• Incomplete vaginal canalization
• suspected when girl reaches puberity w/o menstruation

• Invasive growth of the endometrium into the myometrium,l more extensive on the posterior wall
• More common in diffuse
• focal adenomyosis - adenomyoma

• Caused by chronic cervicitis
• Results from obstructed, dilated endocervical glands
• Also called epithelial inclusion cyst

• Caused by chronic inflammation
• Present with irregular bleeding
• May be pedunclulated

• Obstruction of the cervical canal

     -Internal or external os

• Fluid filled uterus
• Menopausal pt - asymptomatic
• Premenopausal may experience oligomenorrhea or amenorrhea w/ cramps

• Squamous cell most common
• Clinically - vaginal discharge or bleeding
• Sonographically - retrovesical mass, obstruction of ureters, invasion of bladder

• Seen in hysterectomy patients
• Upper limit size of normal - 2.1cm

• Most common cystic lesion of vagina
• Solid masses w/ areas of necrosis
• fluid, blood, or puss

Leiomyomas

(fibroids)

(Myoma)

• Most common benign structure
• African american women
• Estrogen dependent

• May erode into endometrial cavity causing irregular bleeding, anemia
• infertility by preventing adequate implantation
• recurrent miscarriages

• May cause infertility
• Confided to myometrium

• Projects into peritoneal surface
• May be pedunculated
• May migrate

• Dont become malignant
• will shrink but not disappear
• sonographically - uterine enlargement with heterogenous texture, hypoechoic

• Myomas most common cause
• Arcuate artery less common

Arteriovenous

Malformations

• Multiple communications between arterial and venous system w/o capillary network
• rare
• Most are secondary to trauma, malignancy, or infection
• Metrorrhagia w/ blood loss & anemia
• Sonographically - mosaic pattern

Uterine

 Leiomyosarcoma

• Rare
• Smooth muscle tumor in the uterine wall
• If solid components are growing - may be malignant

Endometrial thickness

Menstrual

Endometrial Thickness

Early Proliferative

Endometrial Thickness

Periovulatory

Endometrial Thickness

Secretory

• Most common cause of uterine bleeding
• Develops from prolonged estrogen stimulation
• Thickened endometrium
• Less common during reproductive years

• Overgrowth of endometrial tissue covered by epithelium
• Cause diffuse or focal

• Infection within the endometrium
• In association with Pelivic inflammatory disease
• intense pain

• Endometrial adhesions
• Asherman's syndrome
• Posttraumatic or postsurgical histories
• Bright echoes in endometrial cavity
• best seen in secretory phase or gravid uterus

• Most common gyn malignancy in N. America
• most common clinical presentation is uterine bleeding
• Associated with estrogen replacement therapy
• Earliest change - thickened endometrium
• tomoxifen/arimedex therapy increases risk

• Copper 7
• Tatum T
• Lippes loop