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• Diffusion weighted magnetic resonance imaging (DWI) is increasingly used in cervical cancer. • Functional DWI early in treatment of cervical cancer may help predict survival. • DWI may help clinicians to tailor or individualise treatment appropriately. • This may limit toxicity from ineffective treatment and allow early alternative therapy.

Objective To explore women's views of decision-making relating to hysterectomy.Design Structured questionnaire and in-depth interview surveys.Setting A teaching hospital and a district general hospital in northeast Scotland.Sample Women scheduled for hysterectomy for benign menstrual problems.Methods Pre-operative questionnaires were sent to a consecutive sample of women booked for hysterectomy.A purposive sample was interviewed post-operatively. Main outcome measures Women's experiences of, and satisfaction with, information provision, communication and decision-making processes; the relationship between views of decision-making processes and decisions made. Results One hundred and four women (66%) returned questionnaires. Most responded positively to structured questions about the process by which the decision to have a hysterectomy was reached. Almost all (97%) reported satisfaction with the decision made. Twenty women were interviewed post-operatively. A number, including some who had responded positively on the questionnaire, described aspects of the decisionmaking process that were suboptimal. Women's perceptions of the decision-making process, including the way their doctors communicated with them, did impinge on their views of the course of action selected. Some women had residual doubts about the appropriateness of hysterectomy. Conclusions In a significant minority of women, there are important shortcomings in current patterns of information provision and communication relating to decision-making. These are unlikely to be picked up by conventional structured patient feedback surveys. Further efforts are required to ensure that women are adequately informed and involved in decisions about gynaecological treatments.

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Key content Uterine leiomyosarcomas are the most common uterine sarcoma and they are notoriously aggressive in nature. Preoperative diagnosis is difficult and they are usually detected as an incidental finding at surgery. Tumour stage is the most important prognostic factor. Misdiagnosis or delay in diagnosis can occur following the use of conservative techniques for managing uterine fibroids. The primary treatment is surgical, while the role of adjuvant therapy is still to be clearly defined. Learning objectives To appreciate the diagnostic challenges faced with uterine leiomyosarcomas, especially in view of the similarities with uterine fibroids. To learn about the current views on surgical treatment and adjuvant therapy. To have an understanding of the novel therapies currently under investigation. Ethical issues Can we offer women conservative non‐surgical treatment for fibroids if we cannot confidently exclude leiomyosarcomas? Please cite this article as: Harry VN, Narayansingh GV, Parkin DE. Uterine leiomyosarcomas: a review of the diagnostic and therapeutic pitfalls. The Obstetrician & Gynaecologist 2007;9:88–94.

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Malignant change within scar endometriosis is rare, but increased awareness of this phenomenon is required. Vigilance is paramount and a mass located in or close to a surgical scar should be treated with suspicion.