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Soru

Zorluk: KolayGynecologic Oncology

During a wellness visit, a 67-year-old nulligravid female reports noticing blood on her undergarments over the past three weeks. She notes her last menstrual period occurred at age 51. Her medical history includes type 2 diabetes mellitus, hypertension, and obesity. Her current body mass index is 39 kg/m239 \text{ kg/m}^2. A speculum examination reveals a normal-appearing cervix with no vaginal or vulvar lesions. Transvaginal ultrasonography demonstrates an endometrial stripe thickness of 14 mm14 \text{ mm}. Which of the following is the most appropriate next step in the management of this patient?

  1. Endometrial biopsyCevap
  2. B
    Repeat transvaginal ultrasonography in 6 months
  3. C
    Total extrafascial hysterectomy
  4. D
    Measurement of serum CA-125 concentration
  5. E
    Cervical cytology testing

Cevap

Endometrial biopsy
The correct next step is an endometrial biopsy. This patient presents with postmenopausal bleeding (PMB) and possesses several unopposed estrogen risk factors for endometrial cancer, including obesity, nulligravidity, and type 2 diabetes. The initial evaluation for PMB typically involves either transvaginal ultrasonography or an endometrial biopsy. Because her ultrasound demonstrates an endometrial thickness of 14 mm14 \text{ mm} (normal in postmenopause is ≤4 mm\leq 4 \text{ mm}), she requires immediate histologic evaluation of the endometrium to rule out hyperplasia or carcinoma.

Adım Adım Çözüm

1
Identify the patient's primary clinical presentation and risk factors.
The patient has postmenopausal bleeding with multiple risk factors for endometrial cancer, including advanced age, nulligravidity, type 2 diabetes, and obesity.
Recognizing the high-risk profile establishes the pretest probability for endometrial hyperplasia or carcinoma.
2
Evaluate the objective imaging findings provided.
Transvaginal ultrasonography reveals an endometrial thickness of 14 mm.
In postmenopausal women, an endometrial stripe thickness greater than 4 mm is considered abnormal and warrants further investigation.
3
Determine the required diagnostic intervention.
The patient must undergo an endometrial biopsy to obtain a histologic diagnosis.
Tissue sampling is the definitive method to rule out or diagnose endometrial cancer in symptomatic patients with abnormal ultrasound findings.

Anahtar Kavram

In postmenopausal women presenting with vaginal bleeding, an endometrial thickness greater than 4 mm4 \text{ mm} on transvaginal ultrasound is abnormal and strictly mandates an immediate endometrial biopsy to rule out malignancy.
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Konular

Gynecologic Oncology

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