Endometrial cancer differential diagnosis: Difference between revisions
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==Differentiating Endometrial Cancer From Other Diseases== | ==Differentiating Endometrial Cancer From Other Diseases== | ||
* In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as [[endometrial hyperplasia]], [[endometrial polyp]] and submucosal uterine [[leiomyoma]]. In advanced stages endometrial cancer must be differentiated from uterine [[sarcoma]] and uterine [[lymphoma]].<ref name="pmid22217630">{{cite journal| author=Hippisley-Cox J, Coupland C| title=Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm. | journal=BMJ | year= 2011 | volume= 344 | issue= | pages= d8009 | pmid=22217630 | doi=10.1136/bmj.d8009 | pmc=3251328 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22217630 }} </ref> | * In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as [[endometrial hyperplasia]], [[endometrial polyp]] and submucosal uterine [[leiomyoma]]. In advanced stages endometrial cancer must be differentiated from uterine [[sarcoma]] and uterine [[lymphoma]].<ref name="pmid22217630">{{cite journal| author=Hippisley-Cox J, Coupland C| title=Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm. | journal=BMJ | year= 2011 | volume= 344 | issue= | pages= d8009 | pmid=22217630 | doi=10.1136/bmj.d8009 | pmc=3251328 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22217630 }} </ref> | ||
[[Hematometra| | [[Hematometra|Hematometra]] | ||
{| | {| | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases | ||
! colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |''' | ! colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations''' | ||
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings | ||
! rowspan="4" | | ! rowspan="4" |'''Pap Smear''' | ||
! rowspan="4" | | ! rowspan="4" |Histopathology | ||
! colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |''' | ! colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | ||
|- | |- | ||
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |''' | ! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms''' | ||
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ||
|- | |- | ||
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings | ||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | ||
|- | |- | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Menorrhagia | ||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Intermenstrual bleeding | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic Pain/pressure/ | ||
discomfort | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other | ||
symptoms | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic examination | ||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal examination | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B-HCG | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CA-125 | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasound | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |''' | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Uterine cancer|Endometrial]] [[Uterine cancer|cancer]]'''<ref name="pmid16055605">{{cite journal |vauthors= |title=ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer |journal=Obstet Gynecol |volume=106 |issue=2 |pages=413–25 |date=August 2005 |pmid=16055605 |doi= |url=}}</ref> | ||
<ref name="pmid195920792">{{cite journal |vauthors=Boruta DM, Gehrig PA, Fader AN, Olawaiye AB |title=Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review |journal=Gynecol. Oncol. |volume=115 |issue=1 |pages=142–153 |date=October 2009 |pmid=19592079 |doi=10.1016/j.ygyno.2009.06.011 |url=}}</ref><ref name="pmid6822361">{{cite journal |vauthors=Bokhman JV |title=Two pathogenetic types of endometrial carcinoma |journal=Gynecol. Oncol. |volume=15 |issue=1 |pages=10–7 |date=February 1983 |pmid=6822361 |doi= |url=}}</ref><ref name="pmid20628804">{{cite journal |vauthors=Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F |title=Factors associated with Type I and Type II endometrial cancer |journal=Cancer Causes Control |volume=21 |issue=11 |pages=1851–6 |date=November 2010 |pmid=20628804 |pmc=2962676 |doi=10.1007/s10552-010-9612-8 |url=}}</ref> | <ref name="pmid195920792">{{cite journal |vauthors=Boruta DM, Gehrig PA, Fader AN, Olawaiye AB |title=Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review |journal=Gynecol. Oncol. |volume=115 |issue=1 |pages=142–153 |date=October 2009 |pmid=19592079 |doi=10.1016/j.ygyno.2009.06.011 |url=}}</ref><ref name="pmid6822361">{{cite journal |vauthors=Bokhman JV |title=Two pathogenetic types of endometrial carcinoma |journal=Gynecol. Oncol. |volume=15 |issue=1 |pages=10–7 |date=February 1983 |pmid=6822361 |doi= |url=}}</ref><ref name="pmid20628804">{{cite journal |vauthors=Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F |title=Factors associated with Type I and Type II endometrial cancer |journal=Cancer Causes Control |volume=21 |issue=11 |pages=1851–6 |date=November 2010 |pmid=20628804 |pmc=2962676 |doi=10.1007/s10552-010-9612-8 |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * [[Metrorrhagia]] in premenopausal women | ||
* | * Postcoital bleeding | ||
* | * [[Polyuria]] and [[dysuria]] (due to compression) | ||
* [[Fatigue| | * [[Fatigue|Fatigue]] | ||
* [[Weight loss| | * [[Weight loss|Weight loss]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Enlarged uterus | ||
* | * Vaginal bleeding | ||
* | * Vaginal discharge | ||
* | * Lymphadenopathy | ||
* | * Mesenteric nodules(metastasis) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Enlarged fixed uterus | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |A thickened endometrial lining >4mm | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Endometrial thickening | ||
* | * Lymph node involvement | ||
* | * Pelvic metastasis | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Atypical glandular cells | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |[[Malignant|Endometrial malignant cells]]: | ||
* | * Low grade Type I | ||
* | * High grade Type II | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Histologic diagnosis | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Uterine sarcoma| | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Uterine sarcoma|'''Uterine''']] | ||
[[Leiomyosarcoma|''' | [[Leiomyosarcoma|'''leiomyosarcoma''']]<ref name="pmid9291814">{{cite journal |vauthors=Nordal RR, Thoresen SO |title=Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality |journal=Eur. J. Cancer |volume=33 |issue=6 |pages=907–11 |date=May 1997 |pmid=9291814 |doi= |url=}}</ref> | ||
<ref name="pmid12144683">{{cite journal |vauthors=Goto A, Takeuchi S, Sugimura K, Maruo T |title=Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus |journal=Int. J. Gynecol. Cancer |volume=12 |issue=4 |pages=354–61 |date=2002 |pmid=12144683 |doi= |url=}}</ref><ref name="pmid8179071">{{cite journal |vauthors=Bell SW, Kempson RL, Hendrickson MR |title=Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases |journal=Am. J. Surg. Pathol. |volume=18 |issue=6 |pages=535–58 |date=June 1994 |pmid=8179071 |doi= |url=}}</ref><ref name="pmid20882892">{{cite journal |vauthors=Karpathiou G, Sivridis E, Giatromanolaki A |title=Myxoid leiomyosarcoma of the uterus: a diagnostic challenge |journal=Eur. J. Gynaecol. Oncol. |volume=31 |issue=4 |pages=446–8 |date=2010 |pmid=20882892 |doi= |url=}}</ref> | <ref name="pmid12144683">{{cite journal |vauthors=Goto A, Takeuchi S, Sugimura K, Maruo T |title=Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus |journal=Int. J. Gynecol. Cancer |volume=12 |issue=4 |pages=354–61 |date=2002 |pmid=12144683 |doi= |url=}}</ref><ref name="pmid8179071">{{cite journal |vauthors=Bell SW, Kempson RL, Hendrickson MR |title=Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases |journal=Am. J. Surg. Pathol. |volume=18 |issue=6 |pages=535–58 |date=June 1994 |pmid=8179071 |doi= |url=}}</ref><ref name="pmid20882892">{{cite journal |vauthors=Karpathiou G, Sivridis E, Giatromanolaki A |title=Myxoid leiomyosarcoma of the uterus: a diagnostic challenge |journal=Eur. J. Gynaecol. Oncol. |volume=31 |issue=4 |pages=446–8 |date=2010 |pmid=20882892 |doi= |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Abdominal pain | ||
* | * Urinary symptoms | ||
* | * Abdominal distension | ||
* | * Asymptomatic | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Enlarged or normal | ||
sized [[uterus]] | |||
* | * [[Lymphadenopathy]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Abdominal distention | ||
* [[Lymphadenopathy| | * [[Lymphadenopathy|Lymphadenopathy]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Uterine mass | ||
* | * Lymph node metastases | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Shows details of uterine mass boundaries, extent and spread | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Negative | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Epithiloid shaped smooth muscle cells showing: | ||
* | * High [[mitotic index]] | ||
* | * [[Atypia|Cellular atypia]] | ||
* | * [[Coagulative necrosis]] | ||
Two variants of [[leiomyosarcoma]]: | |||
* | * [[Leiomyosarcoma|Epithelioid leiomyosarcoma]] | ||
* | * Myxoid [[leiomyosarcoma]] (bland features) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Histologic diagnosis | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |''' | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Uterine [[leiomyoma]]'''<ref name="pmid25901428">{{cite journal |vauthors=Stewart EA |title=Clinical practice. Uterine fibroids |journal=N. Engl. J. Med. |volume=372 |issue=17 |pages=1646–55 |date=April 2015 |pmid=25901428 |doi=10.1056/NEJMcp1411029 |url=}}</ref> | ||
<ref name="pmid11904599">{{cite journal |vauthors=Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F |title=Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=3 |pages=409–15 |date=March 2002 |pmid=11904599 |doi= |url=}}</ref><ref name="pmid12427815">{{cite journal |vauthors=Omary RA, Vasireddy S, Chrisman HB, Ryu RK, Pereles FS, Carr JC, Resnick SA, Nemcek AA, Vogelzang RL |title=The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids |journal=J Vasc Interv Radiol |volume=13 |issue=11 |pages=1149–53 |date=November 2002 |pmid=12427815 |doi= |url=}}</ref> | <ref name="pmid11904599">{{cite journal |vauthors=Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F |title=Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=3 |pages=409–15 |date=March 2002 |pmid=11904599 |doi= |url=}}</ref><ref name="pmid12427815">{{cite journal |vauthors=Omary RA, Vasireddy S, Chrisman HB, Ryu RK, Pereles FS, Carr JC, Resnick SA, Nemcek AA, Vogelzang RL |title=The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids |journal=J Vasc Interv Radiol |volume=13 |issue=11 |pages=1149–53 |date=November 2002 |pmid=12427815 |doi= |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+/- | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Asymptomatic | ||
* [[Infertility| | * [[Infertility|Infertility]] | ||
* | * Obstetric complications | ||
* | * [[Dysmenorrhea]] (most common symptoms) | ||
* | * Obstructive symptoms(due to urinary bladder and bowel compression) | ||
* | * Dyspareunia | ||
* | * Torsion or degeneration | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Enlarged mobile uterus | ||
* | * Irregular contour | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Usually normal | ||
* | * Large fibroid uteri may cause abdominal distention | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
or | |||
N | |||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |[[Transvaginal ultrasound|US]] shows: | ||
* | * Hypoechoic, | ||
* | * Well-circumscribed | ||
* | * Round masses | ||
[[Transvaginal ultrasound|US]] determines location of [[fibroid]]: | |||
* | * [[Leiomyoma|Submucosal myomas]] | ||
* | * Intramural [[Leiomyoma|myomas]] | ||
* | * Subserosal [[Leiomyoma|fibroids]] | ||
* | * Cervical [[Leiomyoma|fibroids]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Determines: | ||
** | ** Size | ||
** | ** Location | ||
** | ** Numbers | ||
* | * Shows "popcorn" calcification in the fibroid (degeneration) | ||
* | * Differentiaites between leiomyomas, adenomyosisand adenomyomas | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal appearing bundle of epithiloid shape smooth muscle cells with normal mitotic index | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Imaging | ||
and | |||
Histologic analysis | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |''' | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Uterine carcinosarcomas''' | ||
''' | '''(Malignant mixed''' | ||
'''Mullerian''' | |||
'''tumour''' | |||
'''(MMMT)''' | |||
'''of the uterus)'''<ref name="pmid27878502">{{cite journal |vauthors=Chaffer CL, San Juan BP, Lim E, Weinberg RA |title=EMT, cell plasticity and metastasis |journal=Cancer Metastasis Rev. |volume=35 |issue=4 |pages=645–654 |date=December 2016 |pmid=27878502 |doi=10.1007/s10555-016-9648-7 |url=}}</ref> | |||
<ref name="pmid27791010">{{cite journal |vauthors=Zhao S, Bellone S, Lopez S, Thakral D, Schwab C, English DP, Black J, Cocco E, Choi J, Zammataro L, Predolini F, Bonazzoli E, Bi M, Buza N, Hui P, Wong S, Abu-Khalaf M, Ravaggi A, Bignotti E, Bandiera E, Romani C, Todeschini P, Tassi R, Zanotti L, Odicino F, Pecorelli S, Donzelli C, Ardighieri L, Facchetti F, Falchetti M, Silasi DA, Ratner E, Azodi M, Schwartz PE, Mane S, Angioli R, Terranova C, Quick CM, Edraki B, Bilgüvar K, Lee M, Choi M, Stiegler AL, Boggon TJ, Schlessinger J, Lifton RP, Santin AD |title=Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=113 |issue=43 |pages=12238–12243 |date=October 2016 |pmid=27791010 |pmc=5087050 |doi=10.1073/pnas.1614120113 |url=}}</ref><ref name="pmid14967435">{{cite journal |vauthors=Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ |title=Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=58 |issue=3 |pages=786–96 |date=March 2004 |pmid=14967435 |doi=10.1016/S0360-3016(03)01561-X |url=}}</ref><ref name="pmid18562759">{{cite journal |vauthors=Teo SY, Babagbemi KT, Peters HE, Mortele KJ |title=Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI |journal=AJR Am J Roentgenol |volume=191 |issue=1 |pages=278–83 |date=July 2008 |pmid=18562759 |doi=10.2214/AJR.07.3281 |url=}}</ref> | <ref name="pmid27791010">{{cite journal |vauthors=Zhao S, Bellone S, Lopez S, Thakral D, Schwab C, English DP, Black J, Cocco E, Choi J, Zammataro L, Predolini F, Bonazzoli E, Bi M, Buza N, Hui P, Wong S, Abu-Khalaf M, Ravaggi A, Bignotti E, Bandiera E, Romani C, Todeschini P, Tassi R, Zanotti L, Odicino F, Pecorelli S, Donzelli C, Ardighieri L, Facchetti F, Falchetti M, Silasi DA, Ratner E, Azodi M, Schwartz PE, Mane S, Angioli R, Terranova C, Quick CM, Edraki B, Bilgüvar K, Lee M, Choi M, Stiegler AL, Boggon TJ, Schlessinger J, Lifton RP, Santin AD |title=Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=113 |issue=43 |pages=12238–12243 |date=October 2016 |pmid=27791010 |pmc=5087050 |doi=10.1073/pnas.1614120113 |url=}}</ref><ref name="pmid14967435">{{cite journal |vauthors=Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ |title=Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=58 |issue=3 |pages=786–96 |date=March 2004 |pmid=14967435 |doi=10.1016/S0360-3016(03)01561-X |url=}}</ref><ref name="pmid18562759">{{cite journal |vauthors=Teo SY, Babagbemi KT, Peters HE, Mortele KJ |title=Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI |journal=AJR Am J Roentgenol |volume=191 |issue=1 |pages=278–83 |date=July 2008 |pmid=18562759 |doi=10.2214/AJR.07.3281 |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+/- | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Classical triad: | ||
** | ** Pain | ||
** | ** Bleeding | ||
** | ** Rapidly enlarging uterus | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Enlarged uterus | ||
* | * pelvic mass | ||
* | * Mass protruding through the cervical os | ||
* | * Involvement of the cervix | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Abdominal examination may be normal or may show distention if tumor size is large | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Enlarged uterine cavity | ||
* | * Hyperechoic mass in uterus and cervix | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Heterogenous bulky polypoid mass | ||
with intense enhancement | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Biphasic (carcinoma/sarcoma combination) and contains: | ||
* | * High grade carcinomatous (epithelial) contents | ||
* | * Stromal sarcomatous (connective tissue) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Histologic diagnosis | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" | | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Cervical cancer|Cervical]] [[Cervical cancer|cancer]]''' | ||
'''with''' | |||
'''uterine''' | |||
'''invasion'''<ref name="urlPap and HPV Testing - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet |title=Pap and HPV Testing - National Cancer Institute |format= |work= |accessdate=}}</ref> | |||
<ref name="pmid11041682">{{cite journal |vauthors=Benedet JL, Bender H, Jones H, Ngan HY, Pecorelli S |title=FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology |journal=Int J Gynaecol Obstet |volume=70 |issue=2 |pages=209–62 |date=August 2000 |pmid=11041682 |doi= |url=}}</ref> | <ref name="pmid11041682">{{cite journal |vauthors=Benedet JL, Bender H, Jones H, Ngan HY, Pecorelli S |title=FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology |journal=Int J Gynaecol Obstet |volume=70 |issue=2 |pages=209–62 |date=August 2000 |pmid=11041682 |doi= |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Postcoital bleeding | ||
* | * Copious malodorous vaginal discharge | ||
* | * Pressure-related bowel and bladder symptoms | ||
* | * Hematuria | ||
* | * Vaginal passage of bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Enlarged uterus | ||
* | * Concomitant | ||
cervical lesions | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Abdominal | ||
distention | |||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |For cervical cancer diagnoses, imaging is not usually done rather it is used to see the metastasis. Ultrasound may be used to see tumor size, extent and parametrial invasion. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |To evaluate tumor size and local extent and for its staging. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Pap test is done simultaneously with HPV testing, if cervical cancer is suspected. | |||
Abnormal pap test may show two type of abnormal cells: | |||
* | * [[Squamous cell carcinoma|'''Squamous cell carcinoma''']] | ||
** | ** Low-grade squamous intraepithelial lesions (LSILs) | ||
** | ** High-grade squamous intraepithelial lesions (HSILs) | ||
* | * [[Adenocarcinoma|'''Adenocarcinoma''']] | ||
** | ** Atypical glandular cells (AGC) | ||
** | ** Endocervical adenocarcinoma in situ (AIS) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |If pap test shows abnormal results. [[Colposcopy]] and [[biopsy]] is done. Histologic types are | ||
* | * [[Squamous cell carcinoma]] | ||
* | * [[Adenocarcinoma]] | ||
* | * [[Cervical cancer|Adenosquamous tumors]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Histologic diagnosis | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |''' | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Metastasis]] to the uterus''' | ||
'''from a''' | |||
'''non-gynaecologcial''' | |||
'''malignancy''' | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Asymptomatic | ||
* | * Obstetric complications | ||
* | * [[Dysmenorrhea]] (most common symptoms) | ||
* | * Obstructive symptoms (due to urinary bladder and bowel compression) | ||
* | * Dyspareunia | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Enlarged uterus | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Abdominal distention | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Enlarged uterine cavity | ||
* | * Hyperechoic mass in uterus and cervix | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Shows involvement of uterus, lymph nodes, parmetrial area and surrounding area. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Is normal or may show malignant metastatic cells. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Although biopsy of the metastatic lesions to the uterus is not recommended however, it shows the malignant cells of the primary site. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Biopsy and histology of the primary site of the tumor | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrial polyp| | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrial polyp|'''Endometrial''']] | ||
[[Endometrial polyp| | [[Endometrial polyp|'''polyp''']]<ref name="pmid15252313">{{cite journal |vauthors=Kim KR, Peng R, Ro JY, Robboy SJ |title=A diagnostically useful histopathologic feature of endometrial polyp: the long axis of endometrial glands arranged parallel to surface epithelium |journal=Am. J. Surg. Pathol. |volume=28 |issue=8 |pages=1057–62 |date=August 2004 |pmid=15252313 |doi= |url=}}</ref> | ||
<ref name="pmid21783430">{{cite journal |vauthors=Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J |title=Diagnosis and management of endometrial polyps: a critical review of the literature |journal=J Minim Invasive Gynecol |volume=18 |issue=5 |pages=569–81 |date=2011 |pmid=21783430 |doi=10.1016/j.jmig.2011.05.018 |url=}}</ref> | <ref name="pmid21783430">{{cite journal |vauthors=Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J |title=Diagnosis and management of endometrial polyps: a critical review of the literature |journal=J Minim Invasive Gynecol |volume=18 |issue=5 |pages=569–81 |date=2011 |pmid=21783430 |doi=10.1016/j.jmig.2011.05.018 |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Asymptomatic | ||
* | * Intermenstrual bleeding | ||
* | * Postmenopausal bleeding | ||
* | * Endometrial polyp prolapses (will be visible on speculum examination protruding through cervical os) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal sized | ||
uterus with | |||
smooth surface | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
or | |||
N | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Incidentally on pelvic ultrasound (most common) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |MRI will show polyp size and dimension in detail but it is usually is not required for its diagnoses. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Biopsy and histopathology analysis will show localized hyperplastic growth of endometrial glands and stroma around a vessel. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Imaging | ||
* | * Histologic evaluation | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrial hyperplasia| | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrial hyperplasia|'''Endometrial''']] | ||
[[Endometrial hyperplasia| | [[Endometrial hyperplasia|'''hyperpalsia''']]<ref name="pmid25797956">{{cite journal |vauthors=Emons G, Beckmann MW, Schmidt D, Mallmann P |title=New WHO Classification of Endometrial Hyperplasias |journal=Geburtshilfe Frauenheilkd |volume=75 |issue=2 |pages=135–136 |date=February 2015 |pmid=25797956 |pmc=4361167 |doi=10.1055/s-0034-1396256 |url=}}</ref> | ||
<ref name="pmid17917566">{{cite journal |vauthors=Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D |title=2006 consensus guidelines for the management of women with abnormal cervical screening tests |journal=J Low Genit Tract Dis |volume=11 |issue=4 |pages=201–22 |date=October 2007 |pmid=17917566 |doi=10.1097/LGT.0b013e3181585870 |url=}}</ref><ref name="pmid18061866">{{cite journal |vauthors=Espindola D, Kennedy KA, Fischer EG |title=Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia |journal=Obstet. Gynecol. Clin. North Am. |volume=34 |issue=4 |pages=717–37, ix |date=December 2007 |pmid=18061866 |doi=10.1016/j.ogc.2007.09.001 |url=}}</ref><ref name="pmid15097798">{{cite journal |vauthors=Montgomery BE, Daum GS, Dunton CJ |title=Endometrial hyperplasia: a review |journal=Obstet Gynecol Surv |volume=59 |issue=5 |pages=368–78 |date=May 2004 |pmid=15097798 |doi= |url=}}</ref> | <ref name="pmid17917566">{{cite journal |vauthors=Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D |title=2006 consensus guidelines for the management of women with abnormal cervical screening tests |journal=J Low Genit Tract Dis |volume=11 |issue=4 |pages=201–22 |date=October 2007 |pmid=17917566 |doi=10.1097/LGT.0b013e3181585870 |url=}}</ref><ref name="pmid18061866">{{cite journal |vauthors=Espindola D, Kennedy KA, Fischer EG |title=Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia |journal=Obstet. Gynecol. Clin. North Am. |volume=34 |issue=4 |pages=717–37, ix |date=December 2007 |pmid=18061866 |doi=10.1016/j.ogc.2007.09.001 |url=}}</ref><ref name="pmid15097798">{{cite journal |vauthors=Montgomery BE, Daum GS, Dunton CJ |title=Endometrial hyperplasia: a review |journal=Obstet Gynecol Surv |volume=59 |issue=5 |pages=368–78 |date=May 2004 |pmid=15097798 |doi= |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Asymptomatic | ||
* | * Post menopausal bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal sized | ||
uterus with | |||
smooth surface | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Determines endometrial thickness | ||
* | * Rules out other abnormalities | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Thick endometrial lining | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Abnormal glandular or endometrial cells on pap smear | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Endometrial sampling is used (gold standard) for the diagnosis of endometrial hyperplasia. | ||
* | * Biopsy and histology may show two types: | ||
** | ** '''Non-neoplastic changes''': | ||
*** | *** Disordered endometrial growth | ||
*** | *** Benign hyperplasia | ||
*** | *** Simple hyperplasia | ||
*** | *** Complex hyperplasias without atypia | ||
* | * '''Precancerous changes''': | ||
** | ** Endometrial intraepithelial neoplasms | ||
** | ** Atypical complex hyperplasia | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Histologic | |||
diagnosis | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyoma| | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyoma|'''Uterine''']] | ||
[[Adenomyoma| | [[Adenomyoma|'''adenomyoma''']] | ||
<ref name="pmid4608783">{{cite journal |vauthors=McElin TW, Bird CC |title=Adenomyosis of the uterus |journal=Obstet Gynecol Annu |volume=3 |issue= |pages=425–41 |date=1974 |pmid=4608783 |doi= |url=}}</ref><ref name="pmid22442261">{{cite journal |vauthors=Maheshwari A, Gurunath S, Fatima F, Bhattacharya S |title=Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes |journal=Hum. Reprod. Update |volume=18 |issue=4 |pages=374–92 |date=July 2012 |pmid=22442261 |doi=10.1093/humupd/dms006 |url=}}</ref> | <ref name="pmid4608783">{{cite journal |vauthors=McElin TW, Bird CC |title=Adenomyosis of the uterus |journal=Obstet Gynecol Annu |volume=3 |issue= |pages=425–41 |date=1974 |pmid=4608783 |doi= |url=}}</ref><ref name="pmid22442261">{{cite journal |vauthors=Maheshwari A, Gurunath S, Fatima F, Bhattacharya S |title=Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes |journal=Hum. Reprod. Update |volume=18 |issue=4 |pages=374–92 |date=July 2012 |pmid=22442261 |doi=10.1093/humupd/dms006 |url=}}</ref> | ||
| Line 395: | Line 395: | ||
<ref name="pmid10517452">{{cite journal |vauthors=Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH |title=Diffuse and focal adenomyosis: MR imaging findings |journal=Radiographics |volume=19 Spec No |issue= |pages=S161–70 |date=October 1999 |pmid=10517452 |doi=10.1148/radiographics.19.suppl_1.g99oc03s161 |url=}}</ref> | <ref name="pmid10517452">{{cite journal |vauthors=Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH |title=Diffuse and focal adenomyosis: MR imaging findings |journal=Radiographics |volume=19 Spec No |issue= |pages=S161–70 |date=October 1999 |pmid=10517452 |doi=10.1148/radiographics.19.suppl_1.g99oc03s161 |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |- | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Dysmenorrhea| | * [[Dysmenorrhea|Dysmenorrhea]] | ||
* | * Subfertility | ||
* | * | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Diffusely enlarged | ||
tender boggy uterus | |||
with smooth surface | |||
* | * Uterus may develop masses | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Snow storm appearance in diffuse adenomyosis | ||
* | * Shows a uterine mass in case of adenomas | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Identifies diffuse or focal adenomyosis from leiomyoma | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Mostly normal may show glandular cells in cervical cytology | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Endometrial glands in myometrium of uterus | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Imaging | ||
* | * Histologic | ||
diagnosis | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra| | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra|'''Hematometra''']] | ||
'''(blood within the''' | |||
'''uterine cavity)''' | |||
<ref name="pmid17630156">{{cite journal |vauthors=McCausland AM, McCausland VM |title=Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention |journal=J Minim Invasive Gynecol |volume=14 |issue=4 |pages=399–406 |date=2007 |pmid=17630156 |doi=10.1016/j.jmig.2007.04.004 |url=}}</ref><ref name="pmid20606801">{{cite journal |vauthors=U Nayak A, Swarup A, G S J, N S |title=Hematometra and acute abdomen |journal=J Emerg Trauma Shock |volume=3 |issue=2 |pages=191–2 |date=April 2010 |pmid=20606801 |pmc=2884455 |doi=10.4103/0974-2700.62117 |url=}}</ref> | <ref name="pmid17630156">{{cite journal |vauthors=McCausland AM, McCausland VM |title=Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention |journal=J Minim Invasive Gynecol |volume=14 |issue=4 |pages=399–406 |date=2007 |pmid=17630156 |doi=10.1016/j.jmig.2007.04.004 |url=}}</ref><ref name="pmid20606801">{{cite journal |vauthors=U Nayak A, Swarup A, G S J, N S |title=Hematometra and acute abdomen |journal=J Emerg Trauma Shock |volume=3 |issue=2 |pages=191–2 |date=April 2010 |pmid=20606801 |pmc=2884455 |doi=10.4103/0974-2700.62117 |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |- | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Acute pain abdomen | ||
* | * Cramping in pelvis | ||
* | * Cyclic pain | ||
* | * Dysmenorrhea | ||
* | * Amenorrhea | ||
* | * Hypotension | ||
* | * Vasovagal syncopy | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Firm and enlarged uterus | ||
* | * Adenaxal tenderness | ||
* | * Pelvic examination may be restricted by pain | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Normal | |||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Echogenic fluid in the uterine cavity occluding cervical os | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |MRI is not required for the diagnoses | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Biopsy is not required for the diagnoses | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Ultrasound | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra| | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra|Hematometra]][[Hematometra|Hematometra]][[Hematometra|Hematometra]][[Gestational trophoblastic disease|'''Gestational''']][[Gestational trophoblastic disease|'''trophoblastic''']][[Hematometra|Hematometra]] | ||
[[Gestational trophoblastic disease|'''disease''']] | |||
<ref name="pmid8035373">{{cite journal |vauthors=Bakri YN, Berkowitz RS, Khan J, Goldstein DP, von Sinner W, Jabbar FA |title=Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure |journal=J Reprod Med |volume=39 |issue=3 |pages=175–8 |date=March 1994 |pmid=8035373 |doi= |url=}}</ref><ref name="pmid20728069">{{cite journal |vauthors=Lurain JR |title=Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole |journal=Am. J. Obstet. Gynecol. |volume=203 |issue=6 |pages=531–9 |date=December 2010 |pmid=20728069 |doi=10.1016/j.ajog.2010.06.073 |url=}}</ref> | <ref name="pmid8035373">{{cite journal |vauthors=Bakri YN, Berkowitz RS, Khan J, Goldstein DP, von Sinner W, Jabbar FA |title=Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure |journal=J Reprod Med |volume=39 |issue=3 |pages=175–8 |date=March 1994 |pmid=8035373 |doi= |url=}}</ref><ref name="pmid20728069">{{cite journal |vauthors=Lurain JR |title=Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole |journal=Am. J. Obstet. Gynecol. |volume=203 |issue=6 |pages=531–9 |date=December 2010 |pmid=20728069 |doi=10.1016/j.ajog.2010.06.073 |url=}}</ref> | ||
[[Hematometra| | [[Hematometra|Hematometra]] | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Metastatic symptoms in case of cancer: | ||
* | * Pulmonary symptoms | ||
** | ** Dyspnea | ||
** | ** Chest pain | ||
** | ** Cough | ||
** | ** Hemoptysis | ||
* | * Vaginal metastases | ||
** | ** Vaginal bleeding | ||
** | ** Purulent vaginal discharge | ||
* | * Central nervous system metastases | ||
** | ** Asymptomatic | ||
** | ** Neurologic signs | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Irregularly sized boggy enlarged uterus | ||
* | * Adnexal fullness | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Abdominal distention due to enlarged uterus | ||
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * US shows dilated grape like structures | ||
* | * Diffuse hydropic swelling | ||
* | * Multiples echoes | ||
* | * Cystic spaces invading edometrium and myometrium (in case of invasive disease) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |MRI defines the extent of primary lesion, invasion and distant metastasis | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Pap smear shows trophoblasric cells | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Biopsy and histologic analysis confirms the diagnoses depending on the type of lesion benign or malignant it may sow dilated grape like villous structures or invasive malignant lesions | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Imaging | ||
* | * Histologic | ||
diagnosis | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra| | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra|Hematometra]][[Retained products of conception|'''Incomplete''']] | ||
[[Hematometra| | [[Hematometra|Hematometra]][[Retained products of conception|'''abortion''']] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Abdominal pain/ cramps | ||
* | * vaginal bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Enlarges uterus | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Enlarges abdomen | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |N/[[Anemia|↓]] | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | +↓ | | style="background: #F5F5F5; padding: 5px;" | +↓ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Uterus shows fetus with absent cardiac activity in lower part of uterus | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |MRI is not required for the diagnoses | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Pap smear is not done for the diagnoses | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Suction biopsy and histology shows fetal and placental tissues | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Imaging | ||
* | * Histologic | ||
diagnosis | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Pregnancy''' | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Pregnancy''' | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |No | ||
Menstrual cycle | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Nausea | ||
* | * Absent menstrual cycle | ||
* | * Fatigue | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Enlarged gravid uterus | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Enlarged abdomen | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Fetus inside uterine cavity | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Not needed once ultrasound determines pregnancy | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Normal or may show cervical cells | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Not needed once ultrasound | ||
* May show Fetal tissues | |||
* | amniotic fluid | ||
| style="background: #F5F5F5; padding: 5px;" | Imaging ([[Transvaginal ultrasound]]) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
|- | |- | ||
|} | |} | ||
Revision as of 16:18, 10 February 2019
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Endometrial cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Endometrial cancer differential diagnosis On the Web |
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American Roentgen Ray Society Images of Endometrial cancer differential diagnosis |
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Risk calculators and risk factors for Endometrial cancer differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]Roukoz A. Karam, M.D.[3]
Overview
In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.
Differentiating Endometrial Cancer From Other Diseases
- In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.[1]
| Diseases | Clinical manifestations | Para-clinical findings | Pap Smear | Histopathology | Gold standard | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Physical examination | |||||||||||||
| Lab Findings | Imaging | |||||||||||||
| Menorrhagia | Intermenstrual bleeding | Pelvic Pain/pressure/
discomfort |
Other
symptoms |
Pelvic examination | Abdominal examination | Hb | B-HCG | CA-125 | Ultrasound | MRI | ||||
| Endometrial cancer[2] | + | + | +/- |
|
|
Enlarged fixed uterus | ↓ | - | + | A thickened endometrial lining >4mm |
|
Atypical glandular cells | Endometrial malignant cells:
|
Histologic diagnosis |
| Uterine | +/- | + | +/- |
|
sized uterus |
|
↓ | - | + |
|
Shows details of uterine mass boundaries, extent and spread | Negative | Epithiloid shaped smooth muscle cells showing:
Two variants of leiomyosarcoma:
|
Histologic diagnosis |
| Uterine leiomyoma[10] | +/- | +/- | + |
|
|
|
↓
or N |
- | - | US shows:
US determines location of fibroid:
|
|
Normal | Normal appearing bundle of epithiloid shape smooth muscle cells with normal mitotic index | Imaging
and Histologic analysis |
| Uterine carcinosarcomas
(Malignant mixed Mullerian tumour (MMMT) of the uterus)[13] |
+/- | +/- | +/- |
|
|
Abdominal examination may be normal or may show distention if tumor size is large | ↓ | - | + |
|
Heterogenous bulky polypoid mass
with intense enhancement |
Biphasic (carcinoma/sarcoma combination) and contains:
|
Histologic diagnosis | |
| Cervical cancer
with uterine invasion[17] |
+ | + | +/- |
|
cervical lesions |
Abdominal
distention |
↓ | - | +/- | For cervical cancer diagnoses, imaging is not usually done rather it is used to see the metastasis. Ultrasound may be used to see tumor size, extent and parametrial invasion. | To evaluate tumor size and local extent and for its staging. |
Pap test is done simultaneously with HPV testing, if cervical cancer is suspected. Abnormal pap test may show two type of abnormal cells:
|
If pap test shows abnormal results. Colposcopy and biopsy is done. Histologic types are | Histologic diagnosis |
| Metastasis to the uterus
from a non-gynaecologcial malignancy |
+ | + | +/- |
|
Enlarged uterus | Abdominal distention | ↓ | - | - |
|
Shows involvement of uterus, lymph nodes, parmetrial area and surrounding area. | Is normal or may show malignant metastatic cells. | Although biopsy of the metastatic lesions to the uterus is not recommended however, it shows the malignant cells of the primary site. | Biopsy and histology of the primary site of the tumor |
| Endometrial | + | + | - |
|
Normal sized
uterus with smooth surface |
Normal | ↓ | - | +
or N |
Incidentally on pelvic ultrasound (most common) | MRI will show polyp size and dimension in detail but it is usually is not required for its diagnoses. | Normal | Biopsy and histopathology analysis will show localized hyperplastic growth of endometrial glands and stroma around a vessel. |
|
| Endometrial | + | + | - |
|
Normal sized
uterus with smooth surface |
Normal | ↓ | - | + |
|
Thick endometrial lining | Abnormal glandular or endometrial cells on pap smear |
|
Histologic diagnosis |
| Uterine | - | - | +/- |
|
tender boggy uterus with smooth surface
|
Normal | ↓ | - | + |
|
Identifies diffuse or focal adenomyosis from leiomyoma | Mostly normal may show glandular cells in cervical cytology | Endometrial glands in myometrium of uterus |
diagnosis |
| Hematometra
(blood within the uterine cavity) |
- | - | + |
|
|
Normal |
↓ | - | - | Echogenic fluid in the uterine cavity occluding cervical os | MRI is not required for the diagnoses | Normal | Biopsy is not required for the diagnoses | Ultrasound |
| HematometraHematometraHematometraGestationaltrophoblasticHematometra | +/- | +/- | + | Metastatic symptoms in case of cancer:
|
|
Abdominal distention due to enlarged uterus | ↓ | +/- | + |
|
MRI defines the extent of primary lesion, invasion and distant metastasis | Pap smear shows trophoblasric cells | Biopsy and histologic analysis confirms the diagnoses depending on the type of lesion benign or malignant it may sow dilated grape like villous structures or invasive malignant lesions |
diagnosis |
| HematometraIncomplete | - | + | + |
|
Enlarges uterus | Enlarges abdomen | N/↓ | +/- | +↓ | Uterus shows fetus with absent cardiac activity in lower part of uterus | MRI is not required for the diagnoses | Pap smear is not done for the diagnoses | Suction biopsy and histology shows fetal and placental tissues |
diagnosis |
| Pregnancy | No
Menstrual cycle |
+/- | + |
|
Enlarged gravid uterus | Enlarged abdomen | - | + | - | Fetus inside uterine cavity | Not needed once ultrasound determines pregnancy | Normal or may show cervical cells |
amniotic fluid |
Imaging (Transvaginal ultrasound) |
References
- ↑ Hippisley-Cox J, Coupland C (2011). "Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm". BMJ. 344: d8009. doi:10.1136/bmj.d8009. PMC 3251328. PMID 22217630.
- ↑ "ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer". Obstet Gynecol. 106 (2): 413–25. August 2005. PMID 16055605.
- ↑ Boruta DM, Gehrig PA, Fader AN, Olawaiye AB (October 2009). "Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review". Gynecol. Oncol. 115 (1): 142–153. doi:10.1016/j.ygyno.2009.06.011. PMID 19592079.
- ↑ Bokhman JV (February 1983). "Two pathogenetic types of endometrial carcinoma". Gynecol. Oncol. 15 (1): 10–7. PMID 6822361.
- ↑ Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F (November 2010). "Factors associated with Type I and Type II endometrial cancer". Cancer Causes Control. 21 (11): 1851–6. doi:10.1007/s10552-010-9612-8. PMC 2962676. PMID 20628804.
- ↑ Nordal RR, Thoresen SO (May 1997). "Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality". Eur. J. Cancer. 33 (6): 907–11. PMID 9291814.
- ↑ Goto A, Takeuchi S, Sugimura K, Maruo T (2002). "Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus". Int. J. Gynecol. Cancer. 12 (4): 354–61. PMID 12144683.
- ↑ Bell SW, Kempson RL, Hendrickson MR (June 1994). "Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases". Am. J. Surg. Pathol. 18 (6): 535–58. PMID 8179071.
- ↑ Karpathiou G, Sivridis E, Giatromanolaki A (2010). "Myxoid leiomyosarcoma of the uterus: a diagnostic challenge". Eur. J. Gynaecol. Oncol. 31 (4): 446–8. PMID 20882892.
- ↑ Stewart EA (April 2015). "Clinical practice. Uterine fibroids". N. Engl. J. Med. 372 (17): 1646–55. doi:10.1056/NEJMcp1411029. PMID 25901428.
- ↑ Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F (March 2002). "Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas". Am. J. Obstet. Gynecol. 186 (3): 409–15. PMID 11904599.
- ↑ Omary RA, Vasireddy S, Chrisman HB, Ryu RK, Pereles FS, Carr JC, Resnick SA, Nemcek AA, Vogelzang RL (November 2002). "The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids". J Vasc Interv Radiol. 13 (11): 1149–53. PMID 12427815.
- ↑ Chaffer CL, San Juan BP, Lim E, Weinberg RA (December 2016). "EMT, cell plasticity and metastasis". Cancer Metastasis Rev. 35 (4): 645–654. doi:10.1007/s10555-016-9648-7. PMID 27878502.
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