Symptoms are not typical and require additional diagnostics. It should be located in the upper or middle uterine segment, midway between the two apposed uterine walls (,6). MRI reveals variable abnormal endometrial findings only in approximately 81-84% of patients with endometrial carcinoma. Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. MR imaging is valuable in the evaluation of endometrial cancer. [Medline]. Paracetamol and alcohol: why joint use is dangerous? US findings of endometrial cancer are not specific and can be simulated by the following: PET/CT is not routinely employed in assessing intrauterine disease, but it can detect depth of myometrial invasion and extension into the endocervix. CT of intramural endometrial carcinoma: contrast enhancement is essential. The patient had multiple pulmonary metastases, which is indicative of stage IVB disease. When advanced stages of ovarian cancer, when a malignant lesion spreads to the endometrium, characteristic acyclic bleeding can occur. 3, 12 March 2018 | RadioGraphics, Vol. Figure 12. Seminars in Ultrasound, CT and MRI, Vol. Color and power Doppler US may occasionally aid in determining the presence and extent of tumor invasion and ensuring that biopsies are directed toward regions with increased blood flow (,5). J Comput Assist Tomogr. Stage IVA: Tumor invasion spreads into the urinary bladder or bowel mucosa. (a) Transvaginal US image reveals a uterine mass (arrows) with posterior acoustic shadowing. 8, American Journal of Roentgenology, Vol. 93, No. [Medline]. 1997 Jul. 1995 Sep-Oct. 19(5):766-72. A 57-year-old woman with stage IVB poorly differentiated endometrial carcinoma. [Medline]. [Medline]. During the secretory phase, the endometrium becomes even thicker (7–16 mm) and more echogenic (,Fig 5) (,4,,5). In turn, adenocarcinoma is subdivided into a highly differentiated, moderately differentiated and low-differentiated tumor. Share cases and questions with Physicians on Medscape consult. 2(2):189-210. 1987 Feb. 162(2):297-305. Typical examinations include transabdominal ultrasonography (TAUS) and transvaginal ultrasonography (TVUS), which are supplemented by color Doppler imaging as needed. This was a prospective multicenter study of 1714 women with biopsy‐confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high‐end ultrasound equipment. Other findings include homogeneous hyperechoic endometrial thickening and heterogeneous endometrial thickening. Relatively low accuracy in identifying metastases to lymph nodes, peritoneum, or adnexal structures. Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high‐ and low‐risk endometrial cancer. Figure 1. We thank Dr A. Rossi, Department of Obstetrics and Gynecology, Udine, Italy, and Dr B. Erdodi and Dr A. Jakab, University of Debrecen, Faculty of Medicine, Department of Obstetrics and Gynecology, Debrecen, Hungary for contributing cases to this study. Int J Gynecol Cancer. CT image shows tumor expanding the entire endometrial cavity. 7, 1 June 2014 | Journal of Ultrasound in Medicine, Vol. Any queries (other than missing content) should be directed to the corresponding author for the article. 1, American Journal of Roentgenology, Vol. Note that the marked myometrial thinning, due to both the elderly age and the marked distension of the uterine cavity, limits the assessment of myometrial invasion. Stage IVB: Distant metastases, including intra-abdominal metastases, and/or inguinal lymph nodes. [Medline]. The basic factor that determines the quality of the prognosis for endometrial cancer is the stage at which pathology is detected. Hysterectomy performed after chemotherapy confirmed tumor involvement of the lower uterine segment, the endocervix, and the outer third of the myometrium. The double decidual sac sign appears as a hyperechoic ring about the sac surrounded by a second hyperechoic ring, with a hypoechoic line interposed between the two echogenic rings due to apposition of the endometrial walls. 3, Journal of Evolution of Medical and Dental Sciences, Vol. (a) US image reveals a heterogeneous endometrial mass (arrows) that is difficult to distinguish from the myometrium.
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