Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma

Abstract

Objective To describe the clinical and ultrasound characteristics of uterine sarcomas. Methods This was a retrospective multicenter study. From the databases of 13 ultrasound centers, we identified patients with a histological diagnosis of uterine sarcoma with available ultrasound reports and ultrasound images who had undergone preoperative ultrasound examination between 1996 and 2016. As the first step, each author collected information from the original ultrasound reports from his/her own center on predefined ultrasound features of the tumors and by reviewing the ultrasound images to identify information on variables not described in the original report. As the second step, 16 ultrasound examiners reviewed the images electronically in a consensus meeting and described them using predetermined terminology. Results We identified 116 patients with leiomyosarcoma, 48 with endometrial stromal sarcoma and 31 with undifferentiated endometrial sarcoma. Median age of the patients was 56 years (range, 26–86 years). Most patients were symptomatic at diagnosis (164/183 (89.6%)), the most frequent presenting symptom being abnormal vaginal bleeding (91/183 (49.7%)). Patients with endometrial stromal sarcoma were younger than those with leiomyosarcoma and undifferentiated endometrial sarcoma (median age, 46 years vs 57 and 60 years, respectively). According to the assessment by the original ultrasound examiners, the median diameter of the largest tumor was 91 mm (range, 7–321 mm). Visible normal myometrium was reported in 149/195 (76.4%) cases, and 80.0% (156/195) of lesions were solitary. Most sarcomas (155/195 (79.5%)) were solid masses (> 80% solid tissue), and most manifested inhomogeneous echogenicity of the solid tissue (151/195 (77.4%)); one sarcoma was multilocular without solid components. Cystic areas were described in 87/195 (44.6%) tumors and most cyst cavities had irregular walls (67/87 (77.0%)). Internal shadowing was observed in 42/192 (21.9%) sarcomas and fan‐shaped shadowing in 4/192 (2.1%). Moderate or rich vascularization was found on color‐Doppler examination in 127/187 (67.9%) cases. In 153/195 (78.5%) sarcomas, the original ultrasound examiner suspected malignancy. Though there were some differences, the results of the first and second steps of the analysis were broadly similar. Conclusions Uterine sarcomas typically appear as solid masses with inhomogeneous echogenicity, sometimes with irregular cystic areas but only very occasionally with fan‐shaped shadowing. Most are moderately or very well vascularized. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Cotyledonoid Leiomyoma Clinical Characteristics, Imaging Features, and Review of the Literature

“…Even more delicate is the differential diagnosis with leiomyosarcoma. Sometimes uterine sarcoma reveals rapid growth of a solid mass with intense vascularization and an irregular distribution of vessels and different anechoic areas due to necrosis 33 . Despite these unusual features, symptomatic patients with uterine sarcomas receive a correct preoperative diagnosis in fewer than 50% of cases, which is probably related to the origin of these neoplasms in the myometrium 34 .…”

The Management of the Cotyledonoid Leiomyoma of the Uterus: A Narrative Review of the Literature

“…The comparison and differentiation of cotyledonoid leiomyoma from uterine sarcoma is the actual difficulty. Uterine sarcoma may have a rapid growth and ultrasound images can show an intense vascularization with irregular distribution of vessels and several anechoic areas due to cell necrosis [61]. The magnetic resonance imaging can detect irregular margins of the mass, presenting heterogeneous contrast enhancement areas with slightly high signal intensity on T1-weighted images in the site of cell necrosis [62].…”

Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?

“…However, the ultrasound observation of a large mass, with inhomogeneous structure, without acoustic shadowing, and with rich central vascularization, assessed with colour Doppler has proven to be suspicious of malignancy [151]. On ultrasound, sarcomas typically appear as isolated large solid masses with inhomogeneous echogenicity of the solid tissue, sometimes containing cystic (usually irregular) areas and usually not having shadowing or calcifications [152,153]. e 3D power Doppler with USS has been used more recently in the diagnosis of NPUI as it can clearly show the changes in the uterine artery course in relation to the uterine body.…”