To illustrate MRI diagnostic pitfalls with benign and malignant uterine masses,
and how radiologist's interpretation between two diagnoses (myoma or sarcoma) impacts surgical therapeutic decision.
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,
and atypical myomas; as well as smooth muscle tumor of uncertain malignant potential (STUMP)4,5,6.
MRI preoperative distinction betweenboth diagnoses(using T2-weighted images,...
Findings and procedure details
TABLE OF CONTENTS :
Degenerative modifications in myomas are frequent and often associated (hyaline fibrosis or œdema > 50% of cases).
They modify the MRI signal of the myoma +/- heterogeneity on T2-weighted images7,8.
Table 3 Table 4
In this work,
we revised the key imaging findings (morphological and functionnal MRI) with their histopathological correlation in :
myomas and leiomyomas variants(cystic,œdematous,
endometrial stromal tumors :stromal nodule and endometrial stromal sarcoma (ESS of low to high grade),
A single uterine tumor discovered after 45 years must remind one of sarcoma,
without forgetting the frequent degenerative modifications in ordinary myoma that modify its MRI signal (specially T2).
Frequency argument : 2 leiomyosarcomas per 1000 uterine myomas.
Pelvic MRI in myomas is indicated for mapping of a large polymyomatous uterus / before myomectomy or if atypical myoma in ultrasound or increase in size in post menopause.
Full pelvic MRI protocol is justified if "atypical" myoma in pre-therapeutic management,
associating T2-weighted images correlated with DWI...
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