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Surace A, Baù MG, Privitera S, Botta G, Danese S, Plazzotta C, Mitidieri M, Picardo E. Risk of unexpected uterine leiomyosarcoma during laparoscopic procedures: Experience from a single tertiary institute in Italy. Int J Gynaecol Obstet 2021; 156:236-239. [PMID: 33834486 PMCID: PMC9291939 DOI: 10.1002/ijgo.13701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
Objective To evaluate the incidence of occult uterine sarcomas and investigate whether an accurate and well‐established preoperative assessment for uterine fibroids could help identify uterine sarcomas more effectively. Methods A retrospective analysis of patients who underwent gynecological laparoscopic surgery for presumed uterine fibroids at Sant’Anna Hospital, a single tertiary institute in Turin, Italy, between January 2003 and December 2019. Results Over the 17‐year period, 5826 laparoscopic surgical procedures (myomectomies or subtotal/total hysterectomies) were performed for presumed uterine fibroids. A total of 48 patients with a final diagnosis of uterine sarcoma were identified, the majority of which (n = 39; 81.3%) were recognized as suspicious uterine sarcomas during the preoperative assessment, and morcellement was avoided. The occurrence of unexpected uterine sarcomas was 0.1% (6/5826). Morcellation was conducted in one patient with uterine sarcoma. Conclusion Analysis of our data showed that unexpected uterine sarcomas are uncommon. Accurate preoperative evaluation can help avoid, but does not exclude, the possibility of morcellation of unknown uterine sarcomas.
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Affiliation(s)
- Alessandra Surace
- Gynecology and Obstetrics 2Città della Salute e della ScienzaUniversity of TurinTurinItaly
| | - Maria Grazia Baù
- Gynecology and Obstetrics 3Città della Salute e della ScienzaTurinItaly
| | - Sebastiana Privitera
- Pathology Unit, Department of Medical SciencesCittà della Salute e della ScienzaTurinItaly
| | - Giovanni Botta
- Pathology Unit, Department of Medical SciencesCittà della Salute e della ScienzaTurinItaly
| | - Saverio Danese
- Gynecology and Obstetrics 4Città della Salute e della ScienzaTurinItaly
| | - Claudio Plazzotta
- Gynecology and ObstetricsCittà della Salute e della ScienzaTurinItaly
| | - Marco Mitidieri
- Gynecology and Obstetrics 4Città della Salute e della ScienzaTurinItaly
| | - Elisa Picardo
- Gynecology and Obstetrics 4Città della Salute e della ScienzaTurinItaly
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Primary Uterine Cervical Lymphoma Manifesting as Menolipsis Staged and Followed Up by FDG PET/CT. Clin Nucl Med 2016; 41:590-3. [DOI: 10.1097/rlu.0000000000001196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Graebe K, Garcia-Soto A, Aziz M, Valarezo V, Heller PB, Tchabo N, Tobias DH, Salamon C, Ramieri J, Dise C, Slomovitz BM. Incidental power morcellation of malignancy: A retrospective cohort study. Gynecol Oncol 2015; 136:274-7. [DOI: 10.1016/j.ygyno.2014.11.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/15/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
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Preoperative Ultrasound-Guided Needle Biopsy of 63 Uterine Tumors Having High Signal Intensity Upon T2-Weighted Magnetic Resonance Imaging. Int J Gynecol Cancer 2014; 24:1042-7. [DOI: 10.1097/igc.0000000000000189] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe differential diagnosis between uterine sarcoma and benign leiomyoma is difficult when made only by magnetic resonance imaging (MRI); it usually requires an additional preoperative diagnostic procedure. We report our results using ultrasound-guided needle biopsy for these types of uterine tumors.MethodsUltrasound-guided needle biopsy was performed on 63 patients with uterine smooth muscle tumors suspected of malignancy by MRI. We compared the results of presurgical biopsy against the postsurgical pathology of the tumor.ResultsAmong 63 patients with a high signal intensity of the uterine tumor on T2-weighted MRI (1 case was undetermined), 12 cases (19.3%) were diagnosed by the needle biopsy as malignant, and 51 cases (80.6%) were benign. Among the 12 diagnosed as malignant tumors, 11 had surgery performed, and one was treated with chemotherapy. Among the 51 patients diagnosed with a benign tumor, 27 had surgery performed, and 24 were put on a wait-and-see clinical follow-up schedule. One of the 27 surgical patients with a benign tumor had a postsurgical diagnosis of a low-grade endometrial stromal sarcoma. In the 38 cases where surgery was performed, we found the sensitivity, specificity, and the positive and negative predictive values of the needle biopsy were 91.7%, 100%, 100%, and 96.2%, respectively.ConclusionsUltrasound-guided needle biopsy may be a reliable preoperative diagnostic procedure for uterine tumors with suspected malignancy.
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Sürücü E, Aslan M, Karahan P, Durak H. Multiple leiomyosarcoma foci in 18F-FDG PET-CT. Rev Esp Med Nucl Imagen Mol 2013; 32:269-70. [DOI: 10.1016/j.remn.2012.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/29/2012] [Accepted: 08/06/2012] [Indexed: 11/29/2022]
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Sürücü E, Aslan M, Karahan P, Durak H. Multiple leiomyosarcoma foci in 18F-FDG PET-CT. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol 2011; 122:255-9. [PMID: 21565389 DOI: 10.1016/j.ygyno.2011.04.021] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 04/15/2011] [Accepted: 04/16/2011] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Uterine leiomyosarcoma (LMS) is usually diagnosed after surgery for leiomyoma; thus tumor morcellation frequently occurs. We evaluated the impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine LMS. METHODS Outcomes were retrospectively compared between patients who underwent total abdominal hysterectomy without tumor morcellation and those who underwent surgery that included abdominal, vaginal or laparoscopic tumor morcellation. RESULTS We assessed 56 consecutive patients with stage I and II uterine LMS between 1989 and 2010, 25 with and 31 without tumor morcellation. There were no significant between group differences in age, parity, menopausal status, body mass index, stage, mitotic count, tumor grade, lymph node dissection, adjuvant therapy, and follow-up duration. However, tumor size was significantly smaller (9.8 cm vs. 7.3 cm, P=0.022) and ovarian tissue was more frequently preserved (38.7% vs. 72%, P=0.013) in patients with tumor morcellation. In univariate analysis, only tumor morcellation was significantly associated with poorer disease-free survival (DFS) (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.03-6.50; P=0.043), and higher stage (I vs. II; (OR, 19.12; 95% CI, 1.19-307.11; P=0.037)) and tumor morcellation (OR, 3.07; 95% CI, 1.05-8.93; P=0.040) were significantly associated with poorer overall survival (OS). In multivariate analysis, higher stage (OR, 20.34; 95% CI, 1.27-325.58; P=0.033) and tumor morcellation (OR, 3.11; 95% CI, 1.07-9.06; P=0.038) were significantly associated with poorer OS. The percentage of patients with abdomino-pelvic dissemination, as shown by peritoneal sarcomatosis or vaginal apex recurrence, was significantly greater in patients with than without tumor morcellation (44% vs. 12.9%, P=0.032). CONCLUSION Tumor morcellation during surgery increased the rate of abdomino-pelvic dissemination and adversely affected DFS and OS in patients with apparently early uterine LMS.
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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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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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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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11
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18F-Fluorodeoxyglucose uptake in uterine leiomyomas in healthy women. Clin Imaging 2009; 33:462-7. [DOI: 10.1016/j.clinimag.2009.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 02/10/2009] [Indexed: 11/18/2022]
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12
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CT, MRI, PET, PET/CT, and Ultrasound in the Evaluation of Obstetric and Gynecologic Patients. Surg Clin North Am 2008; 88:361-90, vii. [PMID: 18381118 DOI: 10.1016/j.suc.2008.01.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Role of PET or PET/CT in the post-therapy surveillance of uterine sarcoma. Gynecol Oncol 2008; 109:255-62. [PMID: 18308380 DOI: 10.1016/j.ygyno.2008.01.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 01/15/2008] [Accepted: 01/16/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the clinical accuracy and clinical impact of positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) in detecting and treating tumor recurrence in patients with treated uterine sarcoma. METHODS Results of 36 patients who underwent PET or PET/CT in post-therapy surveillance of uterine sarcoma were retrospectively assessed. Histopathologic confirmation or clinical/radiological outcome at least 6 months after PET or PET/CT was standard of reference. RESULTS The 36 patients underwent 48 PET or PET/CT scans as part of post-therapy surveillance. Thirty scans (8 PET and 22 PET/CT) were performed due to suspicion of disease recurrence on CT, whereas 18 scans (4 PET and 14 PET/CT) were performed as part of routine post-therapy surveillance in asymptomatic patients. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET or PET/CT were 92.9%, 100%, 94.4%, 100% and 80%, respectively, in patients with suspected recurrence and 87.5%, 95.5%, 93.3%, 87.5% and 95.5%, respectively, in asymptomatic patients. PET or PET/CT influenced the management of 12 patients (33.3%), by initiation of previously unplanned treatment in 8 patients and by avoidance of previously planned treatment in 4 patients. CONCLUSION PET or PET/CT was highly effective in discriminating true recurrence in patients with suspected recurrence and was highly sensitive in detecting recurrence in asymptomatic patients. It had impacts on clinical decision making in a high proportion of patients.
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Affiliation(s)
- Jeong-Yeol Park
- Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Bural GG, Shriaknthan S, Houseni M, Alavi A. FDG-PET Is Useful in Staging and Follow-up of Primary Uterine Cervical Lymphoma. Clin Nucl Med 2007; 32:748-50. [PMID: 17710038 DOI: 10.1097/rlu.0b013e318124fd89] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 35-year old woman presented with vaginal bleeding. She had a normal gynecologic examination and Papanicolaou test. A CT scan of the pelvis showed a cervical mass, which on biopsy proved to be B-cell lymphoma. PET before preoperative staging demonstrated a large area of increased FDG uptake in the pelvis, corresponding to the mass seen on the CT scan. There were no other abnormal F-18 FDG avid sites. The patient received chemotherapy followed by total abdominal hysterectomy. Histopathology was consistent with large B-cell lymphoma of the uterine cervix. Posttherapy CT scan and PET scan showed no evidence of active and or residual disease.
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Affiliation(s)
- Gonca G Bural
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Rebollo Aguirre A, Ramos Font C, Bellón Guardia M, Cabello García D, Gallego Peinado M, Rodríguez Fernández A, Llamas Elvira J. Tomografía por emisión de positrones con 18F-fluordesoxiglucosa en pacientes con sarcoma uterino. ACTA ACUST UNITED AC 2007. [DOI: 10.1157/13107970] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Chura JC, Truskinovsky AM, Judson PL, Johnson L, Geller MA, Downs LS. Positron emission tomography and leiomyomas: Clinicopathologic analysis of 3 cases of PET scan-positive leiomyomas and literature review. Gynecol Oncol 2007; 104:247-52. [PMID: 17126891 DOI: 10.1016/j.ygyno.2006.09.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Revised: 09/19/2006] [Accepted: 09/20/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Studies have suggested that PET scans can differentiate between leiomyomas and leiomyosarcomas. Our experience, however, shows that PET scan-positive smooth muscle tumors are not necessarily malignant. CASE REPORTS Three patients with cancer underwent PET imaging. In all three, the most worrisome finding was a PET scan-positive uterine tumor. After surgical extirpation, all three uterine tumors were found to be benign smooth muscle neoplasms. DISCUSSION To explore the potential reason these tumors were positive on PET imaging, we performed a detailed histopathologic and immunohistochemical study of all specimens. Pathologic evaluation revealed a leiomyoma, a cellular leiomyoma, and a stromomyoma. There was no association between an increased Ki67 (proliferative) index and positivity on PET imaging. Increased vascularity, however, appeared to be a feature common to the leiomyomas that were PET-positive.
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Affiliation(s)
- Justin C Chura
- University of Minnesota, Department of Obstetrics, Gynecology, and Women's Health, 420 Delaware Street SE/MMC 395, Minneapolis, MN 55455, USA
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Rebollo-Aguirre AC, Ramos-Font C, Gallego Peinado M, Bellón-Guardia ME, Cabello García D, Rodríguez-Fernández A, Moral Ruiz A, Llamas-Elvira JM. Tomografía de emisión de positrones con fluordesoxiglucosa-F18 en el seguimiento del cáncer de endometrio. ACTA ACUST UNITED AC 2006; 25:359-66. [PMID: 17173784 DOI: 10.1157/13095169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the utility of FDG-PET in the follow-up of patients treated for endometrial cancer and with suspicion of recurrence according to conventional imaging methods (CT, MRI) and/or elevation of serum tumour markers. MATERIALS AND METHODS Between April 2002 and December 2005, eleven patients underwent 17 FDG-PET studies (six with 2 studies); mean age was 63.4 yrs (range, 52-69 yrs) and time since diagnosis ranged from 11 months to 12 yrs (mean of 56 months). Initially, seven patients were in stage I, three in stage III and one in stage IV (FIGO classification). Histologically, they corresponded to 8 endometrioid carcinomas and 3 non endometrioid carcinomas. RESULTS FDG-PET showed infradiaphragmatic uptake in 3 patients and disseminated disease in 7 cases. FDG-PET showed no uptake in one patient. CT (n = 7) or MRI (n = 7) detected infradiaphragmatic lesions in 5 patients and visceral lesions in 2. In 11 patients, tumour markers were elevated (CA125, n = 9; CA19.9, n = 2; CA15.3, n = 2). In 7 patients, FDG-PET modified the information yielded by conventional imaging techniques and in 4 patients, the FDG-PET contributed no additional information. In 2 patients, histologic confirmation of the lesions was obtained and in 9 patients, there were clinical follow-up (from 3 to 20 months, mean of 8.7 months) and imaging studies. CONCLUSIONS FDG-PET is superior to CT and MRI for detecting recurrences in the follow-up of patients with endometrial cancer.
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Affiliation(s)
- A C Rebollo-Aguirre
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada
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Cherng SC, Liou CH, Fan YM, Yuan YN, Chiu CS. Intense FDG Uptake of Metastatic Clear Cell Carcinoma From the Ovary in a Uterine Leiomyoma. Clin Nucl Med 2006; 31:429-31. [PMID: 16785818 DOI: 10.1097/01.rlu.0000223141.38391.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Shiou-Chi Cherng
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Murakami M, Tsukada H, Shida M, Watanabe M, Maeda H, Koido S, Hirasawa T, Muramatsu T, Miyamoto T, Nasu S, Yasuda S, Kajiwara H, Yasuda M, Ide M. Whole-body positron emission tomography with F-18 fluorodeoxyglucose for the detection of recurrence in uterine sarcomas. Int J Gynecol Cancer 2006; 16:854-60. [PMID: 16681773 DOI: 10.1111/j.1525-1438.2006.00532.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We evaluated the usefulness of whole-body positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG-PET) for the detection of recurrence in follow-up patients after primary treatment of uterine sarcoma. Eight patients with pathologically proven uterine sarcoma underwent FDG-PET, computed tomography (CT), and ultrasonography (US). Final diagnoses of recurrence were established in five cases (three carcinosarcomas and two leiomyosarcomas). PET revealed recurrent sites in the intraperitoneum, liver, lung, bone, and retroperitoneal lymph nodes. However, the minimum size of the tumor detected by PET depended on the sites of recurrence. CT and US images showed two false-negative cases of intraperitoneal tumors. PET was able to detect a solitary small intraperitoneal tumor, which was very difficult to detect by CT and US. Positive PET findings did not affect the prognosis in three of the five recurrent patients; however, the remaining two patients consequently underwent the combination therapy consisting of surgery and chemotherapy and survived for more than 1 year after the positive FDG-PET results. Application of PET imaging for the early detection of recurrent sites was useful for the decision of treatment strategy for patients with recurrent uterine sarcoma.
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Affiliation(s)
- M Murakami
- Departments of Obstetrics & Gynecology, Tokai University School of Medicine, Isehara Kanagawa, Japan.
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Ak I, Ozalp S, Yalçin OT, Zor E, Vardareli E. Uptake of 2-[18F]fluoro-2-deoxy-D-glucose in uterine leiomyoma: imaging of four patients by coincidence positron emission tomography. Nucl Med Commun 2005; 25:941-5. [PMID: 15319600 DOI: 10.1097/00006231-200409000-00012] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Uterine leiomyomas, benign tumours of the human uterus, are the most common uterine neoplasm and are composed of smooth muscle with varying amounts of fibrous connective tissue. As a functional imaging modality, 2-[F]fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography can be used to obtain information about glucose metabolism in tissues. In this study, the findings of the F-FDG scans of four patients who were suspected of having malignant gynaecological tumours because of clinical and radiological findings and finally diagnosed as uterine leiomyoma based on histopathological examination were evaluated. Moderately intense F-FDG accumulation was detected in uterine mass localization in lower pelvis. The reason for the accumulation of F-FDG in uterine leiomyomas is not known. It may be explained by the existence of higher levels of growth factors, including basic fibroblast growth factor, transforming growth factor beta, granulocyte-macrophage colony-stimulating factor and receptors, and proliferation of smooth muscle cells in leiomatous uterus.
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Affiliation(s)
- Ilknur Ak
- Departments of Nuclear Medicine, Osmangazi University Faculty of Medicine, 26480 Eskişehir, Turkey.
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21
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Abstract
FDG-PET has a definite role in detecting lymph node involvement and distant metastases. It has also shown encouraging results in assessing tumor recurrence and restaging, but further studies are required before FDG-PET can be incorporated in routine clinical practice for diagnosis of recurrence. In ovarian cancer, FDG-PET has high sensitivity and specificity in identifying patients with recurrent tumor, but lesion localization is difficult with PET. Normal FDG activity in the gastrointestinal tract and bladder may obscure some lesions. Combined PET/CT can help in localizing lesions and differentiating between pathologic and physiologic uptake in the pelvis and abdomen.
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Affiliation(s)
- Rakesh Kumar
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 110 Donner Building, Philadelphia, PA 19104, USA
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O'Brien JM, Brennan DD, Taylor DH, Holloway DP, Hurson B, O'Keane JC, Eustace SJ. Skeletal muscle metastasis from uterine leiomyosarcoma. Skeletal Radiol 2004; 33:655-9. [PMID: 15127247 DOI: 10.1007/s00256-004-0787-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2004] [Revised: 03/22/2004] [Accepted: 03/25/2004] [Indexed: 02/02/2023]
Abstract
A case of a 68-year-old woman who presented with a rapidly enlarging painful right thigh mass is presented. She had a known diagnosis of uterine leiomyosarcoma following a hysterectomy for dysfunctional uterine bleeding. She subsequently developed a single hepatic metastatic deposit that responded well to radiofrequency ablation. Whole-body MRI and MRA revealed a vascular mass in the sartorius muscle and a smaller adjacent mass in the gracilis muscle, proven to represent metastatic leiomyosarcoma of uterine origin. To our knowledge, metastatic uterine leiomyosarcoma to the skeletal muscle has not been described previously in the English medical literature.
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Affiliation(s)
- J M O'Brien
- Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland
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Abstract
Diagnostic imaging has played a major role in the evaluation of patients with the cancers of the reproductive tract. The imaging modalities have included ultrasonography, computed tomography, magnetic resonance imaging, hysterosalpingography, and scintigraphy with radiolabeled monoclonal antibodies. Positron emission tomography (PET) with [F-18]fluorodeoxyglucose also has been shown to be useful in the imaging evaluation of these patients. Clinical applications have included initial staging and posttherapy restaging of disease, detecting metastatic disease, differentiating posttherapy anatomic alterations from recurrent or residual disease, and predicting and evaluating treatment response. In this article, we review the diagnostic utility of dedicated PET and combined PET-computed tomography systems in the imaging assessment of reproductive tract malignancies (excluding prostate cancer) in both sexes with an emphasis on fluorodeoxyglucose applications.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, Universuty of Southern California, Los Angeles, CA 90033, USA
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Affiliation(s)
- Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical College Hospital, Taichung, Taiwan.
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