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Sonohysterography for Evaluation of the Endometrium in Women Treated with Tamoxifen

Lucy E. Hann1, Elissa M. Gretz2,3, Ariadne M. Bach1 and Sonia M. Francis1

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
2 Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
3 Present address: 445 E. 86th St., Apt. 1B, New York, NY 10028.



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  		Fig. 1. —56-year-old woman undergoing tamoxifen therapy for 3 years who had prior endometrial biopsy with negative findings. Sagittal sonohysterogram reveals 3-cm endometrial polyp (calipers) and normal endometrium. Polyp was confirmed at hysteroscopy.

 


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  		Fig. 2A. —55-year-old woman undergoing tamoxifen treatment for 5 years. Endometrium (calipers) is thickened, with cystic areas on sagittal transvaginal sonogram.

 


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  		Fig. 2B. —55-year-old woman undergoing tamoxifen treatment for 5 years. Longitudinal sonohysterogram reveals circumferentially thickened endometrium (solid arrows) measuring 12 mm and containing cystic areas. Catheter (open arrows) is in cervix. Histopathology from hysteroscopy with dilatation and curettage showed endometrial hyperplasia with atypia.

 


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  		Fig. 3A. —77-year-old woman undergoing tamoxifen therapy for 2 years in whom sonohysterography revealed endometrial polyp, but hysteroscopy was negative for polyp and histopathology revealed benign endometrium. Transverse sonohysterogram reveals polypoid mass (arrow) containing cystic areas and projecting into endometrial cavity.

 


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  		Fig. 3B. —77-year-old woman undergoing tamoxifen therapy for 2 years in whom sonohysterography revealed endometrial polyp, but hysteroscopy was negative for polyp and histopathology revealed benign endometrium. Longitudinal color power Doppler sonogram reveals feeding vessel (arrow) that further supports diagnosis of endometrial polyp.

 


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  		Fig. 4A. —63-year-old woman with tamoxifen who required no further examination after sonohysterography revealed that apparent endometrial thickening on transvaginal sonography was caused by subendometrial cysts. Endometrium (arrows) appeared ill-defined, had cystic areas, and measured 11 mm in thickness on sagittal transvaginal sonogram.

 


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  		Fig. 4B. —63-year-old woman with tamoxifen who required no further examination after sonohysterography revealed that apparent endometrial thickening on transvaginal sonography was caused by subendometrial cysts. On longitudinal sonohysterogram, endometrium (open arrows) appears normal and subendometrial cyst (solid arrow) is seen.

 

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