Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis

Lin, Yanyu; Wu, Ren‐Chin; Huang, Yen-Ling; Chen, Kueian; Tseng, Shu-Chi; Wang, Chin‐Jung; Chao, Angel; Lai, Chyong-Huey; Lin, Gigin

doi:10.1007/s00261-022-03431-6

Cited by 10 publications

(13 citation statements)

References 55 publications

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“…Nonetheless, there are a few useful IHC and molecular markers to distinguish between STUMP and LBN, such as IHC staining of Ki-67 and PHH3. 27 , 28 The differentiation between LBN and LMS is the focus of this review because LBN is often misdiagnosed as LMS, 30 , 60 leading to serious clinical consequences, such as overtreatment. Furthermore, some LMS patients may be misdiagnosed because of the lack of histologic evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the use of laparoscopic power morcellation during myomectomy might increase the probability of dissemination of unexpected LMS. 60 Therefore, it is necessary to improve the differential diagnosis between LBN and LMS from both histopathological and preoperative aspects.…”

Section: Discussionmentioning

confidence: 99%

“… 76 Recently, an increasing number of researchers have switched to the use of MRI in the differential diagnosis of USMTs. 60 Additionally, inflammatory markers or liquid biopsy may contribute to preoperative diagnosis. 52 , 57 When the combination of clinical feature evaluation, imaging examination, and serum biomarker detection shows atypical findings, biopsy, such as endometrial biopsy, should be performed.…”

Section: Discussionmentioning

confidence: 99%

“…In T1-weighted images, LBN is typically isointense to hypointense to muscle, while benign uterine leiomyomas are isointense to muscle. 60 STUMP may exhibit interspersed hyperintensities due to hemorrhage, whereas LMS is typically hyperintense to muscle due to hemorrhage and necrosis. In T2-weighted images, LBN may exhibit lace-like heterogeneous hyperintensity, whereas benign uterine leiomyomas are homogeneously hypointense to muscle and a T2-hyperintense rim may be observed due to edema.…”

Section: Different Diagnostic Tools For Lbnmentioning

confidence: 99%

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Leiomyoma with Bizarre Nuclei: A Current Update

Guo¹,

Li²,

Hu³

et al. 2022

IJWH

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Leiomyoma with bizarre nuclei (LBN), also known as symplastic leiomyoma, is a histological subtype of benign leiomyoma with bizarre cells and nuclear atypia. Differentiating LBN from other benign leiomyoma subtypes, uterine smooth muscle tumors of uncertain malignant potential (STUMP), or leiomyosarcoma (LMS) can be diagnostically challenging owing to overlapping features in clinical presentation and pathologic morphological analysis. The difficulty of distinguishing LBN from other lesions, especially from LMS, and the potential of LBN for subsequent malignant transformation make LBN an important topic of research. Herein, we review the definition, diagnosis, treatment, and prognosis of LBN. Histopathological examination is essential for distinguishing LBN from other diseases. Pathology sampling and morphological examination remain the key to diagnosis. The newly established ancillary immunohistochemical (IHC) and molecular genetic analysis can be useful tools for differential diagnosis. Furthermore, serum biomarkers and imaging examination may also be useful diagnostic tools. Attention should be paid to the differentiation between LBN and LMS because morphological diagnosis may still be challenging in some cases. Some IHC markers of LBN have been identified, which may be helpful for differential diagnosis. Furthermore, the use of IHC panels as diagnostic markers may be advocated. Molecular genetic studies suggest that some genes can aid with the differential diagnosis between LBN and LMS. However, increasing evidence support the idea that LBN and LMS are molecularly related, indicating that LBN may represent a potentially malignant stage of precancerous progression. At present, conservative treatment is recommended for primary LBN, especially for patients desiring to retain fertility, but close follow-up with imaging examinations is required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Different Diagnostic Tools For Lbnmentioning

confidence: 99%

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Leiomyoma with Bizarre Nuclei: A Current Update

Guo¹,

Li²,

Hu³

et al. 2022

IJWH

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“…However, there has been no definite cut off for ADC value due to the significant overlap between fibroids and leiomyosarcoma. Given the overlap of MRI imaging features of leiomyosarcoma and fibroids, a combination of conventional and DWI imaging features are to be particularly useful to avoid overlooking the malignant sarcomas for benign fibroids, and DWI improves accuracy of MRI to 92% [ 12 , 13 ]. MRI algorithm has been proposed using high DWI signal as compared to endometrium, low ADC values, and lymphadenopathy, and was found to be useful for differentiating leiomyosarcoma and uterine fibroids [ 14 ].…”

Section: Clinical Applications In Gynecological Non-malignant Conditionsmentioning

confidence: 99%

Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article

Bonde

Lago

Foster

et al. 2022

Cancers

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Functional imaging with diffusion-weighted imaging (DWI) is a complementary tool to conventional diagnostic magnetic resonance imaging sequences. It is being increasingly investigated to predict tumor response and assess tumor recurrence. We elucidate the specific technical modifications of DWI preferred for gynecological imaging, including the different b-values and planes for image acquisition. Additionally, we discuss the problems and potential pitfalls encountered during DWI interpretation and ways to overcome them. DWI has a wide range of clinical applications in malignant and non-malignant gynecological conditions. It provides supplemental information helpful in diagnosing and managing tubo-ovarian abscess, uterine fibroids, endometriosis, adnexal torsion, and dermoid. Similarly, DWI has diverse applications in gynecological oncology in diagnosis, staging, detection of recurrent disease, and tumor response assessment. Quantitative evaluation with apparent diffusion coefficient (ADC) measurement is being increasingly evaluated for correlation with various tumor parameters in managing gynecological malignancies aiding in preoperative treatment planning. Newer advanced DWI techniques of diffusion tensor imaging (DTI) and whole body DWI with background suppression (DWIBS) and their potential uses in pelvic nerve mapping, preoperative planning, and fertility-preserving surgeries are briefly discussed.

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