Objective:To investigate the ultrasonographic and clinical features of postmenopausal ovarian endometriosis(OEM).Methods:Clinical, transvaginal sonography(TVS)and pathological data of 26 postmenopausal OEM patients confirmed by surgery and histology in our hospital from June 2014 to June 2019 were included in this retrospective analysis.The ages of patients ranged from 47 to 65 years(median age: 57 years old), and the age at natural menopause was(48.8±3.3)years.The duration after menopause was 1-25 years(median duration: 8 years). Transvaginal sonography(TVS)results were compared with pathological data.Results:A total of 36 adnexal lesions were found by TVS.Postoperative pathological examination confirmed 39 lesions, of which 76.9%(30 cases)were OEM lesions and 23.1%(9 cases)were non-OEM lesions in the ovary.92.3% of the adnexal lesions(36 cases)were effectively screened by TVS, and 3 lesions less than 1 cm were missed in the ovary.Among 26 subjects, unilateral OEM lesions accounted for 84.6%(22 cases). Simple cysts were the most common concurrent condition(6 cases), followed by uterine leiomyoma(4 cases), ovarian cancer(2 cases)and serous cystadenoma(1 case). The sizes of 30 postmenopausal OEM lesions ranged from 0.8 cm to 6.6 cm, and 53.3%(16 cases)were anechoic, typical of OEM on TVS.TVS found that 40.0%(12 cases)showed no specific sonographic features, 16.7%(5 cases)showed a heterogeneous echo pattern, 13.3%(4 cases)showed a homogeneous hypoecho pattern, and 10.0%(3 cases)showed a hypoechoic mass with strong internal echo, following a shadow behind it.The rate of missed diagnoses of 30 postmenopausal OEM lesions by TVS was 30.0%(9 cases), of which 23.3%(7 cases)were misdiagnosed as solid masses in the adnexal area on TVS, and 6.7%(2 cases)were missed on TVS(OEM lesions less than 1.0 cm).Conclusions:Ultrasonographic heterogeneity exists in postmenopausal OEM patients.Unilateral and anechoic ultrasound is the most common type of ultrasound imaging.It is of great significance to pay attention to TVS examination and corresponding ultrasound imaging analysis in postmenopausal women for the early diagnosis of postmenopausal OEM.

Objective:To investigate the correlations between the labor process and the elastography parameters, and to explore the correlations among the elastography parameters.Methods:A total of 48 pregnant women in the late periods of pregnancy in Beijing Hospital from November 10, 2018 to January 30, 2019 were recruited prospectively. Elastography was performed to measure several elastographic parameters including the cervical length (CL), elasticity contrast index (ECI), hardness ratio (HR), internal orifice uterus(IOS) and external orifice uterus(EOS). They were followed up to delivery, and were divided into normal group and prolonged group according to the time duration of the first stage of labor. The correlation between the parameters and the time duration of the first stage of labor, as well as the relationships among the parameters were evaluated.Results:Among the 48 pregnant women, 35 cases were delivered by the vagina, 13 by cesarean section, 4 of whom were due to the prolongation of the first stage of labor and the other 9 cases for other reasons. The values of the CL and HR in normal group were significantly lower than that in prolonged group ( P=0.004, 0.02). The ECI in the normal group was significantly higher than that in the prolonged group ( P=0.046). Both the IOS and EOS in the normal group were higher than those in prolonged group without no significant difference( P>0.05). For the 35 women who underwent cervical elasticity assessment before labor and finally delivered vaginally, the duration of the first stage of labor was negatively correlated with cervical ECI ( r=-0.415, P<0.05). The ECI were negatively correlated with CL and HR ( r=-0.528, -0.374; P<0.05), and HR were negatively correlated with IOS and EOS ( r=-0.669, -0.558; P<0.01), whereas HR had no significant correlation with CL( P>0.05). Conclusions:The ECI of cervical tissue measured by cervical elastography can be used to semi-quantitatively evaluate the maturity of the cervix, it has potential value in predicting the labor duration and guiding clinical decision-making.

Objective:To analyze the characteristic ultrasonographic findings and clinical symptoms of primary fallopian tube cancer(PFTC)in peri-and post-menopausal women, and to provide a basis for the early diagnosis of PFTC via ultrasonography.Methods:A total of 34 patients with PFTC confirmed by surgery and pathology in Beijing Hospital from May 2012 to January 2022 were retrospectively analyzed.Patients aged between 46-85 years, including 1(2.9%)in early menopausal transition(46 years old), 3(8.8%)in late menopausal transition(48 years old, 49 years old, and 50 years old), and 30(88.2%)in post-menopause.The median age was 60 years(60.9±9.7 years). The ultrasound and clinical features were analyzed and compared with pathological results.Results:Irregular vaginal bleeding was the most common clinical symptom in the 34 patients.According to the characteristics of adnexal masses and the involvement of other organs in the pelvis and abdominal cavity, the 34 cases of PFTC were divided into 4 groups.In Group A, 6 cases showed sausage-like cystic masses in the adnexal area, with unsmooth inner walls, medium echo papillary projections on the inner wall, incomplete strip partitions, and rich or relatively rich blood flow signals on the papillary projections and partitions.On ultrasound, 1 case was diagnosed with hydrosalpinx, 2 cases with cysts in the adnexal area, and 3 cases with PFTC.In Group B, 13 cases presented with cystic or solid masses of irregular shapes and sausage-like changes in some areas.The cystic part had poor sound transmission and the solid part exhibited rich or relatively rich blood flow signals.On ultrasound, 2 cases were diagnosed with PFTC and 11 cases with ovarian cancer with 2 showing intrauterine effusion and 3 showing abdominal and pelvic effusion.There were 11 cases in Group C, presenting with hypoechoic irregular solid masses in the adnexal area, with some accompanied by thickening of the peritoneum of the anterior and posterior fornix and the omentum.There were abundant or relatively abundant blood flow signals inside the masses.On ultrasound, 10 cases were diagnosed with ovarian cancer and 1 with pelvic metastatic cancer.There were 4 cases in Group D, who showed no adnexal mass, but 3 cases had ascites and were suspected of having a malignant tumor of unknown origin.Postoperative pathological results of the 34 PFTC cases revealed that 30 had high-grade serous carcinoma, 1 had low-grade serous carcinoma, 2 had serous tubal intraepithelial carcinoma(STIC), and 1 had serous tubal in-situ carcinoma.There were 3 cases with bilateral PFTC, 10 cases with PFTC on the left and 21 cases on the right.There were 4 cases with PFTC plus ovarian cancer.According to FIGO pathological staging, 8 cases were in stage Ⅰ, 9 in stage Ⅱ, 11 in stage Ⅲ and 6 in stage Ⅳ.The accuracy of preoperative diagnosis of PFTC by ultrasound was 50.0% in Group A and 15.4% in Group B. Preoperative ultrasound did not correctly diagnose PFTC in Group C and Group D, and instead suggested pelvic malignant tumor.Conclusions:Clear display of bilateral ovaries, sausage-like masses in the adnexal area, abundant or relatively abundant low resistive index blood flow signals in papillary projections and low-speed neovascularization are helpful ultrasound signs for the early diagnosis of PFTC, but not very useful for predicting the pathological stages of PFTC.Postmenopausal woman with vaginal bleeding, vaginal secretions or lower abdominal pain should be alert to PFTC.

Objective:To examine the ultrasonographic and clinical features of post-menopausal struma ovarii(PMOS).Methods:Clinical presentations and transvaginal sonography(TVS)data of 7 PMOS patients diagnosed during surgery were retrospectively analyzed and compared with histopathological results.Results:The ages of 7 patients ranged from 52 to 77 years(60.1±8.0 years, median age: 59 years, natural menopause age: 49.9±1.8 years). Ultrasound imaging data showed all adnexal masses were unilateral(1 on the left side, 6 on the right side). The focal lesions were irregular, round or elliptic in shape, measuring 2.8-9.5 cm, with either clear or unclear margins.Two PMSO cases were diagnose as teratoma on ultrasound, showing mixed echogenic patterns, with echoless interior regions and poor sound transmission.Color doppler flow imaging found no blood flow signal inside and around the mixed echogenic areas.Five cases were misdiagnosed on ultrasound, with 2 as postmenopausal ovarian endometrial cyst and 3 as ovarian cystadenocarcinoma.All patients recovered well after surgery.By the end of the follow-up, no recurrence of struma ovarii was found in the 7 cases.Conclusions:PMSO is a rare monodermal teratoma, can be easily misdiagnosed and needs to be differentiated from postmenopausal ovarian endometrial cyst, mature teratoma, ovarian cystadenocarcinoma and other types of lesions.A mass >5 cm may exhibit characteristic ultrasonographic manifestations, including protruding thyroid nodules, cyst wall calcification, etc.A solid portion of the cystic mass with blood flow may suggest a diagnosis of struma ovarii.

Objective:To examine the ultrasound images, clinical features, intraoperative conditions, and pathological features of ovarian clear cell carcinoma(OCCC)during perimenopause, in order to improve the early diagnosis of OCCC via ultrasound examination.Methods:A retrospective analysis of 29 patients, aged 42-72(56.8±7.4)years, who were surgically treated and pathologically diagnosed with OCCC at our hospital between 1 September 2015 and 31 December 2022, including 10 in the non-menopausal phase, 3(10.3%)in early menopausal transition, 7(24.1%)in late menopausal transition, and 19(65.5%)in the post-menopausal phase.The number of pregnancies(1.86±1.04)and the number of births(0.97±0.56)were also recorded.Results:In 29 cases, the masses contained solid components, and the ultrasound manifestations were as follows: (1)single-compartment cystic masses(solid components accounted for <50% of the total volume)were found in 11 cases, with clear borders, regular morphology, ground-glass echoes inside the cystic cavity, multiple solid protrusions inside the cystic cavity, and blood flow signals inside the solid components on color Doppler flow imaging(CDFI); (2)multi-compartment cystic masses(solid components accounted for <50% of the total volume)occurred in 8 cases, with largely clear borders, ground-glass echoes inside the cystic cavity, multiple solid protrusions inside the cavity, thick walls where the protrusions were attached, varying thickness of walls separating the cystic cavities, and blood flow signals inside the solid components, walls where there were solid attachments and thicker parts of the separating walls on CDFI; (3)there were 7 cases with predominantly solid cystic masses(the solid components accounted for >50% of the total volume), unclear borders, poor translucency, irregular morphology of the solid components, uneven internal echoes, and blood flow signals in the solid component on CDFI; (4)solid masses(the solid components accounted for >95%of the total volume)were seen in 3 cases with unclear borders, irregular morphology, uneven internal echoes, and a small number of cystic cavities(cystic portion <5%), with poor translucency in the cystic cavities and blood flow signals in the solid components on CDFI.Intraoperative exploration of ascites was performed in 17 cases, and adhesion between the mass and surrounding organs was found in 27 cases.Postoperative pathological results revealed 26 cases with high grade tumors and 3 cases with intermediate grade tumors.There were 3 cases with bilateral OCCC, 13 with left side OCCC and 13 with right side OCCC.According to the FIGO pathological staging system, 12 cases were in stage Ⅰ, 10 in stage Ⅱ, 5 in stage Ⅲ and 2 in stage Ⅳ.Comparison of different pathological stages(early stages Ⅰ and Ⅱ versus late stages Ⅲ and Ⅳ)showed statistically significant differences in the ratio of pathological stages between patients with different ultrasonographic manifestations( χ2=11.163, P<0.05), and the results of two-by-two comparisons showed that OCCC patients with ultrasonographic manifestations of solid masses(solid component accounting for >95%of the total volume)were more often in the late stage at the time of onset, while OCCC patients with a high number of cystic components within the lesions were more likely to be in the early stage at the time of onset.OCCC patients with more cystic components in the lesions tended to have an earlier onset and a better prognosis. Conclusions:When ultrasound imaging shows primarily a single chamber cystic solid mass in a patient in the perimenopausal phase with an endometriosis history, together with signs of specialized examination and pelvic adhesion during transvaginal sonography, a diagnosis of OCCC should be suspected.It is of great significance to pay attention to transvaginal sonography examination, ultrasound image features and clinical symptoms in perimenopausal women for the early diagnosis of OCCC.