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Huang J, Chen Y, Li Z, Chen M, Huang D, Zhu P, Han X, Zheng Y, Chen X, Yu Z. A bibliometric analysis of literatures on uterine leiomyosarcoma in the last 20 years. Front Oncol 2024; 14:1343533. [PMID: 38410101 PMCID: PMC10894944 DOI: 10.3389/fonc.2024.1343533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Background Uterine leiomyosarcoma(uLMS) is a rare malignant tumor with low clinical specificity and poor prognosis.There are many studies related to uLMS, however, there is still a lack of metrological analyses with generalization. This study provides a bibliometric study of uLMS. Methods and materials We chose the Web of Science (WoS) as our main database due to its extensive interdisciplinary coverage. We specifically focused on the literature from the last 20 years to ensure relevance and practicality. By utilizing the WOS core dataset and leveraging the R package "bibliometric version 4.1.0" and Citespace, we performed a comprehensive bibliometric analysis. This allowed us to pinpoint research hotspots and create visual representations, resulting in the retrieval of 2489 pertinent articles. Results This literature review covers 2489 articles on uterine leiomyosarcoma (uLMS) from the past 20 years. Key findings include an average annual publication rate of 8.75, with a 6.07% yearly growth rate and an average citation count of 17.22. Core+Zone 2 sources contributed 1079 articles and 207 reviews, displaying a 4.98% annual growth rate. The analysis identified top journals, influential authors, and core sources, such as the prevalence of publications from the United States and the dominance of GYNECOLOGIC ONCOLOGY and HENSLEY ML. Bradford's Law and Lotka's Law highlighted core sources and author productivity, respectively. Thematic mapping and factorial analysis revealed research clusters, including etiology, diagnosis, treatment advancements, and surgical approaches, with prominent themes such as gemcitabine and docetaxel. Overall, this comprehensive analysis provides insights into uLMS literature trends and influential factors. Conclusion This thorough bibliometric analysis, in its whole, illuminates the field's guiding principles while also revealing the subtle patterns within the uLMS literature. The knowledge gained here contributes to the current discussion in uLMS and related scientific fields and provides a solid basis for future research paths.
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Affiliation(s)
- Jinhua Huang
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
- College of Medicine, Shantou University, Shantou, Guangdong, China
| | - Yu Chen
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Ziyin Li
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Mimi Chen
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Dingwen Huang
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Peixin Zhu
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xintong Han
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Yi Zheng
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xiaochun Chen
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Zhiying Yu
- Department of Gynecology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
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Preoperative Differentiation of Uterine Leiomyomas and Leiomyosarcomas: Current Possibilities and Future Directions. Cancers (Basel) 2022; 14:cancers14081966. [PMID: 35454875 PMCID: PMC9029111 DOI: 10.3390/cancers14081966] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 01/03/2023] Open
Abstract
The distinguishing of uterine leiomyosarcomas (ULMS) and uterine leiomyomas (ULM) before the operation and histopathological evaluation of tissue is one of the current challenges for clinicians and researchers. Recently, a few new and innovative methods have been developed. However, researchers are trying to create different scales analyzing available parameters and to combine them with imaging methods with the aim of ULMs and ULM preoperative differentiation ULMs and ULM. Moreover, it has been observed that the technology, meaning machine learning models and artificial intelligence (AI), is entering the world of medicine, including gynecology. Therefore, we can predict the diagnosis not only through symptoms, laboratory tests or imaging methods, but also, we can base it on AI. What is the best option to differentiate ULM and ULMS preoperatively? In our review, we focus on the possible methods to diagnose uterine lesions effectively, including clinical signs and symptoms, laboratory tests, imaging methods, molecular aspects, available scales, and AI. In addition, considering costs and availability, we list the most promising methods to be implemented and investigated on a larger scale.
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A case of metastatic endobronchial tumor from uterine leiomyosarcoma. Respir Med Case Rep 2022; 40:101747. [PMID: 36193341 PMCID: PMC9526233 DOI: 10.1016/j.rmcr.2022.101747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/06/2022] [Accepted: 09/23/2022] [Indexed: 11/20/2022] Open
Abstract
A 54-year-old woman presented with persistent productive cough, found to have an endobronchial tumor which obstructed the left upper lobe bronchus. Histopathological examination of a transbronchial biopsy of the endobronchial tumor suggested leiomyosarcoma. A positron emission tomography (PET)-CT revealed uterus tumor with moderate uptake of 18F-fluorodeoxyglucose, suggesting uterine malignancies. From the results of histological findings of the resected uterus and the biopsied bronchial specimen, she was diagnosed with uterine leiomyosarcoma and endobronchial metastasis. The systematic use of PET-CT could be useful for patients presenting with tumors that cause endobronchial metastasis of leiomyosarcomas.
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Najibi S, Gilani MM, Zamani F, Akhavan S, Zamani N. Comparison of the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography in the differentiation between benign and malignant myometrial tumors. Ann Med Surg (Lond) 2021; 70:102813. [PMID: 34691413 PMCID: PMC8519770 DOI: 10.1016/j.amsu.2021.102813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 01/11/2023] Open
Abstract
Background Various modalities including ultrasonography and magnetic resonance imaging (MRI) have been developed as imaging technique for screening malignant myometrial tumors, but a few studies assessed the diagnostic value of these two techniques in differentiation of benign from malignant myometrial tumors that had been the main purpose of this study. Materials and methods This cross-sectional study was performed on 63 women underwent surgery for intrauterine masses that were initially assessed using MRI and ultrasound before surgery at a tertiary hospital in Tehran from 2016 to 2020. Their MRI was reviewed by a reputable radiologist in the field. The findings of histopathological assessment were considered as the gold diagnostic standard. Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI to detect sarcoma were revealed to be 94.6%, 92.3%, 94.6%, 92.3%, and 93.7% respectively. Ultrasonography had not preferable applicability to differentiate sarcoma from benign tumors with sensitivity, specificity, PPV, NPV and accuracy of 35.1%, 88.4%, 81.2%, 48.9%, and 57.1% respectively. The diagnostic performance of both modalities was not affected by baseline clinical conditions including pain, abnormal uterine bleeding and menopausal status. Conclusion MRI but not ultrasonography can effectively differentiate benign from malignant myometrial tumors. Pretreatment Diagnosis of malignant myometrial tumors may be challenging. MRI with DWI can be considered as a diagnostic tool in leiomyosarcoma. Pretreatment distinction between benign and malignant myometrial tumors is necessary.
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Affiliation(s)
- Shaparak Najibi
- Department of Obstetrics and Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modares Gilani
- Department of Gynecologic Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zamani
- Department of Radiology, Children Medical Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Setare Akhavan
- Department of Gynecologic Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Zamani
- Department of Gynecologic Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Yasukawa M, Dainty LA, Sugarbaker PH. Long-term outcomes after cytoreductive surgery and HIPEC for morcellated uterine leiomyosarcoma; A case series. Gynecol Oncol Rep 2021; 36:100741. [PMID: 33748383 PMCID: PMC7970133 DOI: 10.1016/j.gore.2021.100741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 01/25/2023] Open
Abstract
Six patients underwent cytoreductive surgery plus HIPEC and EPIC for morcellated uLMS. There were no postoperative deaths and a single patient had class 3 adverse events. Three-year overall survival was 50% and 5-year survival 33%. Patients with small volume uLMS or low-grade disease showed long-term survival.
Uterine leiomyosarcoma (uLMS) is a rare aggressive malignant mesenchymal tumor with high risk of recurrence and poor prognosis regardless of stage. It is often diagnosed postoperatively following myomectomy, hysterectomy or supracervical hysterectomy for presumed benign disease. Primary surgery at the diagnosis of uLMS is considered to affect outcomes. If the tumor was morcellated, the oncologist will encounter special problems that require knowledgeable management of peritoneal metastases. We previously reported that six patients who successfully underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) plus early postoperative intraperitoneal chemotherapy (EPIC) to manage the disease dissemination that must occur following morcellation. This is a study for long-term outcome of these patients. Six patients were treated with an absence of grade IV adverse events and no mortality. The median Peritoneal Cancer Index (PCI) was 18 and complete cytoreduction without peritoneal metastases visualized within the operative field at the completion of the surgical procedure (CC-0) was achieved in all patients. One patient was diagnosed leiomyomatosis peritonealis postoperatively. Among five patients who were confirmed uterine leiomyosarcoma, the 3-year overall survival was 40.0% and 5-year overall survival was 20.0% with the median follow-up of 18 months (range 5–73 months). The patient with PCI 0 at the time of CRS showed no evidence of disease (NED) at 73 months. We believe that prophylactic CRS contributed her favorable outcome. Therapeutic options for patients with uLMS post-morcellation are limited. Currently, CRS and HIPEC plus EPIC followed by adjuvant systemic chemotherapy may be considered an option for treatment. Further studies in a larger number of patients are needed.
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Affiliation(s)
- Maya Yasukawa
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Louis A Dainty
- Regional Director of Gynecologic Oncology at Georgetown Lombardi Comprehensive Cancer Center, Chief of Gynecologic Oncology Department at MedStar Washington Cancer, Washington, DC, USA
| | - Paul H Sugarbaker
- Chief of Peritoneal Surface Malignancy Program and Director of the Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, DC, USA
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The Risk of Uterine Malignancy in a Population Being Evaluated for Uterine Fibroid Embolization. J Comput Assist Tomogr 2020; 44:893-900. [PMID: 33196598 DOI: 10.1097/rct.0000000000001104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine the frequency of uterine malignancy in patients evaluated for uterine fibroid embolization (UFE) and the role of magnetic resonance imaging in triage. METHODS Records and imaging studies of 864 UFE consult patients were reviewed for MRI findings suggestive of fibroid malignancy. Pathology was obtained for cases with suspicious baseline MRI's, and the most atypical mass was reanalyzed by an experienced radiologist, blinded to the pathological findings. RESULTS Twenty one of 864 patients had baseline MRI findings concerning for malignancy at consultation and 17 had complete records. Re-evaluation suggested that 5 were malignant. Three were confirmed malignant (0.35%). One malignancy among the 843 without suspicious baseline MRI findings was missed at consultation. CONCLUSIONS In our UFE population, uterine malignancy is rare (4/864, 0.46%), and MRI detected the majority, 3 (75%) of 4 before UFE. The observed prevalence of any malignancy was 0.35%, congruent with current Federal Drug Administration estimates.
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Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, Smith J, Addley H, Reinhold C. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging 2019; 100:619-634. [PMID: 31427216 DOI: 10.1016/j.diii.2019.07.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
Uterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical criteria. Furthermore, imaging differentiation between both entities is frequently challenging due to their potential overlapping features. Because a suspected leiomyoma is often managed conservatively or with minimally invasive treatments, the misdiagnosis of leiomyosarcoma for a benign leiomyoma could potentially result in significant treatment delays, therefore increasing morbidity and mortality. In this review, we provide an overview of the differences between leiomyoma and leiomyosarcoma, mainly focusing on imaging characteristics, but also briefly touching upon their demographic, histopathological and clinical differences. The main indications and limitations of available cross-sectional imaging techniques are discussed, including ultrasound, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography. A particular emphasis is placed on the review of specific MRI features that may allow distinction between leiomyomas and leiomyosarcomas according to the most recent evidence in the literature. The potential contribution of texture analysis is also discussed. In order to help guide-imaging diagnosis, we provide an MRI-based diagnostic algorithm which takes into account morphological and functional features, both individually and in combination, in an attempt to optimize radiologic differentiation of leiomyomas from leiomyosarcomas.
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Affiliation(s)
- S Sun
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada.
| | - P A Bonaffini
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - S Nougaret
- Inserm, U1194, Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 34295 Montpellier, France
| | - L Fournier
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - A Dohan
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology A, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - J Chong
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - J Smith
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - H Addley
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - C Reinhold
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
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Albano D, Zizioli V, Treglia G, Odicino F, Giubbini R, Bertagna F. Role of 18F-FDG PET/CT in restaging and follow-up of patients with uterine sarcomas. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Role of 18F-FDG PET/CT in restaging and follow-up of patients with uterine sarcomas. Rev Esp Med Nucl Imagen Mol 2018; 38:10-16. [PMID: 30396849 DOI: 10.1016/j.remn.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Uterine sarcomas are rare tumors with poor prognosis due to the high recurrence rates. The current role of 18F-FDG PET/CT in the post-therapy surveillance is not established yet. MATERIALS AND METHODS Forty-one women with uterine sarcoma underwent 73 18F-FDG PET/CT for restaging in suspected recurrence or during follow-up in asymptomatic patients. Histopathology results and/or clinical/imaging follow-up for at least 12 months were considered the reference standard. The diagnostic accuracy and clinical impact of 18F-FDG PET/CT was calculated. RESULTS Thirty-three 18F-FDG PET/CT were positive, while the remaining 40 studies were negative. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18F-FDG PET/CT were 88%, 98%, 97%, 91% and 93%, respectively. Considering patients with clinical or radiological suspicion of recurrence (n=47) and those during follow-up (n=26), sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG PET/CT were 89%, 100%, 100%, 86% and 94%, and 80%, 95%, 80%, 95% and 92%, respectively. 18F-FDG PET/CT had a positive clinical impact in 9/73 (12%) studies and changed the clinical management in 8/41 (20%) patients. CONCLUSIONS 18F-FDG PET/CT seems to be an accurate method for detection and localization of local and distant recurrence in patients with uterine sarcoma with good sensitivity and specificity and significant impact on clinical decision making.
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Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? AJR Am J Roentgenol 2018; 211:1405-1415. [PMID: 30354268 DOI: 10.2214/ajr.17.19234] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to provide background on the epidemiologic, clinical, and economic impact of uterine leiomyomas, summarize the concerns associated with treating women with potential occult leiomyosarcomas (LMSs), and review the known and emerging imaging features of typical and atypical leiomyomas and explain how to differentiate them from LMSs. CONCLUSION Surgical management of presumed benign uterine leiomyomas received popular media attention when a case of disseminated LMS occurred after laparoscopic power morcellator-assisted hysterectomy. A subsequent U.S. Food and Drug Administration review found a higher prevalence of unsuspected uterine sarcoma and LMS among patients undergoing myomectomy or hysterectomy for presumed benign leiomyomas than was previously reported. This heightened concern has led to increased pressure on radiologists to distinguish LMSs from leiomyomas.
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Juhasz-Böss I, Gabriel L, Bohle RM, Horn LC, Solomayer EF, Breitbach GP. Uterine Leiomyosarcoma. Oncol Res Treat 2018; 41:680-686. [PMID: 30321869 DOI: 10.1159/000494299] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/05/2018] [Indexed: 12/13/2022]
Abstract
Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and it should be done in order to remove the uterus intact. As vaginal, abdominal, and endoscopic surgery - possibly including morcellation - are the methods of choice for the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment and radiotherapy are of no proven value in the adjuvant setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient. Diagnostic tools as well as treatment options in adjuvant and palliative situations are reviewed.
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Value of 18F-FDG PET/CT imaging in the staging, restaging, monitoring of response to therapy and surveillance of uterine leiomyosarcomas. Nucl Med Commun 2018; 39:652-658. [PMID: 29683931 DOI: 10.1097/mnm.0000000000000848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Leiomyosarcoma (LMS) is the most common subtype of uterine sarcomas. It is a rare and aggressive tumour. The aim of the present study was to assess the performance of fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT imaging in four clinical settings: initial staging, restaging, monitoring of response to therapy and post-therapy surveillance of uterine LMS. PATIENTS AND METHODS A bicentric retrospective study was carried out on a group of 21 patients with uterine LMS for whom a total of 52 PET/CT scans were available in initial staging (n=11), restaging (n=11), monitoring of response to therapy (n=17) and post-therapy surveillance (n=13). Clinical (minimum 6 months after PET/CT scan) and/or imaging follow-up and pathology were used as the reference standard. RESULTS In the initial staging, the sensitivity, specificity and accuracy of PET imaging were 80, 100 and 91%, respectively. In the restaging and monitoring of response to therapy, all these indices were 100%, whereas they were lower in post-therapy surveillance at 75, 100 and 85%, respectively, because of two false-negative results. False-negative lesions were an infracentimetric lung nodule in the initial staging and a peritoneal nodule that had increased in size between two PET/CT scans in post-therapy surveillance. PET-negative lesions were all identified on the computed tomography (CT) part of the PET/CT; thus, the performances of the exam improved to 100% on taking into account the CT component of the PET/CT. CONCLUSION PET/CT imaging has a high diagnostic yield in the initial staging and restaging of uterine LMS, but seems less sensitive in post-therapy surveillance. Evaluation of the CT part improves the sensitivity of the PET scan. Thus, PET/CT imaging should be considered in patients presenting with LMS.
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Kusunoki S, Terao Y, Ujihira T, Fujino K, Kaneda H, Kimura M, Ota T, Takeda S. Efficacy of PET/CT to exclude leiomyoma in patients with lesions suspicious for uterine sarcoma on MRI. Taiwan J Obstet Gynecol 2018; 56:508-513. [PMID: 28805609 DOI: 10.1016/j.tjog.2017.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyze the efficacy of positron emission tomography/computed tomography (PET/CT) for the diagnosis of uterine sarcoma. MATERIALS AND METHODS Thirty-four patients evaluated between January 2010 and March 2015 were retrospectively enrolled. All patients in whom uterine sarcoma was suspected based on contrast-enhanced magnetic resonance imaging (MRI) findings (heterogeneous, high signal intensity on T2-weighted images and/or high intensity on T1-weighted images) underwent PET/CT for further assessment. Patients were divided into 2 groups based on postoperative pathological findings: uterine sarcoma (n = 15) and leiomyoma (n = 19). The maximum standardized uptake value (SUVmax) of all lesions was measured using PET/CT; we calculated the optimal cutoff value for diagnosing sarcoma. RESULTS The median SUVmax for uterine sarcoma and leiomyoma was 12 and 4.1, respectively; these values were significantly different. An SUVmax of greater than 7.5 was able to exclude leiomyoma with 80.8% sensitivity and 100% specificity (area under the curve, 95.3%). A cutoff SUVmax of 7.5 yields 100% specificity, and a cutoff SUVmax of 4.4 yields a 100% negative predictive value (NPV). The combination of PET/CT and lactate dehydrogenase (LDH) levels had a sensitivity of 86.6%, specificity of 100%, positive predictive value of 100%, and an NPV of 90.4%. No relation between histopathology or International Federation of Gynecology and Obstetrics (FIGO) stage and 18-fluoro-2-deoxy-d-glucose uptake value on PET/CT was seen. The surgical outcome trended toward a correlation with the SUVmax, although this was not statistically significant. CONCLUSIONS In patients with MRI findings consistent with either uterine sarcoma or leiomyoma, PET/CT can decrease the false-positive rate by setting an optimal cutoff SUVmax of 7.5. Using this cutoff can avoid unnecessary surgery.
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Affiliation(s)
- Soshi Kusunoki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Takafumi Ujihira
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Kazunari Fujino
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Hiroshi Kaneda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Miki Kimura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Tsuyoshi Ota
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
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Tanos V, Berry K. Benign and malignant pathology of the uterus. Best Pract Res Clin Obstet Gynaecol 2018; 46:12-30. [DOI: 10.1016/j.bpobgyn.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
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16
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Skorstad M, Kent A, Lieng M. Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study. Acta Obstet Gynecol Scand 2017; 95:1228-1234. [PMID: 27564388 DOI: 10.1111/aogs.13008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/23/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The goal of this study was to assess the sensitivity of different preoperative diagnostic tools used in women with uterine leiomyosarcomas. MATERIAL AND METHODS Retrospective cohort study of all women with verified uterine leiomyosarcoma in Norway in the period 2000 to 2012. Data were collected from the Cancer Registry of Norway and medical records. RESULTS There were 212 women diagnosed with uterine leiomyosarcoma in the 13-year period. Histopathological examinations by fractional curettage or endometrial biopsies verified malignancy in 55/142 (38.7%). MRI suggested malignancy in 45/55 (81%) of the examinations. CT evaluations indicated suspected malignancy in 64/107 women (59.8%). Biomarkers had low sensitivity for leiomyosarcoma, but suggested more advanced stage disease when high values were detected. Stage IV disease was present in 53.1% versus 25.5% (p = 0.01) of women with CA 125 values above 35 kU/L, compared with women with normal CA 125 values. In 115/212 (54.2%), leiomyosarcoma was only diagnosed postoperatively by histopathological examination of the removed specimen. CONCLUSIONS Preoperative diagnostic modalities appear to have low sensitivity for differentiating leiomyosarcoma from fibroids. In Norway, approximately 54% of uterine leiomyosarcoma are unidentified before surgery. MRI evaluation was the imaging modality with the greatest sensitivity in identifying leiomyosarcoma preoperatively.
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Affiliation(s)
- Mette Skorstad
- Department of Obstetrics and Gynecology, Vestfold Hospital, Tonsberg, Norway.
| | - Andrew Kent
- Department of Gynecology, Royal Surrey Hospital, Guildford, UK
| | - Marit Lieng
- Department of Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: Epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol 2017; 145:208-216. [PMID: 28209496 DOI: 10.1016/j.ygyno.2017.02.019] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
Abstract
Leiomyosarcoma, a rare tumor subtype, accounts for 1% of all uterine malignancies, but contributes to a significant proportion of uterine cancer deaths. Surgery is considered the mainstay of treatment for all soft tissue sarcomas, including uterine variants. However, uterine leiomyosarcoma is challenging to diagnose preoperatively and can mimic the appearance of benign uterine leiomyomas. Recently, concerns have grown in this regard, as surgeons have utilized uterine morcellation and myomectomy procedures unknowingly in the setting of occult uterine sarcoma. Because of aggressive tumor biology and relative chemotherapy and radiotherapy resistance, efficacious therapies to achieve prolonged survival or cure in those with both early and advanced-stage uterine leiomyosarcoma have been elusive. The strongest determinant of survival remains stage at diagnosis, though prediction models may provide a more accurate prognosis. Given the aggressive nature of this sarcoma subtype, novel early detection strategies and targeted therapies are the focus of several recently published and ongoing studies. While gemcitabine/docetaxel and doxorubicin remain the most active regimens in the treatment of advanced or recurrent disease, currently available cytotoxic regimens remain inadequate, with 5-year disease-specific survival of <30%. Pazopanib, trabectedin and olaratumab, are FDA-approved, targeted therapies with activity in uterine and other leiomyosarcomas, while aromatase inhibitors and immunotherapies are under active investigation. This review provides a critical appraisal of the literature regarding the contemporary surgical and medical management of uterine leiomyosarcoma, the role of targeted therapies, and the implications of uterine morcellation on gynecologic surgical practice.
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Affiliation(s)
- Stephanie Ricci
- Division of Gynecologic Oncology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca L Stone
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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19
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High metabolic characteristics of uterine fibroids in 18F-FDG PET/CT imaging and the underlying mechanisms. Nucl Med Commun 2016; 37:1206-11. [DOI: 10.1097/mnm.0000000000000558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Abstract
FDG-PET/CT has been evaluated in a variety of gynecologic malignancies in a variety of settings and is approved by the Centers for Medicare & Medicaid Services for the initial and subsequent treatment strategies of these malignancies. Cervical cancer is typically very FDG avid, and FDG-PET/CT appears to be most valuable for initial staging, radiation therapy planning, and detection of recurrent disease. For ovarian cancer, the most value of FDG-PET/CT appears to be for detecting recurrent disease in the setting of rising CA-125 level and negative or equivocal anatomical imaging studies. Initial studies evaluating response to therapy are promising and further work in this area is needed. FDG uptake in both nonmalignant and physiological processes in the pelvis can make interpretation of FDG-PET/CT in this region challenging and knowledge of these entities and patterns can avoid misinterpretation. Some of the most common findings relate to the cyclic changes that occur as part of the menstrual cycle in premenopausal women. Mucinous tumors and low-volume or peritoneal carcinomatosis are causes of false-negative results on FDG-PET/CT studies. As new tracers are developed, comparisons with patient outcomes and standards of care (eg, FDG-PET/CT) will be needed.
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Affiliation(s)
- Paul Grant
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Christopher Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
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21
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Diffusion-Weighted MRI and FDG-PET in Diagnosis of Endometrial Stromal Nodule. Case Rep Obstet Gynecol 2015; 2015:540283. [PMID: 25694838 PMCID: PMC4324744 DOI: 10.1155/2015/540283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/01/2015] [Indexed: 11/18/2022] Open
Abstract
Preoperative differentiation of benign endometrial stromal nodule (ESN) from malignant low-grade endometrial sarcoma (LGESS) is challenging, because it requires histological evaluation of the tumor-myometrium interface, which is difficult to obtain in conventional endometrial curettage. A 72-year-old postmenopausal woman presented with 5-year history of persistent vaginal bleeding. Histological examination of the endometrial curettage specimen revealed hyperplasia of apparently normal endometrial stromal cells. T2-weighted magnetic resonance imaging (T2W-MRI) showed polypoid tumor occupying the entire uterine cavity. The tumor exhibited high signal intensity in diffusion-weighted MRI (DW-MRI) and intense accumulation of 18F-fluorodeoxyglucose (FDG) in positron emission tomography (PET). Intense FDG accumulation was also observed in the left internal iliac region. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed under the diagnosis of LGESS with lymph node metastasis. However, postoperative histological examination proved that the tumor was ESN without lymph node metastasis. Since mitotic figure is no longer included in the diagnostic criteria of ESN or LGESS, ESN could exhibit high cellularity and high proliferative activity as observed in this case. Therefore, DW-MRI or FDG-PET is not useful in the differentiation of ESN from LGESS.
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22
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Brölmann H, Tanos V, Grimbizis G, Ind T, Philips K, van den Bosch T, Sawalhe S, van den Haak L, Jansen FW, Pijnenborg J, Taran FA, Brucker S, Wattiez A, Campo R, O’Donovan P, de Wilde RL. Options on fibroid morcellation: a literature review. ACTA ACUST UNITED AC 2015; 12:3-15. [PMID: 25774118 PMCID: PMC4349949 DOI: 10.1007/s10397-015-0878-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/01/2015] [Indexed: 11/30/2022]
Abstract
In laparoscopy, specimens have to be removed from the abdominal cavity. If the trocar opening or the vaginal outlet is insufficient to pass the specimen, the specimen needs to be reduced. The power morcellator is an instrument with a fast rotating cylindrical knife which aims to divide the tissue into smaller pieces or fragments. The Food and Drug Administration (FDA) issued a press release in April 2014 that discouraged the use of these power morcellators. This article has the objective to review the literature related to complications by power morcellation of uterine fibroids in laparoscopy and offer recommendations to laparoscopic surgeons in gynaecology. This project was initiated by the executive board of the European Society of Gynaecological Endoscopy. A steering committee on fibroid morcellation was installed and experienced ESGE members requested to chair an action group to address distinct clinical questions. Clinical questions were formulated with regards to the sarcoma risk in presumed uterine fibroids, diagnosis of sarcoma, complications of morcellation and future research. A literature review on the different subjects was conducted, systematic if appropriate and feasible. It was concluded that the true prevalence of uterine sarcoma in presumed fibroids is not known given the wide range of prevalences (0.45–0.014 %) from meta-analyses mainly based on retrospective trials. Age and certain imaging characteristics such as ‘lacunes’ suggesting necrosis and increased central vascularisation of the tumour are associated with a higher risk of uterine sarcoma, although the risks remain low. There is not enough evidence to estimate this risk in individual patients. Complications of morcellation are rare. Reported are direct morcellation injuries to vessels and bowel, the development of so-called parasitic fibroids requiring reintervention and the spread of sarcoma cells in the abdominal cavity, which may possibly or even likely upstaging the disease. Momentarily in-bag morcellation is investigated as it may possibly prevent morcellation complications. Because of lack of evidence, this literature review cannot give strong recommendations but offers only options which are condensed in a flow chart. Prospective data collection may clarify the issue on sarcoma risk in presumed fibroids and technology to extract tissue laparoscopically from the abdominal cavity should be perfected.
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Affiliation(s)
- Hans Brölmann
- Department of Gynaecology, VU University Medical Centre, de Boelelaan 1117, 1181HV Amsterdam, The Netherlands
| | - Vasilios Tanos
- Department of Obstetrics and Gynaecology, Aretaeio Hospital, St George’s Medical School, Nicosia University, Nicosia, Cyprus
| | - Grigoris Grimbizis
- Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Ind
- Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK
| | | | | | - Samir Sawalhe
- Donauisar Klinikum Deggendorf-Dingolfing-Landau, Deggendorf, Germany
| | | | | | | | - Florin-Andrei Taran
- Department for Women’s Health, University Hospital Tuebingen, Eberhard Karls University, Tübingen, Germany
| | - Sara Brucker
- Department for Women’s Health, University Hospital Tuebingen, Eberhard Karls University, Tübingen, Germany
| | | | - Rudi Campo
- Leuven Institute for Fertility and Embryology (LIFE), Leuven, Belgium
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Abstract
In this review, we review the literature on the use of PET in radiation treatment planning, with an emphasis on describing our institutional methodology (where applicable). This discussion is intended to provide other radiation oncologists with methodological details on the use of PET imaging for treatment planning in radiation oncology, or other oncologists with an introduction to the use of PET in planning radiation therapy.
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24
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Caractéristiques clinicopathologiques et facteurs pronostiques des sarcomes utérins dans le centre tunisien. Bull Cancer 2014; 101:669-80. [DOI: 10.1684/bdc.2014.1921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Shwayder J, Sakhel K. Imaging for Uterine Myomas and Adenomyosis. J Minim Invasive Gynecol 2014; 21:362-76. [DOI: 10.1016/j.jmig.2013.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/16/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
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26
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Goldberg J. Current thinking on the role of interventional radiology in women’s health. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.5.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Inoue K, Tsubamoto H, Kawata S, Hao H, Ikeda Y, Oku N, Hirota S. 18
F-Fluorodeoxyglucose uptake and clinicopathological features of recurrent or metastatic endometrial stromal sarcoma. J Obstet Gynaecol Res 2013; 40:576-82. [DOI: 10.1111/jog.12180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kayo Inoue
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
- Department of Obstetrics and Gynecology; Meiwa General Hospital; Nishinomiya Hyogo Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Shuji Kawata
- Nuclear Medicine and PET Center; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Hiroyuki Hao
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Yuki Ikeda
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Naohiko Oku
- Nuclear Medicine and PET Center; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Seiichi Hirota
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
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28
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Özdemir E, Yıldırım Poyraz N, Uzun B, Türkölmez Ş. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the detection of skeletal muscle and skin metastases in uterine leiomyosarcoma: A case report. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Marak CP, Ponea AM, Alappan N, Shaheen S, Guddati AK. Uterine leiomyosarcoma manifesting as a tricuspid valve mass. Case Rep Oncol 2013; 6:119-26. [PMID: 23569446 PMCID: PMC3618104 DOI: 10.1159/000346935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Uterine leiomyosarcoma is a rare malignancy and carries a poorer prognosis when compared to endometrial carcinoma. It has been observed to metastasize to all the major organs. It presents with symptoms of abdominal distension, vaginal bleeding and may pass unnoticed until an advanced stage in patients with leiomyomas. Surgery is a viable option in patients with disease limited to the uterus, but metastasis to the heart may require surgery to prevent acute and catastrophic complications. The case described here involves metastasis to the tricuspid valve, which caused severe tricuspid regurgitation in the setting of acute pulmonary embolism. Surgical resection restored cardiac function and stabilized the patient. This case illustrates a rare site of metastasis of leiomyosarcoma which required immediate intervention and resulted in a favorable outcome.
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Affiliation(s)
- Creticus P Marak
- Division of Pulmonary and Critical Care Medicine, Montefiore Hospital, Albert Einstein College of Medicine, Yeshiva University, New York, N.Y., USA
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30
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Ozdemir E, Poyraz NY, Uzun B, Türkölmez S. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the detection of skeletal muscle and skin metastases in uterine leiomyosarcoma: a case report. Rev Esp Med Nucl Imagen Mol 2012; 32:257-9. [PMID: 23153988 DOI: 10.1016/j.remn.2012.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 09/23/2012] [Accepted: 09/26/2012] [Indexed: 11/29/2022]
Abstract
We report the clinical value of FDG PET/CT imaging in a 57-year-old woman who was diagnosed with uterine leimyosarcoma 6 years ago. In a staging procedure, whole body FDG PET/CT discloses the presence of both local recurrence and remote metastases at widespread musculocutaneous sites, liver and femur. With its advantage of scanning the whole body in a single procedure, we propose the use of PET/CT imaging for the evaluation of patients with uterine leimyosarcomas, a tumor with a propensity for widespread hematogenous spread to unusual sites.
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Affiliation(s)
- E Ozdemir
- Department of Nuclear Medicine, Atatürk Research and Training Hospital, Ankara, Turkey.
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31
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Abstract
OBJECTIVE The purpose of this article is to provide an updated review of uterine sarcomas. The traditionally described neoplasms are reviewed as well as several recently characterized entities in terms of their imaging and clinical aspects. We attempt to provide a longitudinal imaging overview, from initial presentation to follow-up. Imaging features are also described of response to traditional therapeutic agents and newer targeted agents. CONCLUSION A greater understanding of the pathogenesis has improved our ability to image and treat uterine sarcomas, both at initial staging and on follow-up. Targeted therapy is assuming an increasingly important role in the management of these lesions. It is imperative for radiologists to be aware of response characteristics and potential complications of these agents as well as conventional chemotherapeutic agents.
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Abstract
BACKGROUND The histopathological classification and staging system for uterine sarcoma (US) were revised in 2003 and 2009, respectively. However, there is currently no consensus on the significance of various prognostic factors. Therefore the available clinicopathological data on US are summarized in this review. METHODS Articles on uterine sarcoma published in English from 1970 to 2011 were identified systematically by computer-based searches in Medline and the Cochrane Library. RESULTS Prognosis of US is poor, with a five-year survival rate as low as 30%. The most common histological types are leiomyosarcoma (LMS, 63%), endometrial stromal sarcoma (ESS, 21%), adenosarcoma (6%), undifferentiated sarcoma (5%) and other types (5%). Carcinosarcoma is a mixed tumor, which is today regarded as a subset of endometrial carcinoma. Disease stage is the most important prognostic factor for all types of US. However, the prognosis of stage I LMS is also significantly related to tumor size and mitotic index (MI), and stage I ESS is related to MI and tumor cell necrosis (TCN). In adenosarcoma, TCN is the only significant histopathological prognostic factor. Information on the use of preoperative imaging for staging purposes is lacking. Total hysterectomy is the cornerstone of US treatment. The ovary can be preserved in premenopausal women with early-stage LMS and ESS, and routine lymphadenectomy is not necessary unless enlarged lymph nodes are present. As tumor-free resection margins at primary surgery are the most important prognostic factor for survival, sarcoma surgery should be centralized. Adjuvant treatment has changed from radiation therapy to chemotherapy over the last decades, without any change in survival. CONCLUSION There are differences in survival between histological types of US. LMS and ESS can be divided into different prognostic groups and should be treated separately.
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Affiliation(s)
- Claes G Tropé
- Department of Gynaecologic Oncology, Oslo University Hospital, the Norwegian Radium Hospital, Norway.
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33
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[FDG-PET and endometrial cancer]. Bull Cancer 2011; 99:21-8. [PMID: 22182739 DOI: 10.1684/bdc.2011.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
FDG-PET is widely used for the diagnosis, the staging and the search for recurrence of many tumors. However, there are currently no recommendations for its use in endometrial cancer. This article is an update of the literature data to enable everyone to form an opinion on the subject. Future prospects are considered.
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Uterine carcinosarcomas (malignant mixed müllerian tumours): a review with special emphasis on the controversies in management. Obstet Gynecol Int 2011; 2011:470795. [PMID: 22007228 PMCID: PMC3189599 DOI: 10.1155/2011/470795] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/02/2011] [Indexed: 11/17/2022] Open
Abstract
Uterine carcinosarcomas (MMMT-malignant mixed Müllerian tumours) are highly aggressive, rare, biphasic tumours composed of epithelial and mesenchymal elements believed to arise from a monoclonal origin. While hysterectomy with bilateral salpingo-oophorectomy remains the mainstay treatment, high rates of recurrence and metastases suggest a need for lymphadenectomy and postoperative adjuvant treatment. There are no established consensus guidelines for therapeutic patient management. Though well recognized that it improves locoregional control, the role of radiation in improving overall survival outcomes remains undecided. Although various combinations of chemotherapy have been explored, an optimal therapeutic modality is yet to be determined. As overall survival rates have not improved in thirty years, it is suggested that targeted chemotherapy and/or a multimodality approach may yield better outcomes. This paper provides a summary of the aetiopathogenesis of carcinosarcomas (MMMT) limited to the uterus with special emphasis on the controversies in the management of these patients.
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Wu TI, Yen TC, Lai CH. Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Pract Res Clin Obstet Gynaecol 2011; 25:681-9. [PMID: 21816678 DOI: 10.1016/j.bpobgyn.2011.07.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 07/06/2011] [Indexed: 12/23/2022]
Abstract
Uterine sarcomas are uncommon tumours from mesenchymal elements. They are thought to arise primarily from endometrial stroma and uterine muscle, respectively. When endometrial stroma undergoes malignant transformation, it might be accompanied by a malignant epithelial component. Thus, malignant mesenchymal uterine tumours comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated uterine sarcoma and carcinosarcoma. In this chapter, we discusses preoperative presentation, diagnosis and current progress in different imaging modalities, including ultrasonography, computed tomography, magnetic resonance image and positron emission tomography scan. We summarise advances in new technology, which might improve preoperative detection and enhance referral to gynaecologic oncologists for optimal staging surgery and treatment.
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Affiliation(s)
- Tzu-I Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Funaki K, Fukunishi H, Maeda T, Ohbayashi C, Yamaguchi S. Adenomyosis with extensive glandular proliferation simulating infiltrating malignancy on magnetic resonance imaging. Jpn J Radiol 2011; 29:272-5. [PMID: 21607841 DOI: 10.1007/s11604-010-0538-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 10/31/2010] [Indexed: 11/25/2022]
Abstract
We report a case of multicystic adenomyosis, which is an exceedingly rare benign tumor. The patient complained of an irregular menstrual cycle and abnormal genital bleeding that gradually increased in amount and frequency. The patient finally became severely anemic, and a hysterectomy was therefore performed. T2-weighted magnetic resonance imaging (MRI) indicated hyperplasia of the endometrium, with a myometrial lesion, where a high signal intensity multicystic mass was observed. The preoperative diagnosis was complicated by confusing MRI results. Postoperative macroscopic examination revealed a villous endometrium and a myometrium thickened with multiple small cysts containing serous transparent fluid. The final diagnosis, based on the hysterectomy specimen, was adenomyosis coexisting with simple endometrial hyperplasia. The MRI and positron emission tomography images are presented.
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Affiliation(s)
- Kaoru Funaki
- Department of Gynecology, Shinsuma General Hospital, 4-1-6 Isonare-cho, Suma-ku, Kobe 654-0047, Japan.
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Genever AV, Abdi S. Can MRI predict the diagnosis of endometrial carcinosarcoma? Clin Radiol 2011; 66:621-4. [PMID: 21507390 DOI: 10.1016/j.crad.2011.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/26/2011] [Accepted: 02/28/2011] [Indexed: 11/17/2022]
Abstract
AIM To ascertain whether magnetic resonance imaging (MRI) can be used to suggest a diagnosis of endometrial carcinosarcoma. MATERIALS AND METHODS A retrospective imaging review was performed of the MRI images of 39 patients with endometrial carcinosarcoma. Anteroposterior and longitudinal dimensions of the uterus and measurement of the endometrial thickness were taken in the sagittal plane. The ratio of antero-posterior measurement to endometrial thickness was calculated. The same measurements were taken on 50 patients with endometrial adenocarcinoma. A two-tailed t-test and receiver operator characteristic analysis were performed on these measurements for both patient groups. RESULTS There was a statistically significant difference between the longitudinal (p=0.0084) and anteroposterior (p=0.00036) dimensions of the uterus of the two groups. There was also a statistically significant difference between the ratios of anteroposterior dimension to endometrial thickness (p=0.00018). The optimal cut-off ratio above which the radiologist should be alerted to a potential diagnosis of endometrial carcinosarcoma was shown to be 0.63. CONCLUSION MRI can be helpful in suggesting a diagnosis of endometrial carcinosarcoma with the help of some simple measurements.
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Affiliation(s)
- A V Genever
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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38
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Abstract
BACKGROUND Uterine sarcomas account for approximately 3% to 7% of all uterine malignancies. Distinguishing benign and malignant myomas based on physical examination and imaging alone is challenging. CASE A postmenopausal woman with a history of leiomyomas presented to the Emergency Department with chest pain and a right upper lobe lung mass. Blood tests demonstrated profound eosinophilia (58,000/mm). Positron emission tomography-computed tomography scan to exclude distant disease as work-up for presumed lung cancer revealed increased tracer uptake in the lung mass and a pelvic mass. The patient died from complications of hypereosinophilia, and a postmortem diagnosis of metastatic uterine leiomyosarcoma was made. CONCLUSION Significant blood eosinophilia is uncommon in leiomyomas and should raise suspicion of malignant etiology for a pelvic mass.
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39
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Harry VN, Narayansingh GV, Parkin DE. Uterine leiomyosarcomas: a review of the diagnostic and therapeutic pitfalls. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.9.2.088.27309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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40
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Seddon BM, Davda R. Uterine sarcomas--recent progress and future challenges. Eur J Radiol 2011; 78:30-40. [PMID: 21247711 DOI: 10.1016/j.ejrad.2010.12.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
Abstract
Uterine sarcomas are a group of rare tumours that provide considerable challenges in their treatment. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made post-operatively. Current staging systems have been unsatisfactory, although a new FIGO staging system specifically for uterine sarcomas has now been introduced, and may allow better grouping of patients according to expected prognosis. While the mainstay of treatment of early disease is a total abdominal hysterectomy, it is less clear whether routine oophorectomy or lymphadenectomy is necessary. Adjuvant pelvic radiotherapy may improve local tumour control in high risk patients, but is not associated with an overall survival benefit. Similarly there is no good evidence for the routine use of adjuvant chemotherapy. For advanced leiomyosarcoma, newer chemotherapy agents including gemcitabine and docetaxel, and trabectedin, offer some promise, while hormonal therapies appear to be more useful in endometrial stromal sarcoma. Novel targeted agents are now being introduced for sarcomas, and uterine sarcomas, and show some indications of activity. Non-pharmacological treatments, including surgical metastatectomy, radiofrequency ablation, and CyberKnife(®) radiotherapy, are important additions to systemic therapy for advanced metastatic disease.
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Affiliation(s)
- Beatrice M Seddon
- London Sarcoma Service, Department of Oncology, University College Hospital, 1st Floor Central, 250 Euston Road, London, NW1 2PG, United Kingdom.
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41
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Park JH, Han JY, Hyun IY, Lee BI, Moon YS. Case of uterine leiomyoma showing fludeoxyglucose uptake on F-18 fludeoxyglucose positron emission tomography/computed tomography. J Obstet Gynaecol Res 2010; 36:1261-4. [PMID: 21083837 DOI: 10.1111/j.1447-0756.2010.01307.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In order not to over treat uterine leiomyoma and to avoid overlooking uterine leiomyosarcoma, a highly reliable diagnostic method has been thought. Occasionally, it is difficult to discriminate uterine leiomyoma from uterine leiomyosarcoma. Recently positron emission tomography/computed tomography (PET/CT) has been proved useful in assessing pelvic malignancies. We experienced a case of uterine leiomyoma showing increased F-18 fludeoxyglucose uptake on PET/CT in a postmenopausal woman. However, histological analysis demonstrated benign leiomyoma by the hysterectomy. Immunohistochemical analysis of glucose transporter-1 showed negative in leiomyoma. Our case indicates that uterine leiomyoma in a postmenopausal woman may show false positive result of PET/CT.
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Affiliation(s)
- Jee Hyun Park
- Department of Obstetrics and Gynecology, Laboratory Medicine, College of Medicine, Inha University, Incheon, Korea
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42
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Sohaib SA, Verma H, Attygalle AD, Ind TE. Imaging of Uterine Malignancies. Semin Ultrasound CT MR 2010; 31:377-87. [DOI: 10.1053/j.sult.2010.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
OBJECTIVE The purpose of this article is to review FDG PET/CT and MRI findings in a variety of benign and malignant tumors of the uterus and to become familiar with the wide variety of FDG PET/CT findings of this entity. CONCLUSION Benign uterine tumors generally have mild FDG uptake, and leiomyoma rarely shows high uptake. Uterine malignant tumors generally have intense FDG uptake, whereas malignant uterine tumors that are small or that have low cellular density often show minimal uptake.
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Lee AY, Poder L, Qayyum A, Wang ZJ, Yeh BM, Coakley FV. Imaging malignant and apparent malignant transformation of benign gynaecological disease. Clin Radiol 2010; 65:1031-7. [PMID: 21070909 DOI: 10.1016/j.crad.2010.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/07/2010] [Accepted: 07/14/2010] [Indexed: 11/17/2022]
Abstract
Common benign gynaecological diseases, such as leiomyoma, adenomyosis, endometriosis, and mature teratoma, rarely undergo malignant transformation. Benign transformations that may mimic malignancy include benign metastasizing leiomyoma, massive ovarian oedema, decidualization of endometrioma, and rupture of mature teratoma. The aim of this review is to provide a contemporary overview of imaging findings in malignant and apparent malignant transformation of benign gynaecological disease.
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Affiliation(s)
- A Y Lee
- Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA
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Bhosale P, Iyer R, Jhingran A, Podoloff D. PET/CT Imaging in Gynecologic Malignancies Other than Ovarian and Cervical Cancer. PET Clin 2010; 5:463-75. [PMID: 27157973 DOI: 10.1016/j.cpet.2010.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is an imaging modality used for staging, assessing response to therapy, and diagnosis of recurrent cervical and ovarian cancer. The potential role of FDG-PET/CT in other gynecologic malignancies such as endometrial cancer, uterine sarcomas, vaginal, and vulvar cancer has not been fully explored.
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Affiliation(s)
- Priya Bhosale
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030, USA.
| | - Revathy Iyer
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030, USA
| | - Anuja Jhingran
- Department of Radiation Oncology Treatment, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030, USA
| | - Donald Podoloff
- Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030, USA
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46
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Zampolin RL, Shi A. Radiologic Evaluation of Mesenchymal Tumors of the Female Genital Tract. Surg Pathol Clin 2009; 2:581-602. [PMID: 26838772 DOI: 10.1016/j.path.2009.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mesenchymal neoplasms of the female genital tract are a diverse group of tumors, of which the most common are smooth muscle tumors. There is a significant overlap in the imaging characteristics of benign and malignant tumors and final diagnosis often requires pathologic correlation. However, familiarity with typical radiologic features, common imaging pitfalls, and the utility of different imaging modalities can be valuable in the evaluation of mesenchymal tumors. This article highlights the imaging features of the most commonly encountered mesenchymal tumors in the female genital tract.
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Affiliation(s)
- Richard L Zampolin
- Department of Radiology, Montefiore Medical Center, 111 E210th Street, Bronx, NY 10467, USA
| | - Ann Shi
- Department of Radiology, Montefiore Medical Center, 111 E210th Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
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Assessment of Fluorodeoxyglucose Uptake by Leiomyomas in Relation to Histopathologic Subtype and the Menstrual State. J Comput Assist Tomogr 2009; 33:877-81. [DOI: 10.1097/rct.0b013e31819f1bb2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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49
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Suppression of F-18 fluorodeoxyglucose uptake in benign uterine leiomyomas with danazol. Clin Nucl Med 2009; 34:452-5. [PMID: 19542955 DOI: 10.1097/rlu.0b013e3181a7d02a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Abstract
We report the case of pulmonary benign metastasizing leiomyoma in an asymptomatic 64-year-old woman who underwent hysterectomy for a uterine leiomyoma 26 years earlier. Routine chest radiograph revealed bilateral diffuse nodular opacities within the pulmonary lobes. Thoracic computed tomography (CT) scan showed peripheral lung nodules that do not display contrast enhancement. Positron emission tomography (PET)-CT with 18F-fluorodeoxyglucose (18F-FDG PET-CT) demonstrated no significant metabolic activity of the nodules. The lesions were diagnosed as benign metastasizing leiomyoma by histopathologic examination. To our best knowledge, this is the first case studied combining CT and FDG PET-CT technique.
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