Endometrial Hyperplasia Versus Endometrial Cancer

 29 yr old married nulliparous who has had D& C done 3 times that showed atypical hyperplasia of the endometrium. Ultrasound was done by the gynecologist and she queried a myoma. MRI was requested to rule out carcinoma endometrium with myometrial extension. 

In this patient entire endometrial cavity appears replaced by mixed signal intensity area which shows imhomogenous post gadolinium enhancement and non-enhancing areas, which are likely indicating endometrial hyerplasia with doubtful loss of interface with the myometrium in the posterolateral part. Uterus per se is enlarged. This thickened endometrium shows areas of high signal on DWI image provided but there is no corresponding signal suppression on ADC map, which may indicate T2 shine through. Low signal on ADC map in endometrium is usually the sign for differentiating hyperplasia from malignancy, which is not seen in this case. So, finally this case likely indicates extensive endometrial hyperplasia with no low signal on ADC map, and doubtful loss of interface in the posterolateral endo-myometrial junction. Clinical and histological correlation will help.