Uterine myomas and sarcomas – clinical and ultrasound characteristics and
            differential diagnosis using pulsed and color Doppler techniques

Wojtowicz, Kamila; Góra, Tomasz; Guzik, Paweł; Harpula, Magdalena; Chechliński, Paweł; Wolak, Ewelina; Stryjkowska-Góra, Aleksandra

doi:10.15557/jou.2022.0017

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…Risk factors for uterine myomas are well established and include African American ethnicity, the late onset of menopause, positive family history, a long interval since last delivery, hypertension, and consumption of dietary supplements and soy milk. Factors that reduce the risk of uterine myomas include multiple births, the use of oral contraceptives or depot medroxyprogesterone acetate, and smoking in women with a low body mass index [14,15]. On the other hand, uterine sarcomas are rare tumors with poor prognoses.…”

Section: Discussionmentioning

confidence: 99%

How Frequently Benign Uterine Myomas Appear Suspicious for Sarcoma as Assessed by Transvaginal Ultrasound?

Cabezas

López-Picazo

Diaz³

et al. 2023

Diagnostics

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Background: Uterine myomas may resemble uterine sarcomas in some cases. However, the rate of benign myomas appearing as sarcomas at an ultrasound examination is not known. The objective of this study is to determine the percentage of benign myomas that appear suspicious for uterine sarcoma on ultrasound examination. This is a prospective observational multicenter study (June 2019–December 2021) comprising a consecutive series of patients with histologically proven uterine myoma after hysterectomy or myomectomy who underwent transvaginal and/or transabdominal ultrasound prior to surgery. All ultrasound examinations were performed by expert examiners. MUSA criteria were used to describe the lesions (1). Suspicion of sarcoma was established when three or more sonographic features, described by Ludovisi et al. as “frequently seen in uterine sarcoma”, were present (2). These features are no visible myometrium, irregular cystic areas, non-uniform echogenicity, irregular contour, “cooked” appearance, and a Doppler color score of 3–4. In addition, the examiners had to classify the lesion as suspicious based on her/his impression, independent of the number of features present. Eight hundred and ten women were included. The median maximum diameter of the myomas was 58.7 mm (range: 10.0–263.0 mm). Three hundred and forty-nine (43.1%) of the patients had more than one myoma. Using the criterion of >3 suspicious features, 40 (4.9%) of the myomas had suspicious appearance. By subjective impression, the examiners considered 40 (4.9%) cases suspicious. The cases were not exactly the same. We conclude that approximately 5% of benign uterine myomas may exhibit sonographic suspicion of sarcoma. Although it is a small percentage, it is not negligible.

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Section: Discussionmentioning

confidence: 99%

How Frequently Benign Uterine Myomas Appear Suspicious for Sarcoma as Assessed by Transvaginal Ultrasound?

Cabezas

López-Picazo

Diaz³

et al. 2023

Diagnostics

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“…In particular, distinguishing between degenerative myomas or colliquative myomas (without malignant features) and malignant degeneration remains a challenging aspect of imaging. Consequentially, its diagnostic accuracy remains relatively low [62,63].…”

Section: Oncological Riskmentioning

confidence: 99%

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

Cianci,

Gulino,

Palmara

et al. 2023

Medicina

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Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient’s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as “myomectomy laparoscopic and open”, “myomectomy open and minimally invasive”, “myomectomy open and laparoscopic”, and “myomectomy open vs. laparoscopic.” The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.

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“…In fact, an irregular and intense vascularity is typically known as a sign of malignant lesions due to neoangiogenesis related to tumoral microenvironment [4], [16]. In addition, this sonographic sign could be considered even less relevant in uterine sarcomas diagnosis as uterine leiomyomas are usually sparsely vascularized, too [29].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis

et al. 2023

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Objective:To assess the prevalence of sonographic signs in uterine sarcomas women. Materials and Methods:A systematic review and meta-analysis was performed searching 5 electronic databases from inception to June 2022 for all studies that allowed to calculate the prevalence of sonographic signs in uterine sarcomas women. Pooled prevalence with 95% confidence intervals was calculated for each sonographic sign and was a priori defined as “very high” when it was ≥ 80%, “high” when it ranged from 80% to 70%, and less relevant when it was ≤ 70%. Results:6 studies with 317 sarcoma patients were included. Pooled prevalence was: 25.0%(95%CI:15.4-37.9%) for absence of visibility of the myometrium; 80.5%(95%CI:74.8-85.2%) for solid component; 78.3%(95%CI:59.3-89.9%) for inhomogeneous echogenicity of solid component; 47.9%(95%CI:41.1-54.8%) for cystic areas; 80.7%(95%CI:68.3-89.0%) for irregular walls of cystic areas; 72.3%(95%CI:16.7-97.2%) for anechoic cystic areas; 54.8%(95%CI:34.0-74.1%) for absence of shadowing; 73.5%(95%CI:43.3-90.9%) for absence of calcifications; 48.7%(95%CI:18.6-79.8%) for color score 3 or 4; 47.3%(95%CI:37.0-57.8%) for irregular tumor borders; 45.4%(95%CI:27.6-64.3%) for endometrial cavity not visualizable; 10.9%(95%CI:3.5-29.1%) for free pelvic fluid; 6.4%(95%CI:1.1-30.2%) for ascites; 21.2%(95%CI:2.1-76.8%) for intracavitary process; 81.5%(95%CI:56.1-93.8%) for singular lesion. Conclusions:Solid component, irregular walls of cystic areas and singular lesions are signs at very high prevalence, while inhomogeneous echogenicity of solid component, anechoic cystic areas and absence of calcifications are signs at high prevalence. Remaining signs were less relevant.

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Uterine myomas and sarcomas – clinical and ultrasound characteristics and differential diagnosis using pulsed and color Doppler techniques

Cited by 6 publications

References 33 publications

How Frequently Benign Uterine Myomas Appear Suspicious for Sarcoma as Assessed by Transvaginal Ultrasound?

How Frequently Benign Uterine Myomas Appear Suspicious for Sarcoma as Assessed by Transvaginal Ultrasound?

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis

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