Uterine sarcomas: clinical presentation and MRI features.

Santos P, Teresa Margarida Cunha
Diagnostic and interventional radiology (Ankara, Turkey) · 2015 · doi:10.5152/dir.2014.14053 · PMID:25347940 · PMC4463355
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This pictorial review discusses the clinical presentation and distinct magnetic resonance imaging features of uterine sarcomas, emphasizing their utility in preoperative detection, staging, and differentiation from leiomyomas and endometrial carcinoma.

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This pictorial review examines the clinical presentation and magnetic resonance imaging characteristics of uterine sarcomas, a rare group of aggressive mesenchymal tumors. The authors detail specific MRI features such as irregular margins, necrosis, and restricted diffusion that help differentiate these malignancies from more common leiomyomas and endometrial carcinomas. They emphasize that preoperative detection via MRI is crucial for accurate staging and determining appropriate surgical management strategies. Relevance to endometriosis: listed as a differential diagnosis for pelvic masses and abnormal uterine bleeding, though the paper's main focus is on malignant uterine tumors rather than benign conditions like endometriosis or adenomyosis.

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Abstract

Uterine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies. They comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, and adenosarcoma. Compared with the more common endometrial carcinomas, uterine sarcomas behave more aggressively and are associated with a poorer prognosis. Due to their distinct clinical and biological behavior, the International Federation of Gynecology and Obstetrics introduced a new staging system for uterine sarcomas in 2009, categorizing uterine carcinosarcoma as a variant of endometrial carcinoma, rather than a pure sarcoma. Magnetic resonance imaging (MRI) has a developing role in the assessment of these malignancies. Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. MRI is therefore extremely useful in preoperative detection and staging and, consequently, in determination of appropriate management. This pictorial review aims to discuss the clinical features of uterine sarcomas, as well as their most common appearances and distinct characteristics in MRI.
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ABSTRACT Uterine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies. They comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, and adenosarcoma. Compared with the more common endometrial carcinomas, uterine sarcomas behave more aggressively and are associated with a poorer prognosis. Due to their distinct clinical and biological behavior, the International Federation of Gynecology and Obstetrics introduced a new staging system for uterine sarcomas in 2009, categorizing uterine carcinosarcoma as a variant of endometrial carcinoma, rather than a pure sarcoma. Magnetic resonance imaging (MRI) has a developing role in the assessment of these malignancies. Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. MRI is therefore extremely useful in preoperative detection and staging and, consequently, in determination of appropriate management. This pictorial review aims to discuss the clinical features of uterine sarcomas, as well as their most common appearances and distinct characteristics in MRI.

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