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Figure 3a. Benign endometrial cystic polyp in a 70-year-old asymptomatic woman who had undergone tamoxifen therapy for 25 months. (a) Sagittal transvaginal US image shows a thickened central endometrial complex (calipers) with cystic spaces. The presence of a hyperechoic line (arrows) partially surrounding the central endometrial complex favors the diagnosis of a polyp. (b) Sagittal hysterosonogram shows fluid outlining a smooth intracavitary mass (calipers). (c) Photograph obtained at hysteroscopy shows a benign polyp (arrows) that was confirmed at histopathologic study. (Fig 3a and 3b reprinted, with permission, from reference 6.)
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Figure 3b. Benign endometrial cystic polyp in a 70-year-old asymptomatic woman who had undergone tamoxifen therapy for 25 months. (a) Sagittal transvaginal US image shows a thickened central endometrial complex (calipers) with cystic spaces. The presence of a hyperechoic line (arrows) partially surrounding the central endometrial complex favors the diagnosis of a polyp. (b) Sagittal hysterosonogram shows fluid outlining a smooth intracavitary mass (calipers). (c) Photograph obtained at hysteroscopy shows a benign polyp (arrows) that was confirmed at histopathologic study. (Fig 3a and 3b reprinted, with permission, from reference 6.)
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Figure 3c. Benign endometrial cystic polyp in a 70-year-old asymptomatic woman who had undergone tamoxifen therapy for 25 months. (a) Sagittal transvaginal US image shows a thickened central endometrial complex (calipers) with cystic spaces. The presence of a hyperechoic line (arrows) partially surrounding the central endometrial complex favors the diagnosis of a polyp. (b) Sagittal hysterosonogram shows fluid outlining a smooth intracavitary mass (calipers). (c) Photograph obtained at hysteroscopy shows a benign polyp (arrows) that was confirmed at histopathologic study. (Fig 3a and 3b reprinted, with permission, from reference 6.)
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Figure 4a. Benign endometrial polyp with the hyperechoic line sign in a 49-year-old asymptomatic woman who underwent tamoxifen therapy for 12 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show an intraluminal mass (calipers) surrounded by a thin, echogenic endometrium (straight arrows). Several small cysts (curved arrow in b) are seen within the mass. F = fibroid. (c) Transverse transvaginal color Doppler US image shows a single feeding artery in the pedicle of the polyp (arrow). F = fibroid. (d) Sagittal hysterosonogram shows an intracavitary mass (calipers) completely surrounded by fluid. A balloon catheter (arrow) is in the cervix. (e) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows features typical of a benign polyp: fibrotic stroma, irregular endometrial glands, and thick-walled blood vessels.
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Figure 4b. Benign endometrial polyp with the hyperechoic line sign in a 49-year-old asymptomatic woman who underwent tamoxifen therapy for 12 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show an intraluminal mass (calipers) surrounded by a thin, echogenic endometrium (straight arrows). Several small cysts (curved arrow in b) are seen within the mass. F = fibroid. (c) Transverse transvaginal color Doppler US image shows a single feeding artery in the pedicle of the polyp (arrow). F = fibroid. (d) Sagittal hysterosonogram shows an intracavitary mass (calipers) completely surrounded by fluid. A balloon catheter (arrow) is in the cervix. (e) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows features typical of a benign polyp: fibrotic stroma, irregular endometrial glands, and thick-walled blood vessels.
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Figure 4c. Benign endometrial polyp with the hyperechoic line sign in a 49-year-old asymptomatic woman who underwent tamoxifen therapy for 12 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show an intraluminal mass (calipers) surrounded by a thin, echogenic endometrium (straight arrows). Several small cysts (curved arrow in b) are seen within the mass. F = fibroid. (c) Transverse transvaginal color Doppler US image shows a single feeding artery in the pedicle of the polyp (arrow). F = fibroid. (d) Sagittal hysterosonogram shows an intracavitary mass (calipers) completely surrounded by fluid. A balloon catheter (arrow) is in the cervix. (e) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows features typical of a benign polyp: fibrotic stroma, irregular endometrial glands, and thick-walled blood vessels.
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Figure 4d. Benign endometrial polyp with the hyperechoic line sign in a 49-year-old asymptomatic woman who underwent tamoxifen therapy for 12 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show an intraluminal mass (calipers) surrounded by a thin, echogenic endometrium (straight arrows). Several small cysts (curved arrow in b) are seen within the mass. F = fibroid. (c) Transverse transvaginal color Doppler US image shows a single feeding artery in the pedicle of the polyp (arrow). F = fibroid. (d) Sagittal hysterosonogram shows an intracavitary mass (calipers) completely surrounded by fluid. A balloon catheter (arrow) is in the cervix. (e) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows features typical of a benign polyp: fibrotic stroma, irregular endometrial glands, and thick-walled blood vessels.
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Figure 4e. Benign endometrial polyp with the hyperechoic line sign in a 49-year-old asymptomatic woman who underwent tamoxifen therapy for 12 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show an intraluminal mass (calipers) surrounded by a thin, echogenic endometrium (straight arrows). Several small cysts (curved arrow in b) are seen within the mass. F = fibroid. (c) Transverse transvaginal color Doppler US image shows a single feeding artery in the pedicle of the polyp (arrow). F = fibroid. (d) Sagittal hysterosonogram shows an intracavitary mass (calipers) completely surrounded by fluid. A balloon catheter (arrow) is in the cervix. (e) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows features typical of a benign polyp: fibrotic stroma, irregular endometrial glands, and thick-walled blood vessels.
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Figure 5a. Benign endometrial broad-based polyp in a 59-year-old woman who had undergone tamoxifen therapy for 3 years and presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows a 9-mm-thick endometrium (calipers) with small cysts. Cystic changes in the myometrium (arrows) are suggestive of adenomyosis. (b) Sagittal hysterosonogram shows fluid outlining a broad-based intracavitary mass (calipers), which extends from the fundus to the lower portion of the uterus. Hysteroscopic and histopathologic findings confirmed a benign polyp.
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Figure 5b. Benign endometrial broad-based polyp in a 59-year-old woman who had undergone tamoxifen therapy for 3 years and presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows a 9-mm-thick endometrium (calipers) with small cysts. Cystic changes in the myometrium (arrows) are suggestive of adenomyosis. (b) Sagittal hysterosonogram shows fluid outlining a broad-based intracavitary mass (calipers), which extends from the fundus to the lower portion of the uterus. Hysteroscopic and histopathologic findings confirmed a benign polyp.
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Figure 6a. Benign endometrial polyp that appears homogeneous and echogenic in a 63-year-old asymptomatic woman who had undergone tamoxifen therapy for 9 months. (a) Sagittal transvaginal US image shows an endometrial thickness of 8 mm (calipers). F = fibroid. (b) Sagittal hysterosonogram shows fluid outlining an echogenic intracavitary mass (calipers). A balloon catheter (arrow) is in the cervix. Hysteroscopic and histopathologic findings revealed a benign polyp.
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Figure 6b. Benign endometrial polyp that appears homogeneous and echogenic in a 63-year-old asymptomatic woman who had undergone tamoxifen therapy for 9 months. (a) Sagittal transvaginal US image shows an endometrial thickness of 8 mm (calipers). F = fibroid. (b) Sagittal hysterosonogram shows fluid outlining an echogenic intracavitary mass (calipers). A balloon catheter (arrow) is in the cervix. Hysteroscopic and histopathologic findings revealed a benign polyp.
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Figure 7a. Submucosal leiomyoma in a 71-year-old asymptomatic woman who had undergone tamoxifen therapy for 5 years. (a) Sagittal transvaginal US image shows an enlarged uterus with fibroids (F). A 2-cm echogenic fibroid (calipers) displaces the endometrial echo posteriorly (arrowheads). (b) Sagittal hysterosonogram shows thin endometrium (arrowheads) overlying the fibroid (F), which arises from the myometrium with a wide attachment (arrows).
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Figure 7b. Submucosal leiomyoma in a 71-year-old asymptomatic woman who had undergone tamoxifen therapy for 5 years. (a) Sagittal transvaginal US image shows an enlarged uterus with fibroids (F). A 2-cm echogenic fibroid (calipers) displaces the endometrial echo posteriorly (arrowheads). (b) Sagittal hysterosonogram shows thin endometrium (arrowheads) overlying the fibroid (F), which arises from the myometrium with a wide attachment (arrows).
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Figure 8a. Endometrial hyperplasia in a 55-year-old asymptomatic woman who underwent tamoxifen therapy for 5 years. (a) Sagittal transvaginal US image shows a thick endometrium (calipers) with cystic areas. (b) Sagittal hysterosonogram shows circumferentially thickened endometrium (solid arrows) that contains cystic areas. A catheter (open arrow) is in the cervix. (c) Light photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows endometrial hyperplasia with atypia. Architecturally complex, closely packed endometrial glands are lined by cells that exhibit cytologic atypia. (Fig 8a and 8b reprinted, with permission, from reference 25.)
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Figure 8b. Endometrial hyperplasia in a 55-year-old asymptomatic woman who underwent tamoxifen therapy for 5 years. (a) Sagittal transvaginal US image shows a thick endometrium (calipers) with cystic areas. (b) Sagittal hysterosonogram shows circumferentially thickened endometrium (solid arrows) that contains cystic areas. A catheter (open arrow) is in the cervix. (c) Light photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows endometrial hyperplasia with atypia. Architecturally complex, closely packed endometrial glands are lined by cells that exhibit cytologic atypia. (Fig 8a and 8b reprinted, with permission, from reference 25.)
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Figure 8c. Endometrial hyperplasia in a 55-year-old asymptomatic woman who underwent tamoxifen therapy for 5 years. (a) Sagittal transvaginal US image shows a thick endometrium (calipers) with cystic areas. (b) Sagittal hysterosonogram shows circumferentially thickened endometrium (solid arrows) that contains cystic areas. A catheter (open arrow) is in the cervix. (c) Light photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows endometrial hyperplasia with atypia. Architecturally complex, closely packed endometrial glands are lined by cells that exhibit cytologic atypia. (Fig 8a and 8b reprinted, with permission, from reference 25.)
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Figure 9a. Endometrial carcinoma in a 68-year-old woman who had undergone tamoxifen therapy for 5 years and presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows the uterus in a military position and hence suboptimal for measurement of endometrial thickness. There is well-defined thickening of the endometrium (calipers). (b) Sagittal T2-weighted MR image shows the thick, well-defined heterogeneous endometrium (calipers). No evidence of extension of the carcinoma beyond the endometrium is apparent. (c) Light photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows endometrial carcinoma. Confluent, fused endometrial glands exhibit cribriform architecture and nuclear atypia. (Fig 9a and 9b courtesy of Carolyn Reinhold, MD, Department of Radiology, McGill University, Montreal, Canada.)
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Figure 9b. Endometrial carcinoma in a 68-year-old woman who had undergone tamoxifen therapy for 5 years and presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows the uterus in a military position and hence suboptimal for measurement of endometrial thickness. There is well-defined thickening of the endometrium (calipers). (b) Sagittal T2-weighted MR image shows the thick, well-defined heterogeneous endometrium (calipers). No evidence of extension of the carcinoma beyond the endometrium is apparent. (c) Light photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows endometrial carcinoma. Confluent, fused endometrial glands exhibit cribriform architecture and nuclear atypia. (Fig 9a and 9b courtesy of Carolyn Reinhold, MD, Department of Radiology, McGill University, Montreal, Canada.)
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Figure 9c. Endometrial carcinoma in a 68-year-old woman who had undergone tamoxifen therapy for 5 years and presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows the uterus in a military position and hence suboptimal for measurement of endometrial thickness. There is well-defined thickening of the endometrium (calipers). (b) Sagittal T2-weighted MR image shows the thick, well-defined heterogeneous endometrium (calipers). No evidence of extension of the carcinoma beyond the endometrium is apparent. (c) Light photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows endometrial carcinoma. Confluent, fused endometrial glands exhibit cribriform architecture and nuclear atypia. (Fig 9a and 9b courtesy of Carolyn Reinhold, MD, Department of Radiology, McGill University, Montreal, Canada.)
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Figure 10a. Coexisting endometrial polyp, endometrial hyperplasia, and endometrial carcinoma in a 74-year-old asymptomatic woman who had undergone tamoxifen therapy since March 1999. (a) Sagittal transvaginal US image obtained in June 1999 shows a small amount of intracavitary fluid (*), thin anterior and posterior walls (arrows), and 4-mm-thick endometrium (calipers) in the lower uterine segment. Pipelle endometrial biopsy showed atrophic endometrium. (b) Sagittal transvaginal US image obtained in April 2001 shows intracavitary fluid (*), 11-mm endometrial thickening in the lower uterine segment (calipers), thin anterior and posterior walls (straight arrows), and a polypoid mass more superiorly (curved arrow). F = fibroid. Pipelle endometrial biopsy showed endometrial hyperplasia with atypia. The patient underwent subsequent hysterectomy. Histopathologic findings showed a benign endometrial polyp, as well as microscopic foci of endometrial carcinoma in the polyp and adjacent endometrium.
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Figure 10b. Coexisting endometrial polyp, endometrial hyperplasia, and endometrial carcinoma in a 74-year-old asymptomatic woman who had undergone tamoxifen therapy since March 1999. (a) Sagittal transvaginal US image obtained in June 1999 shows a small amount of intracavitary fluid (*), thin anterior and posterior walls (arrows), and 4-mm-thick endometrium (calipers) in the lower uterine segment. Pipelle endometrial biopsy showed atrophic endometrium. (b) Sagittal transvaginal US image obtained in April 2001 shows intracavitary fluid (*), 11-mm endometrial thickening in the lower uterine segment (calipers), thin anterior and posterior walls (straight arrows), and a polypoid mass more superiorly (curved arrow). F = fibroid. Pipelle endometrial biopsy showed endometrial hyperplasia with atypia. The patient underwent subsequent hysterectomy. Histopathologic findings showed a benign endometrial polyp, as well as microscopic foci of endometrial carcinoma in the polyp and adjacent endometrium.
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Figure 11. Poorly visualized endometrial echo at transvaginal US owing to adenomyosis in a 66-year-old asymptomatic woman who had undergone tamoxifen therapy for 45 months. Sagittal transvaginal US image shows a poorly defined, irregular endometrial echo, such that endometrial thickness cannot be reliably measured. Subendometrial cysts (arrows) are suggestive of adenomyosis. Hysterosonographic assessment was unsuccessful because of cervical stenosis. MR imaging allowed confirmation of adenomyosis. Hysteroscopy and histopathologic study showed atrophic endometrium.
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Figure 12a. False-positive appearance of thickened endometrium at transvaginal US owing to adenomyosis in a 59-year-old asymptomatic woman who had undergone tamoxifen therapy for 37 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show a thick, poorly defined central endometrial complex (calipers) with cystic areas. (c, d) Sagittal (c) and transverse (d) hysterosonograms show thin endometrium (small solid arrows). Changes due to adenomyosis, including small cysts (large solid arrows) in the inner myometrium, account for the apparent endometrial thickening at transvaginal US. A balloon catheter (open arrow in c) is in the lower portion of the uterus. Endometrial biopsy revealed atrophic endometrium.
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Figure 12b. False-positive appearance of thickened endometrium at transvaginal US owing to adenomyosis in a 59-year-old asymptomatic woman who had undergone tamoxifen therapy for 37 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show a thick, poorly defined central endometrial complex (calipers) with cystic areas. (c, d) Sagittal (c) and transverse (d) hysterosonograms show thin endometrium (small solid arrows). Changes due to adenomyosis, including small cysts (large solid arrows) in the inner myometrium, account for the apparent endometrial thickening at transvaginal US. A balloon catheter (open arrow in c) is in the lower portion of the uterus. Endometrial biopsy revealed atrophic endometrium.
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Figure 12c. False-positive appearance of thickened endometrium at transvaginal US owing to adenomyosis in a 59-year-old asymptomatic woman who had undergone tamoxifen therapy for 37 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show a thick, poorly defined central endometrial complex (calipers) with cystic areas. (c, d) Sagittal (c) and transverse (d) hysterosonograms show thin endometrium (small solid arrows). Changes due to adenomyosis, including small cysts (large solid arrows) in the inner myometrium, account for the apparent endometrial thickening at transvaginal US. A balloon catheter (open arrow in c) is in the lower portion of the uterus. Endometrial biopsy revealed atrophic endometrium.
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Figure 12d. False-positive appearance of thickened endometrium at transvaginal US owing to adenomyosis in a 59-year-old asymptomatic woman who had undergone tamoxifen therapy for 37 months. (a, b) Sagittal (a) and transverse (b) transvaginal US images show a thick, poorly defined central endometrial complex (calipers) with cystic areas. (c, d) Sagittal (c) and transverse (d) hysterosonograms show thin endometrium (small solid arrows). Changes due to adenomyosis, including small cysts (large solid arrows) in the inner myometrium, account for the apparent endometrial thickening at transvaginal US. A balloon catheter (open arrow in c) is in the lower portion of the uterus. Endometrial biopsy revealed atrophic endometrium.
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Figure 13a. False-positive appearance of thickened endometrium at transvaginal US owing to adenomyosis in a 69-year-old woman undergoing tamoxifen therapy who presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows a thick, poorly defined endometrium (calipers), with cystic changes (arrows) in the myometrium. (b) Sagittal T2-weighted MR image shows a thick junctional zone (between the calipers) and hyperintense cystic changes (arrows) in the ventral myometrium. The thin endometrium (arrowheads) indicates that most of the thickening at transvaginal US is caused by the underlying adenomyosis. Endometrial biopsy showed atrophic endometrium. (c) Light photomicrograph (original magnification, x50; hematoxylin-eosin stain) shows an endometrial gland with surrounding endometrial stroma (arrows) within uterine myometrium. (Fig 13a and 13b courtesy of Carolyn Reinhold, MD, Department of Radiology, McGill University, Montreal, Canada.)
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Figure 13b. False-positive appearance of thickened endometrium at transvaginal US owing to adenomyosis in a 69-year-old woman undergoing tamoxifen therapy who presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows a thick, poorly defined endometrium (calipers), with cystic changes (arrows) in the myometrium. (b) Sagittal T2-weighted MR image shows a thick junctional zone (between the calipers) and hyperintense cystic changes (arrows) in the ventral myometrium. The thin endometrium (arrowheads) indicates that most of the thickening at transvaginal US is caused by the underlying adenomyosis. Endometrial biopsy showed atrophic endometrium. (c) Light photomicrograph (original magnification, x50; hematoxylin-eosin stain) shows an endometrial gland with surrounding endometrial stroma (arrows) within uterine myometrium. (Fig 13a and 13b courtesy of Carolyn Reinhold, MD, Department of Radiology, McGill University, Montreal, Canada.)
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Figure 13c. False-positive appearance of thickened endometrium at transvaginal US owing to adenomyosis in a 69-year-old woman undergoing tamoxifen therapy who presented with postmenopausal bleeding. (a) Sagittal transvaginal US image shows a thick, poorly defined endometrium (calipers), with cystic changes (arrows) in the myometrium. (b) Sagittal T2-weighted MR image shows a thick junctional zone (between the calipers) and hyperintense cystic changes (arrows) in the ventral myometrium. The thin endometrium (arrowheads) indicates that most of the thickening at transvaginal US is caused by the underlying adenomyosis. Endometrial biopsy showed atrophic endometrium. (c) Light photomicrograph (original magnification, x50; hematoxylin-eosin stain) shows an endometrial gland with surrounding endometrial stroma (arrows) within uterine myometrium. (Fig 13a and 13b courtesy of Carolyn Reinhold, MD, Department of Radiology, McGill University, Montreal, Canada.)
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Figure 14a. Endometrial cystic atrophy in a 69-year-old asymptomatic woman who had undergone tamoxifen therapy for 36 months. (a) Sagittal transvaginal US image shows a 7-mm-thick endometrial echo (calipers) with a few cysts (arrows). (b) Sagittal hysterosonogram shows a slightly irregular posterior wall due to endometrial cysts (solid straight arrows). Myometrial cysts (curved arrow) are suggestive of adenomyosis. A catheter (open arrow) is in the cervix. (c) Photograph obtained at hysteroscopy shows scattered, almost transparent protuberances (arrows), which typically disappear upon directed biopsy. (d) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows cystic dilated endometrial glands (*) below the surface (arrows). They are lined with a single layer of inactive, low cuboidal epithelial cells.
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Figure 14b. Endometrial cystic atrophy in a 69-year-old asymptomatic woman who had undergone tamoxifen therapy for 36 months. (a) Sagittal transvaginal US image shows a 7-mm-thick endometrial echo (calipers) with a few cysts (arrows). (b) Sagittal hysterosonogram shows a slightly irregular posterior wall due to endometrial cysts (solid straight arrows). Myometrial cysts (curved arrow) are suggestive of adenomyosis. A catheter (open arrow) is in the cervix. (c) Photograph obtained at hysteroscopy shows scattered, almost transparent protuberances (arrows), which typically disappear upon directed biopsy. (d) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows cystic dilated endometrial glands (*) below the surface (arrows). They are lined with a single layer of inactive, low cuboidal epithelial cells.
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Figure 14c. Endometrial cystic atrophy in a 69-year-old asymptomatic woman who had undergone tamoxifen therapy for 36 months. (a) Sagittal transvaginal US image shows a 7-mm-thick endometrial echo (calipers) with a few cysts (arrows). (b) Sagittal hysterosonogram shows a slightly irregular posterior wall due to endometrial cysts (solid straight arrows). Myometrial cysts (curved arrow) are suggestive of adenomyosis. A catheter (open arrow) is in the cervix. (c) Photograph obtained at hysteroscopy shows scattered, almost transparent protuberances (arrows), which typically disappear upon directed biopsy. (d) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows cystic dilated endometrial glands (*) below the surface (arrows). They are lined with a single layer of inactive, low cuboidal epithelial cells.
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Figure 14d. Endometrial cystic atrophy in a 69-year-old asymptomatic woman who had undergone tamoxifen therapy for 36 months. (a) Sagittal transvaginal US image shows a 7-mm-thick endometrial echo (calipers) with a few cysts (arrows). (b) Sagittal hysterosonogram shows a slightly irregular posterior wall due to endometrial cysts (solid straight arrows). Myometrial cysts (curved arrow) are suggestive of adenomyosis. A catheter (open arrow) is in the cervix. (c) Photograph obtained at hysteroscopy shows scattered, almost transparent protuberances (arrows), which typically disappear upon directed biopsy. (d) Light photomicrograph (original magnification, x25; hematoxylin-eosin stain) shows cystic dilated endometrial glands (*) below the surface (arrows). They are lined with a single layer of inactive, low cuboidal epithelial cells.
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Figure 15a. False-positive appearance of thickened endometrium at transvaginal US due to diffuse endometrial cystic atrophy in an 82-year-old asymptomatic woman who had undergone tamoxifen therapy for 27 months. (a) Sagittal transvaginal US image shows a thick endometrial echo (calipers) with cysts. (b) Sagittal hysterosonogram shows thickened anterior and posterior walls (calipers) due to endometrial cysts. Hysteroscopic diagnosis was endometrial cystic atrophy; findings from endometrial biopsy were consistent with atrophic endometrium.
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Figure 15b. False-positive appearance of thickened endometrium at transvaginal US due to diffuse endometrial cystic atrophy in an 82-year-old asymptomatic woman who had undergone tamoxifen therapy for 27 months. (a) Sagittal transvaginal US image shows a thick endometrial echo (calipers) with cysts. (b) Sagittal hysterosonogram shows thickened anterior and posterior walls (calipers) due to endometrial cysts. Hysteroscopic diagnosis was endometrial cystic atrophy; findings from endometrial biopsy were consistent with atrophic endometrium.
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Figure 16a. False-positive appearance of focal endometrial thickening at hysterosonography due to endometrial cystic atrophy in a 71-year-old asymptomatic woman who had undergone tamoxifen therapy for 21 months. (a) Sagittal transvaginal US image shows a thick heterogeneous endometrial echo (calipers) with small cystic areas. F = fibroid. (b) Sagittal hysterosonogram shows fluid (*) in the endometrial cavity, which has a lobulated outline with scattered protuberances (arrows) that are indistinguishable from focal areas of endometrial thickening. Hysteroscopic diagnosis was endometrial cystic atrophy; findings from endometrial biopsy were consistent with atrophic endometrium. F = fibroid. (Reprinted, with permission, from reference 6.)
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Figure 16b. False-positive appearance of focal endometrial thickening at hysterosonography due to endometrial cystic atrophy in a 71-year-old asymptomatic woman who had undergone tamoxifen therapy for 21 months. (a) Sagittal transvaginal US image shows a thick heterogeneous endometrial echo (calipers) with small cystic areas. F = fibroid. (b) Sagittal hysterosonogram shows fluid (*) in the endometrial cavity, which has a lobulated outline with scattered protuberances (arrows) that are indistinguishable from focal areas of endometrial thickening. Hysteroscopic diagnosis was endometrial cystic atrophy; findings from endometrial biopsy were consistent with atrophic endometrium. F = fibroid. (Reprinted, with permission, from reference 6.)
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Copyright © 2003 by the Radiological Society of North America.
