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Objective:To analyze the characteristic ultrasonographic findings and clinical symptoms of primary fallopian tube cancer(PFTC)in peri-and post-menopausal women, and to provide a basis for the early diagnosis of PFTC via ultrasonography.Methods:A total of 34 patients with PFTC confirmed by surgery and pathology in Beijing Hospital from May 2012 to January 2022 were retrospectively analyzed.Patients aged between 46-85 years, including 1(2.9%)in early menopausal transition(46 years old), 3(8.8%)in late menopausal transition(48 years old, 49 years old, and 50 years old), and 30(88.2%)in post-menopause.The median age was 60 years(60.9±9.7 years). The ultrasound and clinical features were analyzed and compared with pathological results.Results:Irregular vaginal bleeding was the most common clinical symptom in the 34 patients.According to the characteristics of adnexal masses and the involvement of other organs in the pelvis and abdominal cavity, the 34 cases of PFTC were divided into 4 groups.In Group A, 6 cases showed sausage-like cystic masses in the adnexal area, with unsmooth inner walls, medium echo papillary projections on the inner wall, incomplete strip partitions, and rich or relatively rich blood flow signals on the papillary projections and partitions.On ultrasound, 1 case was diagnosed with hydrosalpinx, 2 cases with cysts in the adnexal area, and 3 cases with PFTC.In Group B, 13 cases presented with cystic or solid masses of irregular shapes and sausage-like changes in some areas.The cystic part had poor sound transmission and the solid part exhibited rich or relatively rich blood flow signals.On ultrasound, 2 cases were diagnosed with PFTC and 11 cases with ovarian cancer with 2 showing intrauterine effusion and 3 showing abdominal and pelvic effusion.There were 11 cases in Group C, presenting with hypoechoic irregular solid masses in the adnexal area, with some accompanied by thickening of the peritoneum of the anterior and posterior fornix and the omentum.There were abundant or relatively abundant blood flow signals inside the masses.On ultrasound, 10 cases were diagnosed with ovarian cancer and 1 with pelvic metastatic cancer.There were 4 cases in Group D, who showed no adnexal mass, but 3 cases had ascites and were suspected of having a malignant tumor of unknown origin.Postoperative pathological results of the 34 PFTC cases revealed that 30 had high-grade serous carcinoma, 1 had low-grade serous carcinoma, 2 had serous tubal intraepithelial carcinoma(STIC), and 1 had serous tubal in-situ carcinoma.There were 3 cases with bilateral PFTC, 10 cases with PFTC on the left and 21 cases on the right.There were 4 cases with PFTC plus ovarian cancer.According to FIGO pathological staging, 8 cases were in stage Ⅰ, 9 in stage Ⅱ, 11 in stage Ⅲ and 6 in stage Ⅳ.The accuracy of preoperative diagnosis of PFTC by ultrasound was 50.0% in Group A and 15.4% in Group B. Preoperative ultrasound did not correctly diagnose PFTC in Group C and Group D, and instead suggested pelvic malignant tumor.Conclusions:Clear display of bilateral ovaries, sausage-like masses in the adnexal area, abundant or relatively abundant low resistive index blood flow signals in papillary projections and low-speed neovascularization are helpful ultrasound signs for the early diagnosis of PFTC, but not very useful for predicting the pathological stages of PFTC.Postmenopausal woman with vaginal bleeding, vaginal secretions or lower abdominal pain should be alert to PFTC.
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Objective:To examine the ultrasonographic and clinical features of post-menopausal struma ovarii(PMOS).Methods:Clinical presentations and transvaginal sonography(TVS)data of 7 PMOS patients diagnosed during surgery were retrospectively analyzed and compared with histopathological results.Results:The ages of 7 patients ranged from 52 to 77 years(60.1±8.0 years, median age: 59 years, natural menopause age: 49.9±1.8 years). Ultrasound imaging data showed all adnexal masses were unilateral(1 on the left side, 6 on the right side). The focal lesions were irregular, round or elliptic in shape, measuring 2.8-9.5 cm, with either clear or unclear margins.Two PMSO cases were diagnose as teratoma on ultrasound, showing mixed echogenic patterns, with echoless interior regions and poor sound transmission.Color doppler flow imaging found no blood flow signal inside and around the mixed echogenic areas.Five cases were misdiagnosed on ultrasound, with 2 as postmenopausal ovarian endometrial cyst and 3 as ovarian cystadenocarcinoma.All patients recovered well after surgery.By the end of the follow-up, no recurrence of struma ovarii was found in the 7 cases.Conclusions:PMSO is a rare monodermal teratoma, can be easily misdiagnosed and needs to be differentiated from postmenopausal ovarian endometrial cyst, mature teratoma, ovarian cystadenocarcinoma and other types of lesions.A mass >5 cm may exhibit characteristic ultrasonographic manifestations, including protruding thyroid nodules, cyst wall calcification, etc.A solid portion of the cystic mass with blood flow may suggest a diagnosis of struma ovarii.
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Objective:To investigate the ultrasonographic and clinical features of postmenopausal ovarian endometriosis(OEM).Methods:Clinical, transvaginal sonography(TVS)and pathological data of 26 postmenopausal OEM patients confirmed by surgery and histology in our hospital from June 2014 to June 2019 were included in this retrospective analysis.The ages of patients ranged from 47 to 65 years(median age: 57 years old), and the age at natural menopause was(48.8±3.3)years.The duration after menopause was 1-25 years(median duration: 8 years). Transvaginal sonography(TVS)results were compared with pathological data.Results:A total of 36 adnexal lesions were found by TVS.Postoperative pathological examination confirmed 39 lesions, of which 76.9%(30 cases)were OEM lesions and 23.1%(9 cases)were non-OEM lesions in the ovary.92.3% of the adnexal lesions(36 cases)were effectively screened by TVS, and 3 lesions less than 1 cm were missed in the ovary.Among 26 subjects, unilateral OEM lesions accounted for 84.6%(22 cases). Simple cysts were the most common concurrent condition(6 cases), followed by uterine leiomyoma(4 cases), ovarian cancer(2 cases)and serous cystadenoma(1 case). The sizes of 30 postmenopausal OEM lesions ranged from 0.8 cm to 6.6 cm, and 53.3%(16 cases)were anechoic, typical of OEM on TVS.TVS found that 40.0%(12 cases)showed no specific sonographic features, 16.7%(5 cases)showed a heterogeneous echo pattern, 13.3%(4 cases)showed a homogeneous hypoecho pattern, and 10.0%(3 cases)showed a hypoechoic mass with strong internal echo, following a shadow behind it.The rate of missed diagnoses of 30 postmenopausal OEM lesions by TVS was 30.0%(9 cases), of which 23.3%(7 cases)were misdiagnosed as solid masses in the adnexal area on TVS, and 6.7%(2 cases)were missed on TVS(OEM lesions less than 1.0 cm).Conclusions:Ultrasonographic heterogeneity exists in postmenopausal OEM patients.Unilateral and anechoic ultrasound is the most common type of ultrasound imaging.It is of great significance to pay attention to TVS examination and corresponding ultrasound imaging analysis in postmenopausal women for the early diagnosis of postmenopausal OEM.
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Objective To investigate age-related changes in serum tumor markers carbohydrate antigen 125 (CA125),CA153 and CA199,and the clinical significance of separate and combined detection of these markers for screening endometrial carcinoma(EC) in elderly women with intrauterine abnormalities on transvaginal ultrasound (TVS).Methods Cross-sectional data of 420 elderly women suspected of having an intrauterine abnormality by TVS and undergone hysteroscopy with dilation and curettage from January 2010 to December 2017 were retrospectively analyzed.Patients were divided into a 60-64 years-old group and a 65-83 years-old group.Aging-related changes in positive rates of CA125,CA153 and CA199 were compared between the two groups.Differences in positive rates of tumor markers were compared between different pathological types.Using postoperative pathological diagnosis as the gold standard for EC,the diagnostic sensitivity,specificity and accuracy of serum CA125,CA153 and CA199 alone or in combination for EC were calculated.Results The positive rates of CA125,CA153 and CA199 were 3.9％(16/412),0％(0/172)and 5.0％ (20/404),respectively.The positive rate of CA125 was higher in the 65-83 years-old group(6.5％,16/246)than in the 60-64 years-old group(0.0％,0/166) (P =0.001).The positive rates of CA125 and CA199 in patients with EC were 14.3％ (4/28)and 42.9％ (12/28),which were higher than those in patients with other pathological types.However,the sensitivity of single and combined detection of CA125 and CA199 was too low for the diagnosis of EC(14％、43％).Conclusions The single and combined detection of CA125,CA153 and CA199 for screening EC is of limited value in elderly women.New tumor markers need to be identified and used in combination with TVS for screening EC in elderly women.
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Objective To explore the characteristics of endometrial lesions and uterine cavity abnormality by transvaginal sonography(TVS)and the potential impact of aging on those. Methods 1052 elderly women(aged ≥60 years)underwent hysteroscopy endometrial curettage based on TVS providing an indication of abnormal uterine cavity at our hospital from January 2010 to December 2017 ,and their clinical and pathological data were analyzed.1052 patients were divided by age into a <65 years group and a ≥65 years group. And age tertile stratifications of lower tertile group ,middle tertile group ,and upper tertile group were used to investigate the correlation between ageing and endometirum diseases. Results A total of 1052 elderly women were included ,and the simple endometrial thickening was the most common etiological factor (53.2％ ) ,followed by abnormal endometrial echoes(36.9％ )and endometrial cavity fluid(9.9％ ).All the pathological results of polyps and endometrial cancer accounted for 57.8％ and 4.2％ ,respectively.Age tertile stratification analysis suggested that the proportions of endometrial cavity fluid was 6.1％ (n=20)in the lower tertile group , 5.9％ (n=20)in the middle tertile group ,and 16.7％ (n=64)in the upper tertile group(χ2 =23.40 ,P<0.01). An increasing proportion along with aging for precancerous lesions was 0.0％ (n=0) ,2.4％(n= 8) ,3.1％ (n = 12)(χ2 = 9.04 ,P < 0.01)in lower/middle/upper age tertile groups.But the proportion of endometrial cancer was decreased with ageing [lower/middle/upper tertiles :6.1％ (n=20) ,4.7％ (n=16) ,2.1％ (n=8)(χ2 =7.23 ,P<0.01]. Conclusions TVS is an effective methodfor screening uterine cavity lesions in elderly women. The TVS-detected prevalence of endometrial cavity fluid increases with ageing. The hysteroscopy endometrial pathological examination shows that endometrial cancer decreases and precancerous lesions increase with ageing.