Ultrasound characteristics of sarcoma in the uterine cervix: ‘ballet tutu’ sign

L. Hovsepyan, Lilit Hovsepyan, A. Stepanyan, A. Saradyan, N. Asilbekyan, S. Tevosyan, I. Mazmanian, G. Tonyan, A. Mirzoyan, L. Valentin
In: Ultrasound in Obstetrics & Gynecology · 2025 · vol. 66(6) , pp. 805–807 · doi:10.1002/uog.70103 · PMID:40966104 · W4414313310
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This study describes the ultrasound characteristics of five cases of uterine cervix sarcoma, noting a specific "ballet tutu" sign potentially associated with these rare tumors.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This paper describes ultrasound characteristics of rare uterine cervical sarcomas, illustrated through clinical and imaging findings from five reported cases using transvaginal grayscale ultrasound and color Doppler, with diagnoses confirmed by pathology (including pleomorphic high-grade rhabdomyosarcoma, leiomyosarcoma, NTRK fusion cervical sarcoma, and high-grade endometrial stromal sarcoma). The authors highlight a distinctive ultrasound appearance referred to as the “ballet tutu” sign. A major limitation is that evidence is based on a small number of individual case reports rather than a larger cohort, limiting generalizability. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Appendix S1 Case reports of clinical and ultrasound characteristics of five cases of sarcoma in the uterine cervix. Figure S1 Ultrasound (a–c), macroscopic (d) and microscopic (e) images in Case 1, diagnosed as pleomorphic high-grade rhabdomyosarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. Figure S2 Ultrasound (a–c), macroscopic (d) and microscopic (e) images in Case 2, diagnosed as leiomyosarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. Figure S3 Ultrasound (a–c), macroscopic (d), microscopic (e) and fluorescence in situ hybridization assay (f) images in Case 4, diagnosed as neurotrophic tyrosine receptor kinase fusion cervical sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. Figure S4 Ultrasound (a–c), macroscopic (d) and microscopic (e) images of Case 5, diagnosed as high-grade endometrial stromal sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. Figure S5 Grayscale (a) and color Doppler (b) transvaginal ultrasound images showing relapse of neurotrophic tyrosine receptor kinase fusion cervical sarcoma (Case 4). Videoclip S1 Grayscale and color Doppler ultrasound of leiomyosarcoma in uterine cervix, International Federation of Gynecology and Obstetrics Stage IB, in 37-year-old patient (Case 3). Videoclip S2 Grayscale and color Doppler ultrasound of pleomorphic high-grade rhabdomyosarcoma in uterine cervix, International Federation of Gynecology and Obstetrics (FIGO) Stage IB, in 64-year-old patient (Case 1). In the corpus of the same uterus there was endometrial endometrioid adenocarcinoma, FIGO stage IA (synchronous tumors). Videoclip S3 Grayscale and color Doppler ultrasound of leiomyosarcoma in uterine cervix, International Federation of Gynecology and Obstetrics Stage IB, in 35-year-old patient (Case 2). Videoclip S4 Grayscale and color Doppler ultrasound of neurotrophic tyrosine receptor kinase fusion cervical sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in 44-year-old patient (Case 4). Videoclip S5 Grayscale and color Doppler ultrasound of high-grade endometrial stromal sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in 29-year-old patient (Case 5). Videoclip S6 Grayscale and color Doppler ultrasound showing relapse of neurotrophic tyrosine receptor kinase fusion cervical sarcoma (Case 4). Videoclip S7 Ultrasound showing complete response to treatment with neurotrophic tyrosine receptor kinase (NTRK) inhibitors of relapse of NTRK fusion cervical sarcoma (Case 4). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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Ultrasound characteristics of sarcoma in the uterine cervix: ‘ballet tutu’ sign L. Hovsepyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Department of Gynecology, Erebouni Medical Center, Yerevan, Armenia Search for more papers by this authorA. Stepanyan Department of Gynecological Oncology, Nairi Medical Center, Yerevan, Armenia Search for more papers by this authorA. Saradyan Department of Pathology, Davidyants Laboratories, Yerevan, Armenia Search for more papers by this authorN. Asilbekyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorS. Tevosyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorI. Mazmanian Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorG. Tonyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorA. Mirzoyan Department of Gynecology, Erebouni Medical Center, Yerevan, Armenia Search for more papers by this authorCorresponding Author L. Valentin Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden Department of Obstetrics and Gynecology, Skane University Hospital, Malmö, Sweden Correspondence. (e-mail: [email protected]) Search for more papers by this authorL. Hovsepyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Department of Gynecology, Erebouni Medical Center, Yerevan, Armenia Search for more papers by this authorA. Stepanyan Department of Gynecological Oncology, Nairi Medical Center, Yerevan, Armenia Search for more papers by this authorA. Saradyan Department of Pathology, Davidyants Laboratories, Yerevan, Armenia Search for more papers by this authorN. Asilbekyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorS. Tevosyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorI. Mazmanian Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorG. Tonyan Glasbo Clinic, Center for Reproductive Health, Obstetrics and Gynecology, Yerevan, Armenia Search for more papers by this authorA. Mirzoyan Department of Gynecology, Erebouni Medical Center, Yerevan, Armenia Search for more papers by this authorCorresponding Author L. Valentin Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden Department of Obstetrics and Gynecology, Skane University Hospital, Malmö, Sweden Correspondence. (e-mail: [email protected]) Search for more papers by this authorDATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Supporting Information | Filename | Description | |---|---| | uog70103-sup-0001-Appendix.docxWord 2007 document , 21.7 KB | Appendix S1 Case reports of clinical and ultrasound characteristics of five cases of sarcoma in the uterine cervix. | | uog70103-sup-0002-FigureS1.pptxPowerPoint 2007 presentation , 6.3 MB | Figure S1 Ultrasound (a–c), macroscopic (d) and microscopic (e) images in Case 1, diagnosed as pleomorphic high-grade rhabdomyosarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. | | uog70103-sup-0003-FigureS2.pptxPowerPoint 2007 presentation , 6.4 MB | Figure S2 Ultrasound (a–c), macroscopic (d) and microscopic (e) images in Case 2, diagnosed as leiomyosarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. | | uog70103-sup-0004-FigureS3.pptxPowerPoint 2007 presentation , 8.7 MB | Figure S3 Ultrasound (a–c), macroscopic (d), microscopic (e) and fluorescence in situ hybridization assay (f) images in Case 4, diagnosed as neurotrophic tyrosine receptor kinase fusion cervical sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. | | uog70103-sup-0005-FigureS4.pptxPowerPoint 2007 presentation , 6.9 MB | Figure S4 Ultrasound (a–c), macroscopic (d) and microscopic (e) images of Case 5, diagnosed as high-grade endometrial stromal sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in uterine cervix. | | uog70103-sup-0006-FigureS5.pptxPowerPoint 2007 presentation , 3.5 MB | Figure S5 Grayscale (a) and color Doppler (b) transvaginal ultrasound images showing relapse of neurotrophic tyrosine receptor kinase fusion cervical sarcoma (Case 4). | | uog70103-sup-0007-VideoS1.mp4MPEG-4 video, 70 MB | Videoclip S1 Grayscale and color Doppler ultrasound of leiomyosarcoma in uterine cervix, International Federation of Gynecology and Obstetrics Stage IB, in 37-year-old patient (Case 3). | | uog70103-sup-0008-VideoS2.mp4MPEG-4 video, 69.8 MB | Videoclip S2 Grayscale and color Doppler ultrasound of pleomorphic high-grade rhabdomyosarcoma in uterine cervix, International Federation of Gynecology and Obstetrics (FIGO) Stage IB, in 64-year-old patient (Case 1). In the corpus of the same uterus there was endometrial endometrioid adenocarcinoma, FIGO stage IA (synchronous tumors). | | uog70103-sup-0009-VideoS3.mp4MPEG-4 video, 86.7 MB | Videoclip S3 Grayscale and color Doppler ultrasound of leiomyosarcoma in uterine cervix, International Federation of Gynecology and Obstetrics Stage IB, in 35-year-old patient (Case 2). | | uog70103-sup-0010-VideoS4.mp4MPEG-4 video, 46.4 MB | Videoclip S4 Grayscale and color Doppler ultrasound of neurotrophic tyrosine receptor kinase fusion cervical sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in 44-year-old patient (Case 4). | | uog70103-sup-0011-VideoS5.mp4MPEG-4 video, 29.2 MB | Videoclip S5 Grayscale and color Doppler ultrasound of high-grade endometrial stromal sarcoma, International Federation of Gynecology and Obstetrics Stage IB, in 29-year-old patient (Case 5). | | uog70103-sup-0012-VideoS6.mp4MPEG-4 video, 24 MB | Videoclip S6 Grayscale and color Doppler ultrasound showing relapse of neurotrophic tyrosine receptor kinase fusion cervical sarcoma (Case 4). | | uog70103-sup-0013-VideoS7.mp4MPEG-4 video, 19.8 MB | Videoclip S7 Ultrasound showing complete response to treatment with neurotrophic tyrosine receptor kinase (NTRK) inhibitors of relapse of NTRK fusion cervical sarcoma (Case 4). | Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. References - 1Fadare O. Uncommon sarcomas of the uterine cervix: a review of selected entities. Diagn Pathol. 2006; 1: 30-36. - 2Wright JD, Rosenblum K, Huettner PC, et al. Cervical sarcomas: an analysis of incidence and outcome. Gynecol Oncol. 2005; 99(2): 348-351. - 3Fadare O, Ghofrani N, Stamatakos MD, Tavassoli FA. Mesenchymal lesions of the uterine cervix. Pathology Case Reviews. 2006; 11(3): 140-152. 10.1097/01.pcr.0000217868.84282.77Google Scholar - 4Bansal S, Lewin SN, Burke WM, et al. Sarcoma of the cervix: natural history and outcomes. Gynecol Oncol. 2010; 118(2): 134-138. - 5Ray-Coquard I, Casali PG, Croce S, et al. ESGO/EURACAN/GCIG guidelines for management of patients with uterine sarcomas. Int J Gynecol Cancer. 2024; 34(10): 1499-1521. 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