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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 429-431

Ultrasound and color doppler features of transitional cell carcinoma of the endometrium with pathological correlation


Department of Radio Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Submission29-Nov-2019
Date of Decision10-Dec-2019
Date of Acceptance20-Dec-2019
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Prerna Patwa
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_198_19

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  Abstract 


Endometrial carcinoma is the second most common cancer of the female genital tract after cervical cancer which is still the leading cause of morbidity and mortality in developing countries. The endometrium of the uterus is usually thickened and the mass of the tissue is what forms the tumor growth. Diagnosis of endometrial malignancy involves invasive techniques which include endometrial biopsy as the standard diagnostic tool, although an initial ultrasound examination is one of the first modalities of investigations performed. We present an interesting case of transitional cell carcinoma of the endometrium in a 62-year-old postmenopausal female who presented with abnormal uterine bleeding. Grayscale ultrasound and color Doppler imaging is discussed.

Keywords: Color Doppler, endometrial tumorm, postmenopausal bleed, transitional cell carcinoma, ultrasound


How to cite this article:
Patwa P, Phatak S, Pattabiraman S, Marfani G. Ultrasound and color doppler features of transitional cell carcinoma of the endometrium with pathological correlation. J Datta Meghe Inst Med Sci Univ 2019;14:429-31

How to cite this URL:
Patwa P, Phatak S, Pattabiraman S, Marfani G. Ultrasound and color doppler features of transitional cell carcinoma of the endometrium with pathological correlation. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Aug 13];14:429-31. Available from: http://www.journaldmims.com/text.asp?2019/14/4/429/289852




  Introduction Top


Transitional cell carcinoma (TCC) is rare in the female genital tract. Although it is most common in the ovary, a small series of cases in the cervix have been reported, with isolated cases described in the  Fallopian tube More Details, adnexa uteri, and endometrium. TCC represents a more aggressive neoplasm that more commonly presents at a higher clinical stage. They are not only one of the rare neoplasms but also most commonly seen in postmenopausal women.[1] The incidence of endometrial cancer is increasing and it has high cure rates; hence, cost-effective and noninvasive diagnostic tools for the detection of endometrial cancer in cases with postmenopausal bleeding are of increasing importance which help in early detection and cure.[2]


  Case Report Top


A 62-year-old postmenopausal female presented with bleeding per vagina for 12 days. The patient was referred to the radiology department for further evaluation. On grayscale ultrasound, the uterus measured 8.3 cm × 5.6 cm × 3.9 cm in size with thickened endometrium measuring 24 mm and on the posterior wall of the uterus invading the myometrium, suggestive of invasive disease [Figure 1], and an ill-defined endometrial mass with nodular surface and the presence of fluid collection adjacent to the thickened endometrium [Figure 2]. The lesion showed high vascularity in the central as well as peripheral portions on color Doppler [Figure 3]. There was no abdominal or pelvic lymph node that was appreciated on ultrasound. The patient was operated and her uterus (size 6 cm × 6 cm × 3 cm) with the cervix (3 cm) and bilateral Fallopian tubes with ovaries were removed. The specimen showed cauliflower-like growth which appeared obliterating the endometrial cavity; it was soft and friable and appeared to be infiltrating the surrounding myometrium on both the sides [Figure 4]. The specimen was sent for histopathological examination for further investigation and it showed features suggestive of high-grade carcinoma of the endometrium, TCC. Complete myometrial invasion was seen on histopathological examination also.
Figure 1: Grayscale ultrasound image of the uterus with thickened endometrium measuring 24 mm, on the posterior wall of uterus invading the myometrium, suggestive of invasive disease

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Figure 2: Grayscale ultrasound image of the uterus showing an ill-defined endometrial mass with nodular surface and presence of fluid collection adjacent to the thickened endometrium

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Figure 3: Colour Doppler of the lesion showing high vascularity in the central as well as peripheral portions

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Figure 4: Gross specimen showing cauliflower-like growth which appeared obliterating the endometrial cavity infiltrating the surrounding myometrium on both the sides

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  Discussion Top


Endometrial carcinoma presents most commonly as abnormal uterine bleeding in postmenopausal women. The studies done for detecting endometrial pathologies using Doppler imaging have only been reported to increase the sensitivity and specificity of the sonography.[3] It has been suggested that the intratumoral vascularity is an indicator of the nature of the mass lesion, and more the intratumoral vascularity higher are the chances are that the tumor is malignant.[4] A tumor is classified as high grade when two of these criterions are met 50% solid growth, diffusely infiltrating growth rather than an expansive and tumor necrosis.[5] Color Doppler is one of the helpful modalities of sonography that helps to find the nature of the lesion. Malignant tumors tend to have rich intratumoral blood flow (neovascularization) compared with benign tumors.[4] Ultrasonography signs of endometrial carcinoma include heterogeneous and irregular endometrial thickening. Although these signs are nonspecific and can be seen in endometrial hyperplasia as well as polyps, polypoid tumors tend to cause more diffuse and irregular thickening than a polyp and are more heterogeneous than endometrial hyperplasia. A more specific ultrasound sign is an irregularity of the endometrium–myometrium border, and the finding indicates invasive disease. An intrauterine fluid collection in a postmenopausal patient is possibly related to cervical stenosis, but it should raise concern for endometrial carcinoma.[6],[7],[8],[9],[10],[11]


  Conclusion Top


TCC of the endometrium, although rare, may constitute a diagnostic challenge as it is a diagnosis made on pathology. Imaging modalities aid in diagnostic workup, management, and postoperative follow-up of such patients. Sonography along with color flow Doppler of the mass seen on imaging helps in the diagnosis of the lesion. Malignant masses of the endometrium usually exhibit thickened endometrium with thickness >5 mm in a postmenospausal women presenting with bleeding per vagina, and the mass lesion may show high vascularity which suggests a possibility of a malignant tumor. Thus, this modality is useful in the diagnosis and management of patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lininger RA, Ashfaq R, Albores-Saavedra J, Tavassoli FA. Transitional cell carcinoma of the endometrium and endometrial carcinoma with transitional cell differentiation. Cancer 1997;79:1933-43.  Back to cited text no. 1
    
2.
de Kroon CD, Hiemstra E, Trimbos JB, Jansen FW. Power Doppler area in the diagnosis of endometrial cancer. Int J Gynecol Cancer 2010;20:1160-5.  Back to cited text no. 2
    
3.
Bezircioglu I, Baloglu A, Cetinkaya B, Yigit S, Oziz E. The diagnostic value of the Doppler ultrasonography in distinguishing the endometrial malignancies in women with postmenopausal bleeding. Arch Gynecol Obstet 2012;285:1369-74.  Back to cited text no. 3
    
4.
Emoto M, Tamura R, Shirota K, Hachisuga T, Kawarabayashi T. Clinical usefulness of color Doppler ultrasound in patients with endometrial hyperplasia and carcinoma. Cancer 2002;94:700-6.  Back to cited text no. 4
    
5.
Amant F, Moerman P, Neven P, Timmerman D, van Limbergen E, Vergote I. Endometrial cancer. Lancet 2005;366:491-505.  Back to cited text no. 5
    
6.
Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: Disease and normal variants. Radiographics 2001;21:1409-24.  Back to cited text no. 6
    
7.
Chaudhary KS, Phatak SV. Choroidal Melanoma in a Young Patient Ultrasonography and Magnetic Resonance Imaging. J Datta Meghe Inst Med Sci Univ 2019;14:106-8. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_48_18. [Last accessed on 2019 Sep 22].  Back to cited text no. 7
    
8.
Wankhade A, Vagha S, Shukla S, Bhake A, Laishram S, Agrawal D, et al. To Correlate Histopathological Changes and Transvaginal Sonography Findings in the Endometrium of Patients with Abnormal Uterine Bleeding. J Datta Meghe Inst Med Sci Univ 2019;14:11-5. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_70_18. [Last accessed on 2019 Sep 22].  Back to cited text no. 8
    
9.
Gadge A, Acharya N, Shukla S, Phatak S. Comparative Study of Transvaginal Sonography and Hysteroscopy for the Detection of Endometrial Lesions in Women with Abnormal Uterine Bleeding in Perimenopausal Age Group. J SAFOG 2018;10:155-60. Available from: https://doi.org/10.5005/jp-journals-10006-1580. [Last accessed on 2019 Sep 22].  Back to cited text no. 9
    
10.
Marfani G, Phatak SV, Madurwar KA, Samad S. Role of Sonoelastography in Diagnosing Endometrial Lesions: Our Initial Experience. J Datta Meghe Inst Med Sci Univ 2019;14:31-5. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_89_18. [Last accessed on 2019 Sep 22].  Back to cited text no. 10
    
11.
Manisha S, Bagde N, Shrivastava D. Visual Inspection of Cervix with Acetic Acid: An Alternative to Cytology and Colposcopy in Early Screening of Cervical Cancer in Low-Resource Setup. J Datta Meghe Inst Med Sci Univ 2017;12:32-4. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_19_17. [Last accessed on 2019 Sep 22].  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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