Ultrasound findings in uterine mixed müllerian sarcomas and endometrial stromal sarcomas

Sonographic findings in five cases of mixed mullerian tumors and two cases of endometrial stromal sarcoma which were evaluated before surgery for staging are reviewed. Assessment of myometrial invasion was in agreement with surgical findings in five cases; in the two other cases invasion was overestimated. The echo pattern of these tumors presented some peculiarities. In five patients, four with mixed mullerian tumors and one with endometrial stromal sarcoma, a heterogenous pattern with high-intensity and hypoechoic areas scattered in the myometrium was seen. In the other two cases the sonographic picture was indistinguishable from that of leiomyomas. Sonography is an accurate imaging technique for preoperative staging of uterine sarcomas. If an heterogenous echo pattern of the uterus as described is found at sonography, sarcoma should be suspected and laparotomy performed urgently.