Endometrial Microcalcifications Detected by Ultrasonography: Clinical Associations, Histopathology, and Potential Etiology

Endometrial Calcifications

Benign endometrial calcifications with or without bone fragments are uncommon clinicopathologic findings. They can be detected during pelvic ultrasonography or as incidental pathologic findings. They have been found to be associated with infertility and menstrual anomalies in young adult patients and in symptomatic postmenopausal women with endometrial atrophy and endometrial polyps. Its exact etiology is unknown, its pathogenesis is controversial, and its clinical importance is not fully validated. We performed a retrospective review study over 7 years and found 11 (0.4%) cases of benign endometrial calcifications. The mean patient age was 45.2 years (range = 20-66 years). All of the women complained of menstrual abnormalities and 4 complained of infertility. Six had a previous procedure of abortion, 2 had oral contraceptive pills, and 4 a course of progesterone therapy. Their size and morphology varied from heterogeneous microcalcifications of variable appearances, shattered glassy chunks to detached bones. Four cases were associated with endometrial polyps, 1 with a placental site nodule, 1 with chronic endometritis, and 1 with endometrial hyperplasia. Most showed secretory endometrial tissue and ciliated cell metaplasia. Two cases showed atrophic endometrium. Etiology and pathogenesis are multifactorial and miscellaneous. Progesterone may play a role. Heterogeneous histomorphologic patterns may carry potential pitfalls. Pathologic recognition is clinically important to reassure clinicians in symptomatic postmenopausal women, alert gynecologists to a treatable albeit rare cause of infertility in younger women, and assist in patients' counselling. We also included cases of calcifications associated with endometrial malignancies to compare and contrast malignant endometrial calcifications with benign endometrial calcifications.

Calcification: A Disregarded or Ignored Issue in the Gynecologic Tumor Microenvironments

Although calcification in the gynecologic tumor microenvironments is a common phenomenon, doctors and researchers still disregard or ignore the issue. In fact, this change in the gynecologic tumor microenvironments is clinically significant and a number of studies have reported an association between calcification and gynecological tumor progression. In ovarian cancer, calcification is predominantly psammomatous and largely occurs in serous papillary ovarian tumors. In addition, calcification in ovarian cancer correlated with lower histologic grade and may indicate a poorer survival rate. In uterine fibroids, calcification occurs as a degenerative change and is predictive of a good prognosis. As for endometrial cancer and cervical cancer, calcification rarely occurs in these cancers. The mechanism of calcification in the gynecologic tumor microenvironments is not currently clear. One theory is that calcification occurs due to degeneration of the tumor cells; another theory is that calcification occurs in response to secretions from cells in the tumor microenvironment. Although previous studies have revealed a direct association between calcifications and gynecological tumors, this association has not been fully clarified. To better clarify the significance of calcification in terms of diagnosing and treating gynecological tumors, the associations between calcification and the different histologic stages and prognosis in gynecological tumors should be further studied. In particular, more attention should be paid to the morphological characteristics, chemical nature, and mechanism of calcifications in the gynecological tumor microenvironments.

The Detection of Uterine Leiomyoma (Fibroid) Calcifications on 18F-NaF PET/CT

Uterine leiomyomas (fibroids) are the most common type of uterine neoplasms in premenopausal women. Leiomyomas are estrogen dependent and tend to atrophy and shrink in size after menopause. Dystrophic calcification, cystic changes, and necrosis are among the changes that indicate uterine fibroid involution. We are presenting a calcified uterine leiomyoma in a 61-year-old woman as incidentally detected on F-NaF PET/CT scanning. Many previous publications have reported the accumulation of F-NaF in soft tissue calcifications; these findings further set new directions in the evaluation of the metabolic activity of macrocalcification and microcalcification using molecular imaging probes.

Thyroid follicular neoplasms: can sonography distinguish between adenomas and carcinomas?

PURPOSE

The purpose of this study was to determine whether sonography (US) can usefully differentiate thyroid follicular adenoma (FA) and follicular carcinoma (FC).

METHODS

This retrospective study included 60 pathologically proven FAs and 66 FCs in 123 consecutive patients (17 males and 106 females) with a mean age of 47 +/- 13 years, (17-73 years) who underwent thyroid surgery. We analyzed US features of each nodule, including maximum diameter, echogenicity, composition, presence of calcification, margins, and presence of halo. The frequencies of each US feature were compared by using the chi(2) test or Fisher's exact test between FAs and FCs. The relative risk of malignancy was evaluated by logistic regression analysis.

RESULTS

Isohypoechoic echogenicity, predominantly solid or mixed echotexture, and presence of microcalcifications or rim calcifications were associated with FC (p < 0.05). Logistic regression analysis demonstrated that predominantly solid or mixed echotexture and microcalcifications or rim calcifications were associated with significant increases in relative risk for FC (odds ratio 8.1 and odds ratio 13.5, respectively, p < 0.01).

CONCLUSIONS

The US features of isohypoechoic echogenicity, predominantly solid or mixed echotexture, and microcalcifications or rim calcifications are more common in FC than in FA.