Diffusion-Weighted Imaging of Uterine Endometrial Stromal Sarcoma

Abstract

We demonstrated 2 cases of uterine endometrial stromal sarcoma with emphasis on diffusion-weighted imaging. The tumors showed high signal intensity, and their tumor venous thrombi were clearly depicted on diffusion-weighted imaging. Diffusion-weighted imaging is a useful method not only for diagnosis of endometrial stromal sarcoma but also for preoperative planning.

Endometrial Stromal Sarcoma of the Uterus: Magnetic Resonance Imaging Findings Including Apparent Diffusion Coefficient Value and Its Correlation With Ki-67 Expression

“…19,20 Pathological studies showed a more commonly degenerative change in HGESS than in LGESS. 1,3,4 In our series, degenerative changes were observed in 7 of 13 LGESSs, whereas those changes were observed in both of the 2 HGESSs. Sometimes, the findings of LGESS may mimic a uterine leiomyoma with cystic degeneration 19 ; however, our study showed that the cystic degeneration radially distributed from the central part of the mass to the periphery in 3 LGESSs, which were also a characteristic feature.…”

“…The cystic, hemorrhagic, and necrotic degenerations were observed in 7 of 13 LGESSs and in both of the 2 HGESSs. Microscopically, LGESSs typically showed small, uniform cells with a round to fusiform nucleus, prominent spiral arteriole-like vessels, a lack of cytological atypia, and a rare mitotic activity (G5 mitotic figures/10 highpower fields), whereas HGESS was characterized by larger, round cells, a prominent thin-walled capillary network, and increasing mitotic activity (910 mitotic figures/10 high-power fields) (Figs.…”

“…Magnetic resonance imaging features of 15 ESSs (13 LGESSs and 2 HGESSs) are summarized in Table 3. The maximum diameter of tumors ranged from 3.2 to 12.0 cm (mean, 7.6 T 2.3 cm).…”

“…10Y12 To the best of our knowledge, however, DWI findings have been reported in only 1 study with 2 ESSs. 13 In addition, no study has focused on evaluating the ADC value of ESSs and its correlation with the proliferative marker Ki-67. Therefore, the aim of our study was to investigate the conventional MRI and DWI features of ESSs and also to evaluate the correlation between ADC values and Ki-67 in this relatively large series.…”

Advanced MRI in malignant neoplasms of the uterus

“…Another finding is the continuous extension of the lesion into the adjacent structures along the fallopian tubes, uterine ligaments, or ovaries (120). DWI can visualize this characteristic quite clearly due to the high signal intensity of the tumor (121). An excellent tissue contrast of DWI may facilitate the detection of the detailed tumor extension (121) (Fig.…”