The objective of our study was to determine the utility of diffusion-weighted magnetic resonance (DWMR) to differentiate the atypical uterine leiomyomas and sarcomas, establishing a cut-off value of the apparent diffusion coefficient (ADC) to rule out the malignancy. We performed a diagnostic accuracy retrospective study including 10 patients with pelvic sarcomas and 17 patients with leiomyomas. Atypical morphological features in magnetic resonance (MR) studies occurred in 58.8% of the patients, leading to a significant number of indeterminate diagnoses. In contrast, ADC values were consistent for leiomyomas, sarcomas, primary tumours, recurrences, intrauterine and in the extrauterine pelvic locations. The ADC cut-off value was set in 1 (×10 mm/s). Thus, the ADC values equal or superior to 1 × 10 mm/s were always associated with a leiomyoma. The structural MR accuracy was 66.7%, reaching 100% when using DWMR with dichotomised ADC values. Diffusion-weighted imaging with the quantitative measurement of ADC may be considered a useful preoperative test for the differentiation of atypical leiomyomas from sarcomas. Impact statement What is already known on this subject? Papers reporting the utility of a diffusion-weighted MR for the diagnosis of uterine sarcomas are scarce and consist of a small series. However, the published results are consistent with our study, with the decreased ADCs in the case of malignancy. What do the results of this study add? The main differential characteristic of our study is that we selected only the atypical leiomyomas: they share sonographic and MR features with sarcomas, which often leads to an inaccurate diagnosis. This is also the first paper reporting on the role of DWMR with ADC for these types of tumours in extrauterine pelvic locations. We demonstrated a consistent relationship between dichotomised ADC values in leiomyomas/sarcomas for these particular cases and in recurrent tumours, with no overlap between both the groups, as a difference with the previous reports. What are the implications of these findings for clinical practice and/or further research? Our study can be considered as a proof of concept supporting DWMR with ADC measurement as a useful tool to enhance the diagnostic accuracy of MR, highlighting its value to rule out malignancy. Hence, DWMR seems to be a potential useful test to include in the preoperative evaluation of clinically atypical uterine tumours.

Objectives: To examine xenoestrogen concentration differences between women with leiomyomas or endometriosis and control women, and to study the relationship between the clinical and sociodemographic characteristics of these patients and their xenoestrogen levels. Design: Prospective case-control study Setting: Quironsalud Madrid University Hospital, Spain. Sample: Cases included 117 patients who underwent surgery for uterine leiomyomas (74/117), endometriosis (21/117), or both (22/117). One hundred and four healthy women who underwent surgical procedures for other reasons comprised the control group. Methods: Xenoestrogen concentration was determined in the omental fat of all patients. Using a questionnaire and reviewing the patient´s medical records, the investigators collected sociodemographic data and other relevant variables. Main outcome measures: Xenoestrogen concentration (TEXB-α) in omental fat. Results: A significant majority of the study participants (68.8%) had detectable levels of xenoestrogens. We found no association between TEXB-α in omental fat and the presence of myomas or endometriosis. In the case group, women working in Madrid Community exhibited, on average, 2.83 Eeq pM/g higher levels of TEXB-α compared to those working in other areas (p=0.046). Women who referred use of estrogen-containing hormonal contraceptives had, on average, 3.02 Eeq pM/g higher levels of TEXB-α compared to those who had never used them (p=0.022). Conclusions: This study found no association between omental xenoestrogen levels and leiomyomas or endometriosis. However, their presence in most participants and their association with highly polluted areas emphasizes the importance of limiting environmental exposure to these substances. We also identified an association between hormonal contraceptives use and xenoestrogen concentration.