Giant endometrial polyp protruding from the external cervical os in a postmenopausal woman: magnetic resonance imaging and hysteroscopic findings

Endometrial polyps are most commonly seen in the postmenopausal women with uterine bleeding, although the giant polyps which originate from the uterine cavity and protruding from the cervical os are rare. Several cases which have been described in the literature are usually developed secondary to tamoxifen use, and the polyps do not extend or protrude from the external cervical os. Most of the polyps protruded from the cervical os can mimic a cervical neoplasia or endocervical polyp. We report the case of a giant endometrial polyp (8x4x3 cm in size) which was protruding from the external cervical os and that developed spontaneously without tamoxifen use in a multiparous 73 -year-old woman presenting with vaginal bleeding. Hysteroscopic polypectomy was performed and no recurrence was seen at 6 months after surgery. Diagnosis, management and outcome of this rare entity have been discussed according to the literature

Karaciğer kitle lezyonlarının değerlendirilmesinde kontrastlı power doppler ultrasonografinin yeri

İkinci kuşak sonokontrast madde (Levovist) kullanılarak yapılan power Doppler ultrasonografinin karaciğer kitle lezyonlarında etkinliğini araştırmak. GEREÇ ve YÖNTEM: 51 hastadaki 66 karaciğer tümörü (22 hemanjiom, 24 metastaz, 14 hepatosellüler karsinom, 1 klatskin tümörü) prospektif olarak incelendi İntratümöral vasküler sinyallerin dağılımı (periferal, santral, mozaik) ve vasküler sinyallerin miktarı (yok, minimal, orta ve şiddetli) sübjektif olarak sınıflandırıldı. BULGULAR: Sonokontrast maddenin bolus enjeksiyonu sonrasında intratümöral vasküler siyallerde güçlenme 2. dakikada başlıyor ve 4.-5. dakikalara kadar devam ediyordu. 42 tümörde kontrast madde enjeksiyonu sonrasında power Doppler ultrasonografı ile vasküler sinyalerde artış izlendi. 18 hemanjiom, 4 metastaz ve 1 hepatoselüler karsinomda vasküler sinyalerde artış izlenmedi. İntratümöral vaskülarite varlığı bir malignite kriteri olarak kabul edildiğinde; kontrastsız power Doppler ultrasonografinin malign tümörleri saptamadaki sensitivitesi % 36,3 spesifitesi % 90,9, kontrastlı power Doppler ultrasonografinin sensitivitesi % 86,3 spesifitesi % 8 1,8 idi. SONUÇ: Kontrastlı power Doppler ultrasonografı, tumoral vasküleriteyi inceleme ve karakterize etmede, kontrastsız yapılan power Doppler ultrasonografıden üstündür. Kontrastsız power Doppler ultrasonografı ile intratümöral vaskülerite saptanmayan olgularda, hemanjiom-malign karaciğer tümörü (özellikle metastatik tümör) ayırıcı teşhisinde kontrastlı power Doppler ultrasonografı kullanılabilir. Anahtar Kelimeler: Karaciğer, power Doppler ultrasonografı, LevovistTo evaluate the efficacy of second generation sonocontrast agent (Levovist) in liver tumors using power Doppler sonography. Methods: Fifty-one patients with 66 liver tumors (22 haemangiomas, 24 metastases, 14 hepatocarcinomas and 1 cholangiocellular carcinoma) were examined prospectively. The distribution (peripheral, central, mosaic) and amount (none, minimal, moderate and strong) of intratumoral flow pattern in sonographic examinations were subjectively classified. Results: The administration of the sonocontrast agent with bolus injection caused enhancement to gradually increased up to 2 minutes and lasted in 4 to 5 minutes. After injection of contrast agent, flow signals appeared or increased in 42 tumors. No signal enhancement was observed in 18 haemangiomas, 4 metastases and 1 hepatocelluler carcinoma. As based on the presence of intratumoral vascularity, sensitivity and spesificity for the detection of the malignant liver tumors was 36.3 % and 90.9 % for unenhanced power doppler sonography and 86.3 % and 81.8 % for contrast-enhanced power Doppler sonography respectively. Conclusion: Contrast-enhanced power Doppler sonography is superior to unenhanced power Doppler sonography in the demonstration and characterization of tumor vascularity. Howeover in cases; in which intratumoral vascularity is not detected with unenhanced power Doppler sonography, contrast-enhanced power Doppler sonography can be used to differentiation of haemangiomas and malignant liver tumors especially in metastatic tumor. Key words: Liver; power Doppler ultrasonography, Levovist