Santos Pedro, Cunha Teresa Margarida
Department of Radiology, Hospital de Santa Maria, Lisbon, Portugal.
Diagn Interv Radiol. 2015 Jan-Feb;21(1):4-9. doi: 10.5152/dir.2014.14053.
Uterine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies. They comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, and adenosarcoma. Compared with the more common endometrial carcinomas, uterine sarcomas behave more aggressively and are associated with a poorer prognosis. Due to their distinct clinical and biological behavior, the International Federation of Gynecology and Obstetrics introduced a new staging system for uterine sarcomas in 2009, categorizing uterine carcinosarcoma as a variant of endometrial carcinoma, rather than a pure sarcoma. Magnetic resonance imaging (MRI) has a developing role in the assessment of these malignancies. Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. MRI is therefore extremely useful in preoperative detection and staging and, consequently, in determination of appropriate management. This pictorial review aims to discuss the clinical features of uterine sarcomas, as well as their most common appearances and distinct characteristics in MRI.
子宫肉瘤是一组罕见的间叶源性异质性肿瘤，约占子宫恶性肿瘤的8%。它们包括平滑肌肉瘤、子宫内膜间质肉瘤、未分化子宫内膜肉瘤和腺肉瘤。与更常见的子宫内膜癌相比，子宫肉瘤的行为更具侵袭性，预后较差。由于其独特的临床和生物学行为，国际妇产科联盟于2009年引入了一种新的子宫肉瘤分期系统，将子宫癌肉瘤归类为子宫内膜癌的一种变体，而非单纯的肉瘤。磁共振成像（MRI）在这些恶性肿瘤的评估中发挥着越来越重要的作用。肿瘤定位、边缘不规则或呈结节状、坏死、生长迅速、对比增强强烈以及扩散加权成像受限等特征可提示诊断，并有助于与更常见的平滑肌瘤和子宫内膜癌相鉴别。因此，MRI在术前检测和分期以及确定合适的治疗方案方面极为有用。本图像综述旨在讨论子宫肉瘤的临床特征，以及它们在MRI上最常见的表现和独特特征。
