Uterine Sarcoma. Only pure homologous sarcomas were considered. Age of presentation, clinical findings, histological type and imaging data (CT, US and.
Uterine Sarcomas: a retrospective study N. Costa¹, A. Félix², T.M. Cunha³ ¹Department of Radiology – Centro Hospitalar de Lisboa – Zona Central – Hospital de São José, Lisbon, Portugal ²Department of Pathology – Instituto Português de Oncologia de Francisco Gentil, Lisbon, Portugal ³Department of Radiology – Instituto Português de Oncologia de Francisco Gentil, Lisbon, Portugal
– Uterine Sarcomas are tumors of mesodermal origin which account for 2-6% of uterine malignant tumors. – The correct diagnosis cannot be made based only in clinical grounds. – They can assume various histological subtypes; can be pure, containing only a malignant mesenchymal component, or mixed, containing a malignant mesenchymal component associated with an epithelioid element.
Purpose: To describe the clinical, histological and main imaging findings of Uterine Sarcomas Material and Methods: We retrospectively analyzed the medical records of 40 patients admitted to our institution between 1998 and 2002 with Uterine Sarcoma. Only pure homologous sarcomas were considered. Age of presentation, clinical findings, histological type and imaging data (CT, US and MRI) were reviewed.
Results: The median age of presentation was 57 (56,65) years and ranged from 38 to 88 years. Vaginal bleeding
30
25
20 18
25
Pelvic mass
14
8
10 7
6
6 4 2
Flank pain or\and recurrent urinary infections
6
Weight loss
2
4
Heterogeneous uterus Endometrial abnormalities
10
15
Leiomyosarcoma
14
12
Pelvic pain
7
21
15
Endometrial stromal sarcoma
Sarcomatous tumor
4
3 2
Irregular uterine limits
Undifferentiated sarcoma
0
0
Clinical findings
Pathology findings
Imaging findings
No clinical manifestations
All 40 patients had available clinical data. Vaginal bleeding (62,5%), pelvic mass (17,5%) and pelvic pain (15%) were the main clinical manifestations reported. In six women (15%) investigation was made after routine examination.
Case 1
Imaging data was reviewed in 18 patients (CT, US and MRI). Uterine enlargement was present in all cases. Heterogeneous uterus was described in 14 patients (77,7%) and in 3 patients (16,6%) a sarcomatous tumor was suspected.
Leiomyossarcoma and endometrial stromal sarcoma represented the most common histological types with 52,5% and 37,5%, respectively.
Case 2
Fig.3 Fig.1
Uterine enlargement
16
20
5
18
Case 3
Fig.4
Fig.5
Fig.6
Fig.7
Fig.2
Figures 1 and 2 – A 55-year-old woman, with vaginal bleeding and pelvic pain with a 3 months evolution. Longitudinal ultrasonography (fig. 1) of the pelvis and transvaginal approach (fig. 2) showed a large heterogeneous solid mass in myometrial posterior wall. Note the endometrial stripe (arrow). Histological study revealed a leiomyosarcoma.
Figures 3, 4 and 5 – A 51-year-old woman with vaginal bleeding and right flank pain. Contrast enhanced CT scan showed a marked uterine enlargement that overlaps renal hilum. Well defined uterine margins and heterogeneous density with a whirly diffuse pattern can also be seen. Tumor was classified as a leiomyosarcoma.
Fig.8
Case 4
Fig.10
Fig.11
Fig.12
Fig.13
Figures 10, 11 (top), 12 and 13 (bottom) – A 64-year-old woman with vaginal bleeding and pelvic pain. T1-weighted axial MR image (fig. 10) shows a low-signal intensity uterine mass. The axial (fig.11) and sagittal (fig. 12) T2-weighted MR images show a large subserosal fundal mass anteriorly located of heterogeneous high-signal intensity. Ascites is also present. Contrastenhanced T1-weighted axial MR image (fig. 13) shows the lesion with a peripheral irregular strongly enhancing rim. Gross specimen revealed a leiomyosarcoma with necrosis and hemorrhagic areas.
Fig.9
Figures 6, 7 (top), 8 and 9 (bottom) – An endometrial stromal sarcoma in a 72-year-old woman with no clinical findings. Investigation was made after a suspicious pelvic US routine examination. T1-weighted axial MR image (fig.6) shows an heterogeneous low-signal intensity myometrium mass. The T2-weighted axial (fig.7) and sagittal (fig.8) MR images show an heterogeneous well defined mass in the anterior myometrium wall. Also in the axial image a thin uterine endometrial cavity is visualized. Hysterectomy specimen (fig.9) weighting 490 gr, with the sectioned surface yellow showing no necrosis or hemorrhagic areas.
Conclusions: – Imaging data analysis suggest that uterine sarcomas are associated with uterine enlargement. – Clinical and imaging findings associated with this tumor are unspecific. – Diagnosis is based on pathology findings. – The knowledge of the clinical and imaging spectrum of uterine sarcomas is very important for radiologists not only in differential diagnosis but also in staging and management. European Symposium of Urogenital Radiology (ESUR), Ljubljana, Slovenia, 8-11 September 2005
