Transcript FILE:endo adenocarcinoma

GY case presentation
05.03.28 sonographer권혜영
이 O 자 (F/50)
• C.C: for W/U and OP
• Hx: 05년 2월 vag. Bleeding 있던 분으
로 05.3월 curettage Bx후 op위해 입원
함
• PHx: 30년 전 폐결핵으로 P.O 복용하고
완치됨
04년 2월 vag. Bleeding으로 서울 산부
인과에서 op(?) 받음
• G3P2A1L2
• OP Hx(-)
• PAP(2005.3.2) :WNL
Uterus( longitudinal)
• AVF
• 9.2 X 5.7
Cm
Uterus(transverse)
• 7.2 Cm
• Ut.body:
Sl. Enlargement
endometrium
• 2.6Cm
- thickened
endo. And
irregular
inner
contour
color flow(-)
Endometrium(abn. Findings)
• 3.7 X 1.5
Cm sized
low-level
echoic
lesion in
endo cavity
(likely
hematoma)
Endometrium(abn. Findings)
Lt. ovary
• Lt.ov:
2.2 X 1.3Cm
Impression by sono
• R/O hematometra
• R/O Endometrial cancer
- Rec: E/B
• D/C/B(2005.3.8) after sono
• : uterus curettage
- Adenocarcinoma
Abdominopelvis CT and MRI
• 2005.3.9 시행
• Uterine corpus 에 2.5X 4Cm sized
mass보임( mass는 endometrium 과
myometrium 에 invasion 을 보이나
myometrium의 1/2을 넘지 않음)
• Uterine cervix에 nabothian cyst있음
• Abdomen과 pelvic cavity내에 fluid
collection없슴
결론:
1.Endometrial cancer in uterine corpus
-> stage IB
2.Nabothian cyst in uterine cervix
CA125
2005.3.2
2005.3.10
21.53
13.08
CA19-9
13.17
CEA
0.84
2005.3.14 TAH,BSO.BPLND
Post Op 병리 소견:
자궁의 크기는 10.1x6.7x4.4cm, 무게 167.0gm이었다.
자궁의 겉면은 적갈색으로 매끄러웠다.
자궁내막에는 장경 3.0cm의 polypoid한 lesion이 있었다.
Mass는 endometrium에서 arising하여 자궁강으로 돌출하여 있
었고,매우 friable하였다. (자궁경관의 길이는 2.5cm, 자궁내
막강의 길이는 6.0cm이었으며,
자궁내막의 두께는 0.1cm, 자궁근층의 두께는 3.0cm이었다.)
절단면은 균질한 회백색이었으며 병변은 자궁근층의 표면만
침윤하고 있었다 (depth of invasion, 0.3cm).
Endometrioid adenocarcinoma, well differentiated,
grade 1, 3.0cm
Definition
• Endometrial cancer involves
cancerous growth of the
endometrium
• Alternative Names:
- endometrial/uterine adenocarcinoma
- uterine cancer
Causes,incidence,risk factor
• 60~70 year: 1% to 2%
• Before 40 year: 2% to 5%
• Increased risk: increased levels of
natural estrogen
Associated condition
•
•
•
•
•
•
•
•
Obesity
Hypertension
Polycystic ovarian disease
Nulliparity
Infertility
Early menarch
Late menopause
Tamoxifen(breast ca)
Symptom
abnormal bleeding,abnormal
menstrual periods
• Lower abdominal pain,pelvic
cramping
• thin white or clear vaginal discharge
in postmenopausal women
Staging of carcinoma
• Stage I
- Stage Ia G123 Tumor limited to endometrium
- Stage Ib G123 invasion to less than one-half the
myometrium
- Stage Ic G123 invasion to more than one-half
the myometrium
• Stage II
- Stage IIa G123 Endocervical glandular
involvement only
- Stage Iib G123 cervical stromal invasion
Staging of carcinoma
• Stage III
- Stage IIIa G123 Tumor invades serosa and/or adnexa
and/or positive peritoneal cytology
- Stage IIIb G123 Vaginal metastases
- Stage IIIc G123 Metastases ti pelvic and/or para-aortic
lymph nodes
• Stage IV
- Stage IVa G123 Tumor invades bladder and/or bowel
mucosa
- Stage IVb Distant metastases including intra-abdominal
and/or inguinal lymph nodes
Treatment
• Stage I : surgical
hysterectomy,bilateral salpingoooporectomy
• Stage II: surgery + radiation therapy