Diagnostic Ultrasound - Abdomen and Pelvis

Endometrial Carcinoma
Diagnoses: Female Pelvis
TERMINOLOGY
• Malignant proliferation of abnormal endometrial glands
IMAGING
• Mass in endometrial cavity with internal color flow
• Endometrial thickening: Mixed echogenicity more
suspicious than homogeneous
• Smooth margins in early stage disease (stage 1A)
• Disruption of subendometrial halo suggests myometrial
invasion (stage 1B)
• Multiple feeding vessels
TOP DIFFERENTIAL DIAGNOSES
• Endometrial hyperplasia
• Endometrial polyp
• Submucosal fibroid
• Uterine sarcoma
• Adenomyosis
KEY FACTS
PATHOLOGY
• Majority are adenocarcinoma, 75% endometrioid type
(associated with estrogen stimulation)
• Serous (papillary serous), clear cell types also occur (not
associated with estrogen stimulation)
CLINICAL ISSUES
• Postmenopausal women with abnormal vaginal bleeding
• Most common gynecologic malignancy
DIAGNOSTIC CHECKLIST
• Irregularly thickened endometrial echo complex in
postmenopausal patient with vaginal bleeding
• Imaging alone cannot differentiate hyperplasia from
carcinoma
• > 5 mm bilayer thickness in postmenopausal patient with
vaginal bleeding → biopsy
• Transvaginal ultrasound (TVUS) for initial detection
• MR for local staging; CECT for lymphadenopathy, mets
(Left) Longitudinal
transvaginal ultrasound in a
woman with irregular vaginal
bleeding shows a thickened
endometrium. The fundal
endometrium is echogenic ſt
but with subtle heterogeneity
and hypoechogenicity
inferiorly . Biopsy confirmed
endometrioid carcinoma.
(Right) Longitudinal
transvaginal US of a
retroverted uterus in a patient
with postmenopausal bleeding
shows a polypoid mass ſt
distending the uterine cavity.
Endocervical curettage
confirmed endometrioid
carcinoma.
(Left) Longitudinal
transvaginal US shows a large
polypoid mass ſt within the
endometrial cavity, with an
additional smaller inferior
mass st, the latter leading to
obstructive hematometros .
Pathology revealed
carcinosarcoma. (Right)
Transabdominal ultrasound
shows an internally
heterogeneous mixed
echogenicity mass ſt
expanding the uterine cavity,
with poorly defined margins
and internal calcifications .
Pathology confirmed
endometrial sarcoma.
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