Femenina de 54 años de edad, menarquia a los 12 años, primera relación sexual a los 22 años. Dos gestas con dos partos naturales. Es enviada para chequeos abdominal y ginecológico. Presenta manchados vías transvaginal ocasionales. Estuvo con Diu Mirena hormonal durante dos periodos consecutivos de 5 años cada uno y posteriormente a la retirada del último se le instauro tratamiento hormonal para los sofocos, sudoraciones, nerviosismo etc. de la menopausia. La paciente además presenta dos nódulos solidos en el tiroides los cuales han sido biopsiados con resultados negativos para tumoración maligna. Se le realiza un examen sonografico abdominal con el hallazgo de dos pequeñas imágenes nodulares localizadas en lóbulo derecho compatibles con el diagnostico de hemangiomas hepáticos (fotos 1-2) los cuales son hallazgos benignos. El hígado muestra la presencia de aumento de su ecogenicidad en relación a cortex renal derecho compatible con el diagnostico de esteatosis hepática grado I-(foto 3), la paciente tiene antecedentes familiares de Diabetes Mellitus y presenta un peso adecuado (no es obesa).El resto del examen abdominal no encuentra lesiones. La sonografía pélvica vía transvaginal demuestra un útero de pequeño tamaño y ovarios con ausencia de folículos demostrables sonograficamente ambos datos compatibles con el estatus de paciente menopáusica. Lo que llama poderosamente la atención es la presencia de imagen muy hiperecogénica, central que se corresponde con un marcado engrosamiento endometrial, mide aprox: 3.10 cm (lo normal es menor de 16 mm)-(foto 6). Realizamos exploración con Doppler Color (foto 7) lo cual demuestra ligero aumento del flujo periférico del endometrio. Aplicamos la Elastografia al área endometrial engrosada lo cual nos demuestra un score 2 de Ueno y un strain ratio de 0.05 (foto 8) ambos hallazgos compatibles con tejido blando de carácter benigno. Deducimos que la gran hipertrofia endometrial ha sido provocada por el uso por largos periodos de tiempo de componentes hormonales tanto durante el uso por 10 años del DIU hormonal de Mirena como la administración posterior de hormonas para intentar controlar los síntomas de la menopausia.
Induced Endometrial Hypertrophy
54-year-old female, menarche at age 12, first sexual intercourse at age 22. Two pregnancies with two natural births. She was sent for abdominal and gynecological check-ups. She had occasional spotting via the vaginal route. She was on a hormonal Mirena IUD for two consecutive periods of 5 years each. After the last one was removed, she was started on hormonal treatment for hot flashes, sweating, nervousness, etc. of menopause. The patient also had two solid nodules in the thyroid, which were biopsied with negative results for malignant tumors. An abdominal ultrasound examination was performed, and two small nodular images located in the right lobe were compatible with the diagnosis of hepatic hemangiomas (photos 1-2), which are benign findings. The liver shows the presence of increased echogenicity about the right renal cortex compatible with the diagnosis of hepatic steatosis grade I (photo 3). The patient has a family history of Diabetes Mellitus and is of adequate weight (she is not obese). The rest of the abdominal examination found no lesions. The pelvic ultrasound via transvaginal reveals a small uterus and ovaries with an absence of follicles demonstrable sonographically, both data compatible with the status of a menopausal patient. What is particularly striking is the presence of a very hyperechoic, central image that corresponds to a marked endometrial thickening, measuring approximately 3.10 cm (normal is less than 16 mm) (photo 6). We performed an examination with Color Doppler (photo 7) which shows a slight increase in the peripheral flow of the endometrium. We applied Elastography to the thickened endometrial area, which showed a Ueno score of 2 and a strain ratio of 0.05 (photo 8), both findings compatible with benign soft tissue. We deduce that the large endometrial hypertrophy has been caused by the use of hormonal components for long periods, both during the 10-year use of the Mirena hormonal IUD and the subsequent administration of hormones to try to control the symptoms of menopause.
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| 1-Nodulo Hepatico |
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| 2-Nodulo Hepatico |
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| 3-Esteatosis Hepatica |
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| 4-Utero Axial |
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| 5-Utero Transverso |
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| 6-Hipertrofia Endometrial |
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7-Doppler Area Endometrial |
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8-Elastografia Endometrial |
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