How to differentiate uterine leiomyosarcoma from leiomyoma with imaging

Publication date: Available online 16 August 2019Source: Diagnostic and Interventional ImagingAuthor(s): S. Sun, P.A. Bonaffini, S. Nougaret, L. Fournier, A. Dohan, J. Chong, J. Smith, H. Addley, C. ReinholdAbstractUterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical criteria. Furthermore, imaging differentiation between both entities is frequently challenging due to their potential overlapping features. Because a suspected leiomyoma is often managed conservatively or with minimally invasive treatments, the misdiagnosis of leiomyosarcoma for a benign leiomyoma could potentially result in significant treatment delays, therefore increasing morbidity and mortality. In this review, we provide an overview of the differences between leiomyoma and leiomyosarcoma, mainly focusing on imaging characteristics, but also briefly touching upon their demographic, histopathological and clinical differences. The main indications and limitations of available cross-sectional imaging techniques are discussed, including ultrasound, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography. A particular emphasis is placed on the review of specific MRI features that may allow distinction between leiomyomas and leiomyosarcomas according to the most recent evidence in the literature. The potential contribution of texture analysis is also discusse...
Source: Diagnostic and Interventional Imaging - Category: Radiology Source Type: research

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AbstractPurposeTo establish MRI features that help differentiate atypical leiomyomas and leiomyomas with degeneration that show hyperintensity on T2WI from leiomyosarcomas.Methods and materialsThis retrospective study evaluated 41 women who performed MRI before undergoing hysterectomy and had histologically proven atypical leiomyomas, leiomyomas with degeneration or leiomyosarcomas (21 leiomyomas; 20 leiomyosarcomas); only patients with T2 hyperintense myometrial tumors were included. The association between MRI features (contours; free pelvic fluid; intra-tumoral hemorrhagic areas, T2 heterogeneity; T2 dark areas; flow vo...
Source: Abdominal Imaging - Category: Radiology Source Type: research
Journal of Gynecologic Surgery, Ahead of Print.
Source: Journal of Gynecologic Surgery - Category: OBGYN Authors: Source Type: research
Purpose of review Uterine leiomyomas are the most common benign uterine smooth muscle tumors. On the basis of imaging, these masses are often presumed to be benign conventional leiomyomas and surgical excision is a common treatment choice. After myomectomy or hysterectomy for presumed leiomyomas, the surgical pathology report may reveal an unexpected diagnosis of another type of mesenchymal tumor. These can range from a variant of benign smooth muscle tumors to smooth muscle tumors of uncertain malignant potential to malignant sarcomas. This review describes these variant pathologies and reviews data on recurrence risk a...
Source: Current Opinion in Obstetrics and Gynecology - Category: OBGYN Tags: SPECIAL COMMENTARIES Source Type: research
Laco J, Krbal L, Tichá I, Dundr P Abstract Leiomyoma with bizarre nuclei (LBN) is an uncommon variant of uterine smooth muscle neoplasm. Involvement of fumarate hydratase (FH) has been suggested in the pathogenesis of a subset of LBN. The goal of our study is to assess the clinicopathological, morphological, immunohistochemical and molecular findings focusing on FH in LBNs (n = 108) and compare it with the findings in usual leiomyomas (UL; n = 50) and leiomyosarcomas (LMS; n = 42). Immunohistochemically, loss of FH expression was found in 67/108 of LBN, 1/50 of UL ...
Source: Pathology Oncology Research - Category: Pathology Authors: Tags: Pathol Oncol Res Source Type: research
ConclusionsAt a tertiary musculoskeletal oncology referral clinic, primary STMs ≤ 2 cm with indeterminate imaging features should be managed cautiously despite their small size and/or superficial location.
Source: Skeletal Radiology - Category: Radiology Source Type: research
We report an unusual case of a leiomyosarcoma arising six months post myomectomy in a 16-year old female.Graphical abstractRadiographic images (A) starting with the CT of mass on day 0 followed by the CT abdomen/pelvis of second pelvic mass leiomyosarcoma on day 185, the MRI prior to staging surgery on day 317, and finishing up with the MRI of the recurrence of malignancy. Timeline of patient events (B). Our patient initially underwent a diagnostic laparoscopy with pelvic mass biopsies showing leiomyoma which was followed by an abdominal myomectomy. She re-presented to the hospital on Day 190 and urgently underwent an expl...
Source: Gynecologic Oncology Reports - Category: OBGYN Source Type: research
ConclusionsAlthough a majority of the subepithelial lesions in the cardia of the stomach are benign, 20% of the cases diagnosed with GIST have a high malignant potential. Preoperative EUS-FNB might be a useful tool for decision-making regarding the ultimate management and outcomes of these lesions.
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
Abstract Uterine smooth muscle tumors of unknown malignant potential [STUMP]s are neoplasms with pathological features that preclude an equivocal diagnosis of leiomyosarcoma, but that do not fulfill the criteria for leiomyoma or its variants, and raise concerns that the tumors may behave in a malign fashion. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard treatment if fertility is completed, whereas myomectomy alone can be taken into consideration in young patients who desire to preserve childbearing potential. A careful surveillance every 6 months for 5 years and then yearly...
Source: Gynecologic Oncology - Category: Cancer & Oncology Authors: Tags: Gynecol Oncol Source Type: research
Abstract Leiomyosarcomas are rare, aggressive tumors, which exhibit a poor prognosis regardless of stage. Pre-operative diagnosis can be difficult as leiomyosarcoma can mimic features of the more common, benign uterine leiomyoma. The goal of this study was to identify specific molecular markers to discriminate between uterine leiomyosarcomas and leiomyomas to facilitate timely, accurate diagnosis and treatment. Gene expression profiles of three leiomyosarcomas, leiomyomas, and normal myometrial tissue samples were analyzed using the Affymetrix Human Gene 1.0 ST Array. GC-robust multiarray average calculation and A...
Source: Experimental and Molecular Pathology - Category: Pathology Authors: Tags: Exp Mol Pathol Source Type: research
Esophageal submucosal tumors (SMTs) are tissue protuberances covered with normal mucosa, usually without clinical symptoms. In esophagus, leiomyomas and gastrointestinal stromal tumors (GISTs) are two common SMTs and originate from the muscularis propria (MP) layer. The most are benign, but 10.8% leiomyomas might turn into leiomyosarcomas. GISTs are reported to be potentially malignant, especially with the large size or irregular boundary. Submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) are recently introduced to remove submucosal tumors (SMTs) originating from the muscularis propria (MP) layer.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Tuesday abstract Source Type: research
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