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

Endometrial Carcinoma

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

E. Risk Factors1) obesity --2) type 2 diabetes -3) early menstruation & late menopause .4) nulliparity or a history of infertility .5) polycystic ovaries.6) patients with estrogen producing tumors of the ovaries such as

granulosa cell tumors . 7) Estrogen –only replacement therapy (ERT).

8) Family history – possible genetic link

– Hereditary nonpolyposis colorectal cancer (HNPCC). Inherited disease caused by an abnormality in a gene important for DNA repair.

9) Personal history of breast cancer or ovarian cancer .10) Tamoxifin 11) Stress

Endometrial carcinoma

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

Endometrial Carcinoma

Cervical carcinoma

CT Endometrial Carcinoma

MRI Endometrial Carcinoma

C. Prevalence & Incidence

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

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

Normal ovary

Polycystic ovaries

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

What are the symptoms of polycystic ovarian syndrome (PCOS)? menstrual disturbances elevated levels of male hormones (androgen).

Other signs and symptoms of PCOS include:obesity and weight gain,elevated insulin levels and insulin resistanceoily skin, dandruff, infertility, skin discolorations, high cholesterol levels, elevated blood pressure, and multiple, small cysts in the ovaries. Any of the above symptoms and signs may be absent in PCOS, with the exception .

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

Polycystic ovary

Sonographic appearance of ovarian mass

Any mass in the ovary or adnexa may be solid or cyst.Solid mass in the adnexa may be1- Pedunculated fibroid ( myoma ) .2- ovarian solid mass ,ovarian fibromas, adenofibroma, thecoma, burner tumors .Cystic mass may be benign ( non neoplasm) or neoplasm .Sign of benign cystic mass .Sign of neoplasm .

Ovarian masses Ovarian Cysts ( non neoplastic )

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

Ovarian cyst ( CT scan )

MRI ovarian cyst

Lu cyst

• endometrial cyst ( endometrioma ) it is nonneoplastic cyst .

• The ovary is involved in 80% of all cases of endometriosis. These masses may be large (15-20cm) and are filled with old blood .

• US • Hemorrhagic cysts .• US

Hemorrhagic cystsonograms show complex intraovarian cyst (C) surrounded

by rim of healthy ovarian tissue. Cyst contains retracting clot. Calipers indicate boundary of ovaries.

Hemorrhagic cyst color US

Ruptured hemorrhagic cyst

Chocilate cyst

Dermoid cyst ( teratomas )Is a germ cell tumor of the ovary .Contained of the cyst : 1-Sonography Cystic teratomas are probably the most common ovarian neoplasm in patients younger than the age of 50 years.Cyst , hypoechic , plugs of nodule .2- CT scan3- Plain X-ray . It is better to be removed .

Dermoid cyst ( plain X-ray

Ultrasound Dermoid cyst

CT Dermoid cyst

Female genital tract • Ovarian tumours • The commonest is cystadenoma & cystadenocarcinima.• Ultrasonography • Diagnosis by US, CT & MRI • US, CT& MRI may show • Hydronephrosis from ureteric obstruction .• Enlarges lymph nodes .• Liver metastasis .• Ascitis. • Omental & peritoneal metastases are difficult to be visible because of there

small size .• Treatment is surgical removal but staging should be carried out befor surg.• The main role of post operative imaging is for follow up

• Hemorrhage within the cyst may make the sonographic appearance confusing , hemorrhage is excellent evidence that the mass is benign.

• Often called the “silent cancer”• Tumor size in post menopausal is important the larger

the size of the lesion, the higher the likelihood of malignancy. Large size also indicate that the mass has persistent for some time .

• It is important to realize that the ovary is relatively common site for metastasis . The primary is from colon, stomach & breast.

II. Ovarian Cancer• For most pre-menopausal women, a

growth on the ovary is benign (90%) – for post-menopausal women there is a 70% chance of it being benign

– Tumor growth that begins in the egg-producing cells (germ cell tumors) –

– Tumor growth that begins on the surface of the ovary (epithelial cell tumors)

A. Risk Factors1) Continuous egg production (never pregnant, never used birth control,

or first birth after age 30)2) Early menstruation & late menopause .3) Obesity4) Diet 5) Fertility drugs 6) Estrogen replacement therapy .7) Genetics.– <10% of women found to have ovarian cancer have inherited the

disease– BRCA1 and BRCA2 are implicated in ovarian cancer too– Family history breast cancer

CT. Detection

Rudimentary uterus

Conganital anomalies of the uterus

3D ultrasound image of didelphys uterus

IUCD

3 D US

Hysterosalpingography ( HSG ) Contrast study of uterus , fallopian tubes .Indications 1- Infertility .2- recurrent abortion .3- monitor the effect of tubal

surgery , 4- after ectopic pregnancy .Contraindication 1- acute pelvic infection . 2- sever renal or cardiac disease . 3- sensitivity to contrast . 4- recent dilatation or curettage .5- pregnancy .Week prior & week following menstrual cycle .

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