Rangeland Rummy - a board game to support adaptive management of rangeland-based livestock systems.

Rangeland-based livestock systems have to deal with the significant instability and uncertainty of the agricultural context (policy changes, volatility of input prices, etc.), and especially of the climatic context. Thus, they are particularly concerned by adaptive management strategies. To support the development of such strategies, we developed a board game including a computer model called "Rangeland Rummy". It is to be used by groups of farmers and agricultural consultants in the context of short workshops (about 3 h). Rangeland Rummy builds upon five types of material object: (i) a game board; (ii) a calendar stick indicating the starting date of the game board; (iii) sticks marked with the feed resources available for combinations of vegetation types and their management practices; (iv) cards to define animal groups and their feeding requirements throughout the year; (v) cards related to types of feed that can be attributed to animal groups throughout the year. Using these material objects, farmers collectively design a rangeland-based livestock system. This system is immediately evaluated using a computer model, i.e. a spreadsheet providing graphs and indicators providing information on, among other things, the extent to which quantitative and qualitative animal feeding requirements are covered across the year. Playing the game thus consists in collectively and iteratively designing and evaluating rangeland-based livestock systems, while confronting the players with new contextual challenges (e.g. interannual variability of weather, volatility of input prices) or new farmers' objectives (e.g. being self-sufficient for animal feeding). An example of application of Rangeland Rummy with 3 farmers in southern France is reported. Applications show that it tends to develop farmers' adaptive capacity by stimulating their discussions and the exchange of locally-relevant knowledge on management strategies and practices in rangeland-based livestock systems.

Gestational trophoblastic neoplasia after achieving a nondetectable serum human chorionic gonadotrophin level.

OBJECTIVE: To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole. DESIGN: A retrospective review of data from a national gestational trophoblastic disease centre. SETTING: The Trophoblastic Disease Unit, Dakar, Senegal. SAMPLE: Women with pregnancies affected by hydatidiform mole registered between 2006 and 2012. METHODS: The women were followed up in accordance with the hospital protocol 'Score de Dakar'. For women who progressed to gestational trophoblastic neoplasia (GTN) the time to onset of GTN, treatment and evolution were evaluated. The rate of evolution to GTN after normalisation of hCG was determined. MAIN OUTCOME MEASURES: Rate of occurrence of GTN after chemotherapy for hydatidiform mole. RESULTS: Five hundred and thirty-one women were diagnosed to have molar pregnancies. According to the hospital's protocol, 107 (20.2%) of these had chemotherapy and 224 (42.2%) had prophylactic chemotherapy. Five hundred and thirteen women (96.4%; 95% confidence interval [95% CI] 95.05-98.14%) achieved remission. Eighteen women (3.4%; 95% CI 1.86-4.94%) developed GTN (11 before remission and seven after remission). Seven women out of the 18 developed GTN after hCG normalisation (1.3%). Five of these seven were diagnosed beyond the recommended period of follow up. The mean interval to diagnosis of GTN was 18.7 months. These seven women underwent combination chemotherapy: five achieved complete remission whereas two died from GTN. CONCLUSIONS: Cytotoxic therapy for hydatidiform mole does not prevent GTN, it delays its diagnosis and promotes GTN after normalisation of hCG.

[Consequences of hysterectomy at the national- hospital of Pikine in Dakar]. / Conséquences de l'hystérectomie àu centre hospitalier national de Pikine a Dakar.

BACKGROUND: Despite the frequency of hysterectomy, several studies have reported physical and psychological sequelae of this intervention. BUT: To evaluate the consequences of hysterectomy, their level of importance and how patients experience hysterectomy. METHODS: That is a prospective study of 70 patients who underwent a hysterectomy from January 2009 to June 2011 at Pikine National Hospital. The experience of hysterectomy was determined by the physical and psychosocial felt after surgery. RESULTS: Hysterectomy represented 5.9 % of gynecological surgical activities. The indications were dominated by myoma (57.1%). Hysterectomy was performed abdominally in 78.6% of cases and associated with bilateral salpingo-oophorectomy in 87% of cases. After surgery, new symptoms appeared: hot flushes, night sweats, urinary incontinence and urge incontinence in respectively 65.7%, 54.3%, 7.1% and 11.4% of patients. A proportion of 45.6% of them had resumed sexual activity after 90 days. The fear of pain at the time of intercourse was expressed in 55.7% of cases. A decrease in the frequency of sexual intercourse was found in 54.3% of patients. A drop of pleasure during sex was expressed in 38.6% of patients. Psychological effects were also reported by patients: decreased confidence in 31.4% of patients, feeling of being rejected by her husband in 5.7% of cases, sensation of mutilation in 24.3% of cases. CONCLUSION: Physical and psychological postoperative impacts of hysterectomy are real. Adequate accompanying measures are necessary, in addition to preoperative preparation, to allow patients to improve the experience of hysterectomy.

[Pregnancies associated with valvular prosthesis at Dakar Teaching Hospital: prognosis, epidemiological, clinical and therapeutical aspects]. / Prothèse valvulaire cardiaque et grossesse au CHU de Dakar: aspects épidémiologiques, cliniques, pronostiques et modalités thérapeutiques.

OBJECTIVE: The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses. METHODOLOGY: We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar. RESULTS: The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children. CONCLUSION: With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.

[Breast cancer screening in Dakar: knowledge and practice of breast self examination among a female population in Senegal]. / Dépistage du cancer du sein: connaissance et pratique de l'auto-examen des seins au sein d'une population féminine au Sénégal.

In front of the absence of a mammographic screening program and the late diagnosis of the breast cancers in Senegal, we wanted to evaluate the knowledge and the practice of the breast self examination (BSE) by feminine population in Senegal. During the period between July 10th to August 25th 2006, through five big hospitals in Dakar, we interviewed 300 patients coming from a medical or surgical consultation. For every patient we studied the social and demographic characteristics, the antecedents and arguments about the knowledge and practice of BSE. We found, in majority, a young population (the average age was 34 years), no sent to school (26.7%), without any financial income (58.7%), with a brief knowledge about BSE (42.7%) and a regular practice of BSE (29%). The information about BSE originated essentially from educational television (52.9%). This knowledge and practice were significantly influenced by the study level (p = 0.000) and the level of financial income (p = 0.02). Among these who presented certain factors of breast cancer risk, the knowledge and the practice of the BSE were however low. The authors insist on the need to encourage the women schooling and their socioprofessional insertion so to improve the knowledge and practice of the breast self-examination in our developing countries.

Management of gestational trophoblastic diseases in a low resource country: establishment of a national center and its results.

To describe the process of establishing a reference center for gestational trophoblastic diseases (GTD) in Senegal and to report its main results so far. We describe the history and establishment of the center, which is based on the experience of the main international centers. The adaptations made to patient follow-up are detailed, while we follow FIGO and WHO diagnostic and management criteria. Finally, we report our main results. Between 2011 and 2017, 878 files were registered at the Center. More than half of the women had no histological confirmation of GTD (60.8 %). The diagnosis was then based on ultrasound images or macroscopic examination of molar vesicles. Spontaneous remission occurred in 64.5 % of the cases, while gestational trophoblastic neoplasia developed in 23.5 %. The FIGO criteria were slightly adapted for hCG monitoring. Methotrexate was the drug of choice in the low-risk group (97.8 %), while the EMACO protocol was financially difficult for nearly half of the high-risk group. The overall remission rate was 83 % and the specific lethality 11.6 %. Our center has demonstrated the efficiency of centralizing the management of GTDs. Difficulty in access to hCG and antimitotic drugs makes management difficult. However, we have introduced alternative solutions that we are working to improve.

[Sexual abuse: epidemiological, clinical aspects and management at gynaecological and obstetrical department of Dakar University Hospital]. / Profil épidémioclinique et prise en charge des victimes d'abus sexuels à la clinique gynécologique et obstétricale du CHU de Dakar.

OBJECTIVES: To carry out the epidemiological and clinical characteristics of supposed victims of sexual abuse and to evaluate case management. PATIENTS AND METHODS: A prospective study was conducted about cases of presumed sexual abuse received at the gynaecological and obstetrical clinic department of Aristide-le-Dantec hospital from January 2003 to May 2005. RESULTS: A total of 55 cases were reported and represented 0.4% of admissions in the clinic during the period of study. Twenty percent of them (20%) were referred on judicial requisition. The mean time between sexual abuse and consultation was 15 days. Victims were 14 years old in average, nulligeste in 96.5% of cases and living in the suburban area of Dakar. The presumed "violenter" was a man of 32 years, belonging to the environment of the victim in 70% of cases (spiritual guide, joint-tenant, friend of the family...). The type of sexual assault was an unprotected genito-genital intercourse in 67.3% of cases. On the clinical plan, 70.9% of patients suffered recent genital traumatism, 54.5% genital examination showed hymeneal lesions. The HIV test was positive in two cases. During the follow-up of the patients, three pregnancies occurred and for only 9.1%, a psychological assistance was proposed. CONCLUSION: Sexual abuses represent a current sociocultural issue. Prevention required large information campaign. Early management is necessary in order to prevent the sexual transmitted diseases and psychological side effects.

[The histological aspect of the uterine vein wall according to age and parity]. / Effets de l'age et de la grossesse sur les veines uterines de la femme Senegalaise.

Veinous pathology is increasingly involved in numerous gynecological and obstetrical conditions. This study describes the histological aspects of uterine vein wall according to age and parity. Uterine vein were taken during autopsy of 50 black women of various age and parity. Necroscopic samples of uterine veins were taken from 50 black women of various and diverse age and parity. Microscopic stains were used to assess histological modifications of veinous walls according to age and parity. The disorganization of elastic fibers, collagen fibers of the media, the muscular wall and elastic fibers of the adventice increased with age. The main histological modifications associated with increasing parity were the increase of collagen tissue and the disorganization of the veinous wall. This study provides useful information for other studies regarding the histological analysis of pelvic veins removed during caesarian section for vascular pathology such eclampsia, abruption.

[Periodontal status in a sample of Senegalese women using hormonal contraception]. / Etat parodontal d'une population de femmes Sénégalaises sous contraception hormonale.

Hormonal contraception is based on the use of synthetic hormones containing variable doses of oestrogen and progesterone making it possible to avoid pregnancy in a temporary and reversible way. The objective of this study is to evaluate the periodontal status of a sample of Senegalese women under hormonal contraceptive. One hundred women using contraception since at least 6 month were paired on the age, the socio-economic profile and oral hygiene with a control group. Oral hygiene (plaque index (PI) of Silness and Löe), the inflammation (gingival index (GI) of Löe and Silness), probing depth and clinical attachment loss were recorded. With equal hygiene, the scores of the gingival index were significantly higher among women under contraceptive (p < 0.001). Inflammation was significantly more marked for the women who used contraception in injectable form compared to the control group (p < 0.001). Probing depth (3.01 +/- 0.04) and clinical attachment loss (3.19 +/- 0.08) were significantly more important among women under contraceptive (p < 0.001). The women under contraceptive seem to set up a group at risk for developing a periodontal disease, it is thus necessary to systematise periodontal appraisal before and during contraceptive use period.

Differences in circulating dendritic cell subtypes in peripheral, placental and cord blood in African pregnant women.

Dendritic cells (DC) are important for induction of primary immune responses and immunological tolerance. Changes in the frequency of DC subsets were analyzed in peripheral blood from pregnant women (mPB) and compared to placental blood (PB) and cord blood (CB). DCs were identified by flow cytometry in whole blood as lineage negative and HLA-DR-positive cells. Different DC subtypes were identified with CD123 and CD11c markers. In these data, the percentage of DC was significantly lower in mPB, PB and CB than in control women, but the absolute number of DC was higher in CB, suggesting that numbers of DC in CB do not explain the decrease of the immune response in newborn infants. Myeloid DCs (MDC) decreased in all compartments of pregnant women compared to control women, especially in mPB where MDC became lower than lymphoid DCs. An increase of less differentiated DC was observed in mPB and CB from pregnant women. DCs in pregnant women were mainly immature DC with a proportion of CD83-positive DC, identical as control women. The levels of IFNgamma, TNFalpha, IL-2, IL-4, IL-5 and IL-10 were not different in the three compartments (mPB, PB, CB). In conclusion, the phenotype and subset of DCs were different in pregnant women than in control women, suggesting a role in maintenance of immune tolerance against the fetus. The distribution of DC subsets was different in mPB, PB and CB. Their role in the regulation of immune response remains to be elicited.

[First-trimester abortion at University Hospital Center in Dakar, Senegal: utility of manual vacuum aspiration]. / Avortements du premier trimestre au chu de Dakar: interêt de l'aspiration manuelle intra-uterine.

The purpose of this retrospective study was to evaluate the utility of the manual vacuum aspiration (MVA) for management of incomplete first-trimester abortions. All patients treated for incomplete first trimester abortion using MVA under local anesthesia at University Hospital Center in Dakar from January 1, 2002 to December 31, 2003 were included. A total of 2379 pregnancy losses were recorded among the 14476 patients admitted during the study period. First-trimester abortion was treated using the MVA method under local anesthesia in 1372 cases (57.7%). For 87% of patients, the duration of hospitalization was less than 12 hours. The epidemiological characteristics of these women were young age (mean, 29 years old), low parity (mean, 2 children) and low gestational age (mean, 10 weeks after amenorrhea). Spontaneous abortion accounted for 94.4% of cases and clandestine abortion for 5.6%. No complications occurred during MVA procedures and no morbidity was observed with a follow-up of one year. These findings show that MVA is a safe and effective method for completing incomplete first-trimester abortions. In our practice use of this simple technique led to a considerable improvement in post-abortion care.

[Advantages of laparoscopic assisted vaginal hysterectomy in surgery of endometrial carcinoma]. / Avantages de la voie vaginale coelio-assistée dans la chirurgie des cancers de l'endomètre.

INTRODUCTION: In to respect the principles of oncological surgery and to reduce the operative morbidity, the authors of this study propose to find the proper place of the laparoscopic-assisted vaginal hysterectomy in the surgery of endometrial carcinomas. PATIENTS AND METHODS: Between the 1st of June 2002 and 31 of May 2005, we realize a retrospective and comparative study for 36 laparoscopic-assisted vaginal hysterectomy and 20 laparotomies concerning 56 patients. RESULTS: In primary stages (stages I and II of FIGO), laparoscopic assisted vaginal hysterectomy is as powerful as the laparotomy whereas in more advanced stages, laparotomy was more complete and effective (p=0,07). One conversion case was observed (2.8%) in a context of peritoneal carcinosis (stage IIIc). There was not statistically significant difference about the operatives complications (p = 0.51). On the other hand, the postoperative comfort was so far better in the laparoscopic-assisted vaginal hysterectomy group (p=0.0002). The average delay of followed without relapses was 22,3 months in the laparoscopic-assisted vaginal hysterectomy group versus 23 months in the laparotomy group (p=0.51). CONCLUSION: Considering these results, the authors retain that, in primary stages (I-II, FIGO), laparoscopic-assisted vaginal hysterectomy represents a real option in the surgery of endometrial carcinoma. On the other hand, the advanced stages should be reserved for laparotomy.

[Von Willebrand disease and menorrhagia]. / Maladie de Willebrand et ménorragie.

INTRODUCTION: Known since over than seventy years, von willebrand disaese is the most common herediary bleeding disorder. This condition was first described by Pr. Willebrand in 1926 in a family with (positive) history of excesive bleeding tendency. Von Willebrand desease is characterized by a lifelong tendency toward easy spontaneous mucosal or post operative bleeding. In females, excessive or prolonged menorrhagia could be a sign of von willebrand desease; symptoms that are often misunderstood to be gynecologic rather than hematologic problem. In the present work, we have tried to screen for this anomaly in females with menorrhagia, following a simple anamnestic, clinical and biological protocol. PATIENTS AND METHOD: In a seventeen month study, fifty two procreating females with menorrhagia were recruited in the haematology laboratory of Aristide le Dantec hospital with the cooperation of gynecology and obstetric departements of Aristide Le Dantec, Abass Ndao and grand yoff Hospitals. RESULTS: Eight patients were revealed to be von willebrand positive (prevalence: 15%). The diagnosis was retained on the basis of epidemiological, clinical and biological data. CONCLUSION: These simple and accessible criteria should allow better handling of patients with hemorragic disorders.

Simulation training for emergency obstetric and neonatal care in Senegal preliminary results.

To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner. This approach was used to train 432 providers in 10 months and to document the increase in each participants' technical achievements. The combination of training with the "learning by doing" model ensured that providers learned and mastered all EmONC skills and reduced the missed learning opportunities observed in former EmONC training sessions. Assessing the impact of training on EmONC indicators and introducing this learning modality in basic training are the two major challenges we currently face.

[Time-course of neonatal precocious mortality between 1994 and 2003 at the Dakar University Teaching Hospital]. / Evolution de la mortalité néonatale précoce entre 1994 et 2003 au CHU de Dakar.

OBJECTIVE: To evaluate early neonatal mortality at the University Teaching Hospital and assess changes in the rate and causes during the last ten years. MATERIAL AND METHOD: We performed a retrospective analysis of neonatal deaths recorded at the Neonatal and Premature Unit (NPU) in 2003. The results were compared with earlier evaluations. Comparison of proportions was used for statistical analysis to eliminate the random element in rate variations. The significance threshold was < or =5%. RESULTS: We registered 364 neonatal deaths: 243 among 4853 newborns in our maternity ward and 121 among 213 newborns transferred from a referring maternity. Early neonatal mortality rate 45.5 per 1,000 live births. Mortality particularly concerned newborns with a birth weight < or =2,500 grams (66%) and Apgar scores < or =6. Early neonatal mortality fell significantly since 1994, while overall mortality remained high among newborns transferred from referring maternities. The most frequent causes were premature birth (49%), acute fetal distress (23%) and neonatal infection (18%). CONCLUSION: Early neonatal mortality has decreased remains at a high level. It could be improved by limiting the number of premature births, neonatal suffering and neonatal infection. In a parallel direction we recommend organizing a perinatal network in Dakar.

[Efficiency of kangaroo care on thermoregulation and weight gain of a preterm newborn cohort in Dakar]. / Efficacite de l'elevage par la methode kangourou sur la thermo- regulation et le gain ponderal d'une cohorte de prematures.

AIM OF THIS STUDY: to evaluate the efficacy of kangaroo method on thermoregulation and weight gain of a cohort of preterm. METHODS: it is a retrospective study based on files of preterm baby weighting below 2000 g, included after discharge to neonatal unit of Aristide Le Dantec maternity for kangaroo method care. Efficiency was appreciated on thermic curve evolution and daily weight gain. RESULTS: 56 preterm babies were including. Mean gestational age was 33 +/- 7,6 weeks and mean birth weight, 1488 +/- 277,6 g (median = 1500 g). Mean temperature was satisfying during follow up and was stable around 37 +/- 0,5 degrees C at discharge of program with mean daily weight gain of 33 +/- 7,6 g. We had only one case of death. CONCLUSION: The results of this study point out efficacy of kangaroo method on thermoregulation, weight gain and survival of preterm babies. We advocate for promotion in developing countries because of its low cost.

Profile of black woman in Senegal with breast cancer.

To describe the profile of Senegalese black women with breast cancer. This is a retrospective and prospective study of patients receiving care for breast cancer in the breast diseases department of the Aristide Le Dantec Teaching Hospital in Dakar from 2010 through June 2014. 188 women patients met the inclusion criteria. Their mean age at diagnosis was 43.3 years. The age of onset of the first menses was early (<12 years) in 7 patients (4.9%). More than two thirds of the women (71.6%) were premenopausal at diagnosis. At least one pregnancy was reported by 161 women (86.1%) and 96.3 had given birth. Mean age at first pregnancy was 19.47 years, and 85.9% had had their first pregnancy before the age of 30. Similarly, 133 (87.3%) had breastfed, for a mean duration of 18.36 months. In our country, breast cancer occurs in young women, who had their first menses after 12 years, are premenopausal, had their first pregnancy before the age of 30, and breastfed for several months. These data suggest that further study of this profile is needed but that the testing policy must change drastically, to start much earlier than 50 years.

[Vaginal cesarean delivery in modern obstetric practice]. / Place de la césarienne vaginale dans l'obstétrique moderne.

OBJECTIVE: To report the experience of our unit with vaginal cesarean deliveries. PATIENTS AND METHODS: This is a retrospective, descriptive study of seven vaginal cesarean deliveries performed in the maternity unit of the Centre Hospitalier Regional Universitaire de Saint-Louis in Senegal during the third quarter of 2012. The women's clinical characteristics were studied and indications for cesarean sections discussed. RESULTS: The seven vaginal cesareans accounted for 3.2% of the cesarean deliveries performed during the study period (219) and 0.6% of all births (1428). The women's average age was 31 years. Gestational age ranged from 17 to 34 weeks of gestation. The principal indication for surgery was placental abruption, in 5 (72%) cases). The fetus was dead in 4 of the 7 cases. The mean 5-min Apgar score at birth for the liveborn infants was 5 (of an optimum score of 10). Mean fetal weight at birth was 1700 g. The mean operative time was 20.7 minutes. In one case, the incision extended to the uterine corpus. The postoperative course was uneventful in all cases. CONCLUSION: Vaginal cesarean is safe, fast, but not without complications. It requires perfect mastery of vaginal surgery.

Breast cancer in women younger than 35 years : features and outcomes in the breast unit at Aristide le Dantec Teaching Hospital, Dakar.

The aim of this study was to determine the clinical features and outcomes of women younger than 35 years with breast cancer. This study was performed at Gynecologic and Obstetric Clinic of Dakar Teaching Hospital and retrospectively reviewed the records of all women younger than 35 years seen in our department for histologically proven breast cancer. Data were analyzed with SPSS software (Statistical Package for Social Science) Version 23. Between 2007 and 2015, 62 women with breast cancer met the inclusion criteria and were included. The incidence of women in this age group treated in our department was 22.6%. The median age at diagnosis was 29.7 years. The mean time to consultation was 12.5 months, and the disease was locally advanced at diagnosis in 79% of cases. Histological study found 85.5% of cancers were invasive ductal carcinoma. The immunohistochemical study found positive hormone receptors in 12 women (19.4%) and overexpression of HER-2 in 8 (12.9%). Chemotherapy was performed in 54 patients (87.1%), and surgery in 47 (62.9%). Recurrence occurred in 12. In all, 22 women died (35.5%) by the end of the study period. Mean survival was 36.7 months (CI 29.5 to 43.9) and median survival 39.7 months (CI 22.1 to 57.5). This high incidence rate in our study is consistent with that found in young African-American women and is worrisome. These results seem to point towards a genetic origin and call for a thorough search of the profile. They also call also for the involvement of pathologists and collaboration with other research teams.

[Sonographic features of gestational choriocarcinoma]. / Aspects echographiques du choriocarcinome gestationnel. Résultats préliminaires a propos 13 cas.

PURPOSE: To describe the sonographic morphological features of gestational choriocarcinoma. MATERIALS AND METHODS: Retrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in 8 cases. RESULTS: The tumor presented multiple features (nodular, submucosal, macrocystic, multicystic, compact and microcystic) often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal with small corpus luteum cysts noted in only 5 cases. In 2 cases, ultrasound modified the clinical staging. CONCLUSION: Sonographic features of gestational choriocarcinoma are variable, and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.