Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology

Russo, Claudio Di; Camilli, S.; Martire, Francesco Giuseppe; Giovanni, A. Di; Lazzeri, Lucia; Malzoni, Mario; Zupi, Errico; Exacoustòs, C.

doi:10.1002/uog.24855

Cited by 19 publications

(18 citation statements)

References 24 publications

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“…The echogenicity of the lesion has been suggested as a useful ultrasound feature to identify uterine sarcoma 12 . However, our findings are in line with those of Russo et al 24 , demonstrating that many benign lesions also show non-uniform echogenicity. We detected acoustic shadows in over 60% of uterine sarcomas, which is more than reported previously 12 .…”

Section: Discussionsupporting

confidence: 93%

Ultrasound features using MUSA terms and definitions in uterine sarcoma and leiomyoma: cohort study

De Bruyn,

Ceusters,

Vanden Brande

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectiveA timely and correct preoperative diagnosis of a uterine sarcoma will increase patients’ survival. The primary aim of our study was to describe the ultrasound features in uterine sarcomas compared to uterine leiomyomas based on MUSA (Morphological Uterus Sonographic Assessment) terms and definitions. The secondary aim was to assess the interobserver agreement of the MUSA ultrasound features.MethodsThis retrospective cohort study assessed uterine sarcomas from 1997 until 2019 and uterine leiomyomas from 2016 until 2019 treated in a single tertiary center. Patients’ demographics, presenting symptoms and outcome were extracted from the patients’ files. The ultrasound images were re‐evaluated independently by two sonologists using the MUSA terms and definitions. Descriptive statistics were calculated and interobserver agreement was assessed with Cohen's Kappa (with squared weights) or intraclass correlation coefficient depending on the type of variable.ResultsHundred and seven patients were included, of whom 16 had a uterine sarcoma and 91 a uterine leiomyoma. Abnormal uterine bleeding was the most frequent presenting symptom (69/107, 65%). Compared to leiomyoma cases, uterine sarcoma patients were older (mean age of 65 years (IQR 60‐70 years) versus (vs.) 48 years (IQR 43‐52 years)) and mostly postmenopausal (13/16 (81%) vs. 15/91 (16%)). In the uterine sarcoma cohort, leiomyosarcoma was the most frequent histological type (6/16 (38%) followed by adenosarcoma (4/16 (25%). On ultrasound evaluation, according to observer 1 and 2, the tumor border was irregular in most sarcomas (in 11/16 (69%) and 13/16 (81%), respectively), whereas leiomyomas were most frequently regular (in 65/91 (71%) and 82/91 (90%), respectively). The observers classified the lesion echogenicity as non‐uniform, in 68/91 (75%) and 51/91 (56%) of leiomyomas and 15/16 (94%) of uterine sarcoma. More than 60% of the uterine sarcomas showed acoustic shadows (in 11/16 (69%) and 10/16 (62%) respectively) whereas calcifications were reported in a small minority of them (in 0/16 (0%) and 2/16 (13%) respectively). In uterine sarcomas, the intralesional vascularity was reported as moderate to abundant in 13/16 (81%) and 15/16 (94%) respectively while circumferential vascularity was scored as high in 6/16 (38%) by both observers. The interobserver agreement for presence of cystic areas, calcifications, acoustic shadow and central necrosis, color score (overall, intralesional and circumferential), and maximal diameter of the lesion, was moderate. The agreement for lesion tumor border and echogenicity was fair.ConclusionsA postmenopausal patient, presenting with abnormal uterine bleeding and a new or growing mesenchymal mass with irregular tumor borders at ultrasonography, moderate to abundant intralesional vascularity, presence of cystic areas and absence of calcifications, carries a higher risk of having a uterine sarcoma. The interobserver agreement for most MUSA terms and definitions is moderate. Future studies should validate the above clinical and ultrasound findings in a prospective multicenter collection of uterine mesenchymal tumors.This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 93%

Ultrasound features using MUSA terms and definitions in uterine sarcoma and leiomyoma: cohort study

De Bruyn,

Ceusters,

Vanden Brande

et al. 2024

Ultrasound in Obstet & Gyne

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“…According to further GO and KEGG analysis, the DEGs were mainly enriched in connective tissue development and collagen-containing extracellular matrix, as well as the Wnt signaling pathway and JAK-STAT signaling pathway. The GO enrichment results are in line with our common experiments since UFs are composed of smooth muscle cells and varying amounts of fibrous connective tissue ( 33 ). The wingless-type (Wnt) signaling is considered a growth and development-related factor of the UFs, the elevated expression of WNT11, WNT16, and WNT5b, etc., were widely reported ( 34 , 35 ).…”

Section: Discussionsupporting

confidence: 89%

An autophagy-related diagnostic biomarker for uterine fibroids: FOS

Cai

et al. 2023

Front. Med.

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Uterine fibroids (UFs) are the most common benign gynecologic tumors in reproductive-aged women. The typical diagnostic strategies of UFs are transvaginal ultrasonography and pathological feature, while molecular biomarkers are considered conventional options in the assessment of the origin and development of UFs in recent years. Here, we extracted the differential expression genes (DEGs) and differential DNA methylation genes (DMGs) of UFs from the Gene Expression Omnibus (GEO) database, GSE64763, GSE120854, GSE45188, and GSE45187. 167 DEGs with aberrant DNA methylation were identified, and further Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed by the relevant R package. We next discerned 2 hub genes (FOS, and TNFSF10) with autophagy involvement by overlapping 167 DEGs and 232 autophagic regulators from Human Autophagy Database. FOS was identified as the most crucial gene through the Protein–Protein Interactions (PPI) network with the correlation of the immune scores. Moreover, the down-regulated expression of FOS in UFs tissue at both mRNA and protein levels was validated by RT-qPCR and immunohistochemistry respectively. The area under the ROC curve (AUC) of FOS was 0.856, with a sensitivity of 86.2% and a specificity of 73.9%. Overall, we explored the possible biomarker of UFs undergoing DNA—methylated autophagy and provided clinicians with a comprehensive assessment of UFs.

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“…However, Ludovisi et al found that about a quarter of the LMS in their study had minimal or absent vascularization [10]. In the analysis of highly vascularized mesenchymal masses reported by Russo et al, only 7% of highly vascularized myometrial tumors were malignant, and all of them were in women over 40 years old [29]. Similarly, our experience shows that vascularization is not a conclusive factor.…”

Section: Discussionmentioning

confidence: 38%

Overlap of Suspicious and Non-Suspicious Features in the Ultrasound Evaluations of Leiomyosarcoma: A Single-Center Experience

et al. 2023

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Leiomyosarcoma (LMS) is a rare type of mesenchymal tumor. Suspecting LMS before surgery is crucial for proper patient management. Ultrasound is the primary method for assessing myometrial lesions. The overlapping of clinical, laboratory, as well as ultrasound features between fibroids and LMS makes differential diagnosis difficult. We report our single-center experience in ultrasound imaging assessment of LMS patients, highlighting that misleading findings such as shadowing and absent or minimal vascularization may also occur in LMS. To avoid mistakes, a comprehensive evaluation of potentially overlapping ultrasound features is necessary in preoperative ultrasound evaluations of all myometrial tumors.

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Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology

Cited by 19 publications

References 24 publications

Ultrasound features using MUSA terms and definitions in uterine sarcoma and leiomyoma: cohort study

Ultrasound features using MUSA terms and definitions in uterine sarcoma and leiomyoma: cohort study

An autophagy-related diagnostic biomarker for uterine fibroids: FOS

Overlap of Suspicious and Non-Suspicious Features in the Ultrasound Evaluations of Leiomyosarcoma: A Single-Center Experience

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