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Ob Gyn: Uterus Miscellaneous Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ OB GYN ❯ Uterus Miscellaneous

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  • “Uterine leiomyomas, sometimes incorrectly colloquially referred to as uterine fibroids, are the most frequently encountered benign myomatous tumors of the uterus, being observed in up to 20—40% of reproductive-age women and 70—80% of perimenopausal women. In addition, these benign tumors may become symptomatic in 20—50% of patients and subsequently produce pelvic pain, subfertility or abnormal uterine bleeding, requiring gynecologic hospitalization in about 30% of affected women.”
    How to differentiate uterine leiomyosarcoma from leiomyoma with imaging
    Sun S et al.
    Diagnostic and Interventional Imaging (2019) 100, 619—634
  • “On the malignant spectrum, uterine sarcomas tend to occur in an older patient population when compared to leiomyomas, and only account for 3—7% of all uterine malignancies. They often present with the same symptoms as leiomyomas and thus cannot reliably be distinguished clinically .Leiomyosarcomas (LMSs) are the most common uterine sarcomas, with an estimated annual incidence of 0.5—7/100,000 per women, followed by endometrial stromal sarcomas with an annual incidence of 1—2/million per woman.”
    How to differentiate uterine leiomyosarcoma from leiomyoma with imaging
    Sun S et al.
    Diagnostic and Interventional Imaging (2019) 100, 619—634
  • “CT plays a limited role in the initial diagnosis and local staging of myometrial lesions. CT is excellent for demonstrating calcifications; they are often found in leiomyomas but may also be present in LMSs. CT can also be useful in the initial evaluation of patients presenting with acute abdominal pain, especially those with torsed subserosal leiomyomas, which can then undergo hemorrhagic necrosis and confound the diagnosis. In women with LMS, CT is primarily used for staging purposes and to exclude distant recurrence post therapy (LMS tends to metastasize to the lungs and liver). CT is also optimal for visualizing the postoperative pelvic anatomy, allowing for proper evaluation of surgical complications including bowel obstruction or injury, ureteral or bladder injuries and urinary fistulas .”
    How to differentiate uterine leiomyosarcoma from leiomyoma with imaging
    Sun S et al.
    Diagnostic and Interventional Imaging (2019) 100, 619—634
  • "While CT alone is not particularly helpful for the differentiation of leiomyomas from LMSs, it has shown utility in combination with 18F-Fludeoxyglucose (18F-FDG)-PET in the context of indeterminate myometrial lesions on MRI. It is thought that malignant tumors experience upregulation of glucose transporter genes (GLUTs) either due to increase of normal cellular enzymes or synthesis of new transporters after transformation due to oncogenes. Based on this hypothesis, greater 18F-FDG uptake of LMS would be expected in comparison to leiomyomas due to their increased metabolic rate and glycolysis. There are few studies on this specific topic, however a study by Umesaki et al. has shown 100% sensitivity of 18F-FDG PET in the diagnosis of uterine sarcoma vs. leiomyoma with a positive standardized uptake value (SUV) cut-off value of 2.5.”
    How to differentiate uterine leiomyosarcoma from leiomyoma with imaging
    Sun S et al.
    Diagnostic and Interventional Imaging (2019) 100, 619—634
  • “Uterine lipomas are extraordinarily rare entities. The presence of fat in the uterine corpus is not exceptional and, in fact, it is known that some leiomyomas have an adipose tissue component, in variable proportions, associated to smooth muscular fibre. These cases are known as lipoleiomyomasand certain authors consider them to be hamartomatous lesions. On the other hand, lipomas are those tumours that are exclusively comprised of mature adipose tissue. The clinical manifestations do not usually differ greatly to those caused by leiomyomas except that they affect women that are somewhat older and normally postmenopausal.”

    Lipoma of the Uterine Corpus: Exceptional Eventuality Combined with an Ovarian Thecoma
    Vilallonga R et al.
    Case Reports in Medicine, vol. 2009, Article ID 340603, 4 pages, 2009.
  • “Most lipomas are located in the body of the uterine corpus and the size can range from a few millimetres up to masses of more than several dozen centimetres in diameter. Diagnosis is accomplished after a meticulous analysis of the surgical piece, although some radiological techniques may indicate their existence prior to surgery. Their prognosis is excellent, except in cases associated to malignant intracavitary pathology.”

    Lipoma of the Uterine Corpus: Exceptional Eventuality Combined with an Ovarian Thecoma
    Vilallonga R et al.
    Case Reports in Medicine, vol. 2009, Article ID 340603, 4 pages, 2009.
  • “More than half the cases first present with uterine bleeding, and a somewhat smaller proportion, as in the case of our patient, with abdominal pain when these tumours reach larger dimensions. Pain is rare as a unique symptom and the pain referred by our patient is difficult to explain with these findings. Lipomas of the uterine corpus usually appear in women with a higher mean average age than is common for leiomyomas, mainly after the menopause, with most being postmenopausal”

    Lipoma of the Uterine Corpus: Exceptional Eventuality Combined with an Ovarian Thecoma
    Vilallonga R et al.
    Case Reports in Medicine, vol. 2009, Article ID 340603, 4 pages, 2009.

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