|ECR 2018 / C-3205|
|Uterine mass in pelvic MRI : the "atypical" myoma puzzle for the radiologist and the gynecologist.|
Uterine leiomyomas are the most common gynecologic tumor (commonly diagnosed in pelvic ultrasound and affecting 50% of women at menopause), whereas the incidence of uterine sarcomas is rare (1.7 per 100,000 women) with a majority of leiomyosarcomas (LMS)1,2,3.
Myoma and LMS are at the opposite ends of pathologic spectrum of uterine smooth muscle tumors, including « leiomyoma variants » such as mitotically active, cellular, and atypical myomas ; as well as smooth muscle tumor of uncertain malignant potential (STUMP)4,5,6. Table 1
MRI preoperative distinction between both diagnoses (using T2-weighted images, diffusion (DWI) with apparent diffusion coefficient (ADC) and perfusion) is fundamental for therapeutic management, because surgical fragmentation of sarcomas is contraindicated. Negative consequences of tumoral morcellation on survival of patients who are found to have malignant instead of benign uterine masses is recognized (risk of intraperitoneal dissemination and distant metastases).
Imaging findings of « leiomyoma variants » are a diagnostic challenge for any radiologist who regularly performs pelvic MRI. Table 2
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