Presentation
Menopausal bleeding for the previous two days. Menopause for the previous sixteen years.
Patient Data
Retroverted uterus, measuring 64 (length) x 34 (width) x 32 (anteroposterior) mm. Normal myometrial echopattern without any mass lesion. Normal uterine cervix. The endometrium was replaced by elongated soft tissue thickening, measuring 35 (length) x 12 (anteroposterior) mm. There are peripheral solid hyperechoic areas with central large cystic spaces. Vascularity is present along the posterior endometrium. Thin rim of the fluid between the lesion and the endometrium near the fundus. Normal endometrial-myometrial junction. Atrophic ovaries without follicles. No adnexal lesion/ free fluid in the pelvis.
The first and second photos show protruding polyps at the external cervical os. The third photo shows a polyp extending to the fundus region. The fourth photo reveals the polyp base at the fundus region.
Case Discussion
The patient was referred with the clinical diagnosis of endometrial polyp as it was visible at the external cervical os. Endometrial thickening with cystic areas was noted. I failed to see a fluid rim between the lesion and the endometrium favouring an intraluminal lesion, which was later pointed out to me by a colleague.
Hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathology revealed an endometrial polyp without malignant changes, mild adenomyosis, chronic cervicitis, and normal ovaries and fallopian tubes.
Uterus specimen photos courtesy of the operating surgeon, Dr. Drashti R. Patel.
Unable to process the form. Check for errors and try again.