Differentiation of uterine low-grade endometrial stromal sarcoma from rare leiomyoma variants by magnetic resonance imaging

Himoto, Yuki; Kido, Aki; Sakata, Akihiko; Moribata, Yusaku; Kurata, Yasuhisa; Suzuki, Ayako; Matsumura, Noriomi; Shitano, Fuki; Kawahara, Shunsuke; Kubo, Shigeto; Umeoka, Shigeaki; Minamiguchi, Sachiko; Mandai, Masaki

doi:10.1038/s41598-021-98473-z

Cited by 6 publications

(4 citation statements)

References 22 publications

(49 reference statements)

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“… 3 Additionally, the solid component of a low-grade ESS often appears relatively homogeneous, without the speckled appearance, commonly observed in typical leiomyomas. 4 The homogeneous solid component, along with the frequent occurrence of cystic degeneration, as demonstrated in this case, can be a valuable clue in the differential diagnosis of a low-grade ESS. 4 …”

Section: Discussionmentioning

confidence: 61%

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A case of low-grade endometrial stromal sarcoma presented as an intramyometrial mass mimicking uterine leiomyoma on MRI

Tamada,

Edo,

Sakima

et al. 2023

BJR|Case Reports

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A low-grade endometrial stromal sarcoma (ESS) has a pattern of presenting as an intramyometrial mass and is often misdiagnosed as cellular leiomyoma or degenerative uterine leiomyoma. A low-grade ESS is a malignant tumour that requires total hysterectomy with bilateral salpingo-oophorectomy; while a leiomyoma is a benign tumour and could be acceptable for enucleation. As the treatment strategies differ between a low-grade ESS and leiomyoma, radiologists should be familiar with the characteristic MRI findings of a low-grade ESS. A 51-year-old woman with abnormal uterine bleeding had been observed for 2 years at a previous hospital for a uterine leiomyoma based on MRI findings. A contrast-enhanced MRI demonstrated an intramyometrial mass composed of three components with the hypointense rim on T2-weighted images (T2WI): the first component was a homogeneous solid structure with mild hyperintensity on T2WI with a low apparent diffusion coefficient value; the second component was cystic; the third component was a structure of low signal intensity on T2WI similar to the muscle. Although a degenerative uterine leiomyoma was a differential diagnosis, these MRI findings were suggestive of a low-grade ESS. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and partial omentectomy were performed. The pathological diagnosis was a low-grade ESS. In a low-grade ESS, there are three major patterns of MRI findings: one of these patterns is the less popular but clinically important intramyometrial mass pattern, which can be misdiagnosed as a leiomyoma, and this case conformed to this pattern.

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Section: Discussionmentioning

confidence: 61%

“… 4 The homogeneous solid component, along with the frequent occurrence of cystic degeneration, as demonstrated in this case, can be a valuable clue in the differential diagnosis of a low-grade ESS. 4 …”

Section: Discussionmentioning

confidence: 61%

A case of low-grade endometrial stromal sarcoma presented as an intramyometrial mass mimicking uterine leiomyoma on MRI

Tamada,

Edo,

Sakima

et al. 2023

BJR|Case Reports

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“…Los SEE-BG deben diferenciarse de otros tipos de diferenciación, como focal de tipo músculo liso, rabdoide focal o estructuras tipo cordones sexuales (10) . Además, otros diagnósticos diferenciales incluyen al leiomioma epitelioide, leiomiosarcoma epitelioide, PEComa, tumor mülleriano mixto y metástasis de tumor de cordones sexuales ovárico (13) .…”

Section: Discussionunclassified

Sarcoma del estroma endometrial de bajo grado

Rondón-Tapía¹,

Torres-Cepeda²

2022

Rev peru ginecol obstet.

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El sarcoma del estroma endometrial es una neoplasia maligna poco frecuente que se origina en el estroma endometrial. Puede tener varias formas de diferenciación, entre ellas del músculo liso y del cordón sexual. El sarcoma del estroma endometrial de bajo grado es un tipo de tumor endometrial raro, que constituye solo el 0,2% de todas las neoplasias uterinas. Su etiología es desconocida, pero algunos casos se asocian con obesidad, síndrome de ovario poliquístico, diabetes mellitus, menarquia temprana y terapia de sustitución de estrógenos o al tamoxifeno. La sintomatología es inespecífica, varía desde el dolor pélvico hasta el sangrado genital anormal progresivo y es difícil de reconocer por las imágenes radiológicas. En la mayoría de los casos, el diagnóstico se realiza mediante una evaluación anatomopatológica. La tinción inmunohistoquímica también puede ayudar a diferenciarlo de otras neoplasias. Por lo tanto, es importante tener un alto índice de sospecha para este tipo de neoplasia rara. Su tratamiento es quirúrgico y su seguimiento debe ser a largo plazo, debido al alto riesgo de recidivas tardías y metástasis. Se presenta un caso de sarcoma estromal endometrial de bajo grado.

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“… 53 To differentiate ESS from LM variants, the ADC value is a useful tool. Himoto et al 54 showed that the cutoff values of 0.932 and 0.776 × 10 −3 mm 2 /s using the mean value of 3 circular ROIs of >25 mm 2 resulted in sensitivities of 78% and 89% and specificities of 76% and 65%, respectively, for differentiating ESS from LM variants. However, similar to LMS, some overlap between ESS and rare LM variants was observed due to hypercellularity.…”

Section: Myometrial Tumorsmentioning

confidence: 99%

Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging

2023

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Diffusion-weighted imaging (DWI) is an increasingly valuable sequence in daily clinical practice, providing both functional and morphological information. The use of DWI can help quantify diffusion using the apparent diffusion coefficient, which reflects the physiological features of the tissue and tumor microcirculation. This knowledge is crucial for understanding and interpreting gynecological imaging. This article reviews the clinical utility of DWI for gynecological imaging, highlighting its ability to aid in the detection of endometrial and cervical cancers, as well as tumor extension and metastasis. In addition, DWI can easily detect the solid components of ovarian cancer (including dissemination), assist in the diagnosis of adnexal torsion, and potentially show bone marrow status. Apparent diffusion coefficient measurement is useful for differentiating between endometrial lesions, uterine leiomyomas, and sarcomas, and may provide important information for predicting the prognosis of gynecological cancers.

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Differentiation of uterine low-grade endometrial stromal sarcoma from rare leiomyoma variants by magnetic resonance imaging

Cited by 6 publications

References 22 publications

A case of low-grade endometrial stromal sarcoma presented as an intramyometrial mass mimicking uterine leiomyoma on MRI

A case of low-grade endometrial stromal sarcoma presented as an intramyometrial mass mimicking uterine leiomyoma on MRI

Sarcoma del estroma endometrial de bajo grado

Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging

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