Primary Malignant Mixed Müllerian Tumor of the Uterus: Findings on Sonography, CT, and Gadolinium-Enhanced MRI

Teo, Sze Yiun; Babagbemi, Kemi; Peters, Hope E.; Mortelé, Koenraad J.

doi:10.2214/ajr.07.3281

Cited by 52 publications

(37 citation statements)

References 15 publications

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“…**Contrast-enhanced T 1 -weighted image was not obtained for one case. CER, contrast-enhanced ratio of main solid part; n. s., not significant; SI, signal intensity intensity on T 2 -weighted images, 16,18,19 but they have been reported to have no specific MR findings because of various coexisting malignant components that include necroses and hemorrhages. In particular, small-sized carcinosarcomas are difficult to distinguish from endometrial carcinomas.…”

Section: Discussionmentioning

confidence: 99%

Assessment of MR Imaging as a Tool to Differentiate between the Major Histological Types of Uterine Sarcomas

et al. 2015

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Objectives: We retrospectively compared and quantified magnetic resonance (MR) images to distinguish major histological types of uterine sarcomas and malignant and benign tumors.Methods: MR images were obtained from patients who underwent preoperative examinations. We compared 25 pathologically confirmed uterine sarcomas (8 leiomyosarcomas, 11 carcinosarcomas, 6 endometrial stromal sarcomas) with 25 uterine leiomyomas. MR findings included tumor size, location, contour, signal intensity (SI), and contrast enhancement. Analysis focused on the contrast ratio (CR) of SI in T 2 -weighted images for the areas of lowest, highest, and main SI of each tumor as well as the contrast-enhanced ratio (CER) for the main solid part of each tumor in contrast-enhanced T 1 -weighted images. We evaluated diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) values in 18 tumors (4 sarcomas, 14 leiomyomas).Results: Uterine sarcomas and leiomyomas differed significantly in tumor location, contour, hemorrhaging, necrotic and cystic components, CR for the area of lowest SI (P < 0.05), CR for the area of main SI (P < 0.01), and CER (P < 0.05). Leiomyosarcomas were larger than carcinosarcomas or endometrial stromal sarcomas, and the CR for the area of lowest SI of leiomyosarcomas (P < 0.05) was significantly lower. The CER for endometrial stromal sarcomas (P < 0.05) showed the most homogeneous enhancement. Hemorrhagic or necrotic and cystic components were found more often in larger tumors, although there was no significant difference in their occurrence between sarcoma types. All uterine sarcomas showed high intensity on DW images. The ADC values were lower of uterine sarcomas than leiomyomas, although the difference was not statistically significant.Conclusion: Quantitative assessment using the CR or CER was useful for distinguishing benign and malignant uterine tumors as well as major histological types of uterine sarcomas.

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Section: Discussionmentioning

confidence: 99%

Assessment of MR Imaging as a Tool to Differentiate between the Major Histological Types of Uterine Sarcomas

et al. 2015

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“…MMMT texture on T2-weighted images was heterogenous in 82%. In the study by Teo et al (6), two MMMTs showed intense, but heterogenous enhancement after gadolinium administration; whereas, 80% of patients in the study by Tanaka et al (7) showed area of avid enhancement.…”

Section: Index Termsmentioning

confidence: 89%

Malignant Mixed Mullerian Tumor Arising from the Uterine Cervix: A Case Report

Shim

Lee

et al. 2012

J Korean Soc Radiol

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Malignant mixed mullerian tumors (MMMTs) are a rare uterine tumor and contribute to approximately 1-3% of all corpus malignant tumors. MMMTs are usually in the uterine corpus, but can also arise from the uterine cervix, vagina, ovaries and fallofian tubes. MMMTs of the uterine cervix are extremely rare. MMMTs are highly malignant and tend to maintain a rapid growth and exhibit a high rate of recurrence. Therefore, the prognosis of patients diagnosed with these types of tumors is extremely poor. We report a rare case of a malignant mixed mullerian tumor arising from the uterine cervix and introduce CT and MRI findings. CT and magnetic resonance findings of the uterine cervical MMMT in our case show highly aggressive features, such as parametrial involvement, pelvic and paraaortic lymphadenopathy, and distant metastasis and high enhancement.

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“…The number of CT annual examinations per 1000 people in Japan was the 6th among 17 countries (146 vs. a mean of 122), and that of MR examinations was the 4th (68 vs. a mean of 45). Japan belongs to the group with a high number of examinations, but the number is not impressive, considering the very high number of systems (Fig.…”

Section: Comparisons Between Japan and Foreign Countriesmentioning

confidence: 97%

“…Endometrial stromal sarcoma exhibits various invasion patterns, and MRI findings such as bands of low signal intensity on T2-weighted imaging and continuous tumor extent along the blood vessels and the ligaments are informative [121]. Carcinosarcoma is difficult to differentiate from uterine body cancer; however, on MRI it is a large mass that dilates the uterine cavity and shows characteristic MRI features such as heterogeneous hyperintensity on T2-weighted imaging, early and persistent enhancement and/or gradual and delayed strong enhancement [122,123].…”

Section: Commentsmentioning

confidence: 99%

The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline

et al. 2015

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Diagnostic imaging is undoubtedly important in modern medicine, and final clinical decisions are often made based on it. Fortunately, Japan has the highest numbers of diagnostic imaging instruments, such as CT and MRI devices, and boasts easy access to them as well as a high level of diagnostic accuracy. In consequence, a very large number of imaging examinations are performed, but diagnostic instruments are installed in so many medical facilities that expert management of these examinations tends to be insufficient. Particularly, in order to avoid risks, clinicians have recently become indifferent to indications of imaging modalities and tend to rely on CT or MRI resulting in increasing the number of imaging examinations in Japan. This is a serious problem from the viewpoints of avoidance of unnecessary exposure and medical economy. Under these circumstances, the Japan Radiological Society and Japanese College of Radiology jointly initiated the preparation of new guidelines for diagnostic imaging. However, the field of diagnostic imaging is extremely wide, and it is impossible to cover all diseases. Therefore, in drafting the guidelines, we selected important diseases and focused on ''showing evidence and suggestions in the form of clinical questions (CQs)'' concerning clinically encountered questions and ''describing routine imagingThe Japan Radiological Society/Japanese College of Radiology Imaging Guideline was published in 2013.The homepage of the Japan Radiological Society contains information about all CQs of the Japanese Imaging Guideline 2013 as an English version http://www.radiology.jp/english/guideline.html. Radiol (2016) 34:43-79 DOI 10.1007 techniques presently considered to be standards to guarantee the quality of imaging examinations''. In so doing, we adhered to the basic principles of assuming the readers to be ''radiologists specializing in diagnostic imaging'', ''simultaneously respecting the global standards and attending to the situation in Japan'', and ''making the guidelines consistent with those of other scientific societies related to imaging''. As a result, the guidelines became the largest ever, consisting of 152 CQs, nine areas of imaging techniques, and seven reviews, but no other guidelines in the world summarize problems concerning diagnostic imaging in the form of CQs. In this sense, the guidelines are considered to reflect the abilities of diagnostic radiologists in Japan. The contents of the guidelines are essential knowledge for radiologists, but we believe that they are also of use to general clinicians and clinical radiological technicians. While the number and contents of CQs are still insufficient, and while chapters such as those on imaging in children and emergency imaging need to be supplemented, the guidelines will be serially improved through future revisions. Lastly, we would like to extend our sincere thanks to the 153 members of the drafting committee who authored the guidelines, 12 committee chairpersons who coordinated their efforts, six members of the...

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Primary Malignant Mixed Müllerian Tumor of the Uterus: Findings on Sonography, CT, and Gadolinium-Enhanced MRI

Cited by 52 publications

References 15 publications

Assessment of MR Imaging as a Tool to Differentiate between the Major Histological Types of Uterine Sarcomas

Assessment of MR Imaging as a Tool to Differentiate between the Major Histological Types of Uterine Sarcomas

Malignant Mixed Mullerian Tumor Arising from the Uterine Cervix: A Case Report

The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline

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