Cancer de l'endomètre : diagnostic - AMC Chirurgie Cancers Pelviens


Titre: AMC Chirurgie Cancers Pelviens - Cancer de l'endomètre : diagnostic
Diagnostic: Cancer de l'endomètre : diagnostic
Auteur: KINKEL Karen
Commentaire: Dfouni Natalia
Hôpital: HUG
Département: Département de Radiologie
Date: 04.04.2003
ID: 3711
Chapitre: Utérus


Clinical Presentation: Patientes ménopausées se plaignant demétrorragie.
Commentaire: Dans les deux cas le diagnostic de cancer delíendomètre est posé
en pathologie après curetage endométrial .L'épaississement endométrial identifié à
l'échographie poselíindication du curetage. Cancer of the uterus Endometrial canceris the
most frequent cancer in the female pelvis in developedcountries. There is no existing
routine screening for endometrialcancer. The diagnosis is suspected in women presenting
withpost-menopausal bleeding and an endometrial thickness larger than 5mm, measured
by transvaginal ultrasound. Endometrial biopsy withendocervical curettage confirms the
diagnosis in differentiatingbetween benign and malignant conditions. Histopathology
alsoassesses presence of tumor in the cervix, the type of cancer(adenocarcinoma, clear
cell carcinoma, papillary carcinoma) and thedegree of cellular differentiation (grade).
Histological riskfactors of poor prognosis (intermediate or high grade tumors,papillary or
clear cell carcinoma) or clinical suspicion ofendocervical extension warrant pre-operative
staging in order toprovide more prognostic information concerning the extent of thedisease
into the myometrium, the cervix, the adnexa, the peritoneumor lymph nodes. Deep
myometrial invasion is highly correlated withlymph node invasion and cervical invasion.
Preoperative knowledgeof myometrial invasion can therefore influence the type and
extentof initial surgical treatment (extent of lymphadenectomy and typeof hysterectomy)
and might increase the patient's survival due toadequate treatment at the time of
diagnosis. Staging methods ofendometrial cancer are abdominal and transvaginal
ultrasound,contrast-enhanced CT and MR imaging. MR imaging has shown to be themost
accurate method to diagnose deep myometrial invasion comparedto CT and ultrasound. A
MR examination changes the probability ofdeep myometrial invasion from 13% (grade 1),
35% (grade 2) and 54 %(grade 3) to 60%, 84% and 92% respectively with a positive
resultand to 1%, 5% and 10% respectively with a negative result for deepmyometrial
invasion. Therefore MR imaging has become the method ofchoice to differentiate
between patients that will needlymphadenectomy (standby of a surgical oncologist, frozen
section)versus those that will not and that can be operated by a generalgynecologist. MR
imaging is also the only imaging modality withevidence based results for cervical
involvement. If myometrial,cervical and lymph node status assessment are
required,contrast-enhanced MR imaging provides the most completeevaluation.
Description: - diapo 1 : image axiale díun utérus distendu par uncontenu
hétérogène non spécifique. - diapo 2 : image sagittale díunutérus avec épaississement
endométrial dépassant la limitesupérieure des normes chez une patiente
ménopausée(5mm)


Ordre: 1008
Dislocation: 0
Polytraumatisé: 0
Ouvert: 0
Pathologic: 0
Opération: 00.00.00
Graft: 0


Références: Radiology 2002 mars

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