Adenocarcinoma of the endometrium commonly presents at an early stage and is readily diagnosed by dilatation and curettage. Ultrasound has not bee accurate in differentiating this malignant neoplasm from benign causes of uterine enlargement such as leiomyoma. In this study, the sonographic findings in 21 patients with adenocarcinoma of the endometrium were compared with the clinical and pathological findings. Although no ultrasound criteria were diagnostic of carcinoma, there were statistically significant differences in uterine shape and echo pattern between Stage I-II and Stage III-IV disease: 94% of patients with Stage I-II disease had a normal or bulbous uterus and a normal or hypoechoic parenchymal pattern, while patients with a lobular uterus and/or mixed echo pattern had Stage III-IV. The only clinical errors in staging were in cases of Stage II or III disease. Ultrasound may be helpful in pretreatment staging of more difficult cases.

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Thirty-nine patients with trophoblastic disease were studied to determine the usefulness of ultrasound in identifying risk patterns and response to therapy. Serial measurements of serum human chorionic gonadotropin-beta subunit (HCG-BSU) were compared with ultrasonographic uterine and theca lutein cyst volumes. In 16 patients ultrasound demonstrated theca lutein cysts, many of which were not palpable on physical examination. Although there was a significant decrease in uterine volume and a change in the sonographic pattern following evacuation, volume slowly returned to normal over a period of several months. Persistent trophoblastic disease was more accurately detected by HCG-BSU measurements than by ultrasound. Persistent disease developed in 44% of those patients who had theca lutein cysts and in 22% of those without cysts. Patients with theca lutein cysts did not consistently have higher HCG-BSU levels than patients without cysts, and it is concluded that ultrasound is the best method for detecting these cysts.