Ko Yuri, Chung Jinha, Lee Sa Ra, Kim Sung Hoon, Chae Heedong, Kang Byung Moon
Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Menopausal Med. 2019 Dec;25(3):158-163. doi: 10.6118/jmm.19015.
To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.
We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or "Swiss cheese" appearance.
We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with "Swiss cheese" appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.
Sonographic findings of thick uterine endometrium with "Swiss cheese" appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.
在绝经前后女性中，发现经阴道超声检查显示子宫内膜增厚且呈蜂窝状表现的相似妇科情况。
我们回顾性分析了2010年1月至2016年12月接受子宫内膜组织活检患者的病例。我们还收集了门诊灵活宫腔镜检查结果及手术病理结果。我们分析了393例确诊子宫内膜病变患者的数据。在这些患者中，69例经阴道超声图像显示子宫内膜增厚且呈蜂窝状或“瑞士奶酪”样表现。
我们发现，诸如伴有变性的黏膜下平滑肌瘤、子宫内膜息肉、与他莫昔芬使用相关的假性囊性子宫内膜改变、孕激素相关的子宫内膜改变、积脓、胎盘残留及子宫粘连等妇科情况，在经阴道超声图像中表现为相似的子宫内膜增厚且呈“瑞士奶酪”样外观。绝经后女性最常见的诊断为萎缩性子宫内膜炎，其次为子宫内膜癌和子宫内膜息肉。绝经前女性最常见的诊断为无病理情况的异常子宫出血。
由于多种情况具有子宫内膜增厚且呈“瑞士奶酪”样外观这一特征，因此在做出初步诊断前，需结合患者病史和主要症状对经阴道超声检查结果进行全面评估。
