Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital.
Junior Resident, Fukushima Red Cross Hospital.
Fukushima J Med Sci. 2024 Oct 18;70(4):211-218. doi: 10.5387/fms.23-00018. Epub 2024 Oct 4.
Although uterine sarcoma is a rare disease, its prognosis is extremely poor;thus, it is important to differentiate it from uterine leiomyoma. In this retrospective study, we examined the association between preoperative MRI findings and postoperative pathology results in 170 patients with uterine tumors who underwent preoperative MRI examination at Fukushima Red Cross Hospital. In 4 cases of sarcoma / smooth muscle tumor of unknown malignant potential (STUMP), abnormal findings were found at a high frequency with T1-weighted imaging (T1WI) (75%), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast enhancement (CE) (100%). In cases of ordinary leiomyoma, on the other hand, abnormal findings were less frequent. The rates of high DWI signal intensity for degenerated and cellular leiomyoma were 31% and 64%, respectively, and the CE-positive rates were 31% and 57%, respectively. Apparent Diffusion Coefficient (ADC) values appeared to be useful in differentiating degenerated leiomyoma from sarcoma. The relatively characteristic findings of uterine sarcoma on MRI images may overlap with those of degenerated leiomyoma and cellular leiomyoma, making it difficult to diagnose sarcoma on imaging alone. However, findings that distinguish sarcoma from ordinary, degenerated, and cellular leiomyoma cases are worthy of attention, to avoid overlooking sarcoma.
虽然子宫肉瘤是一种罕见的疾病，但它的预后极差；因此，将其与子宫肌瘤区分开来非常重要。在这项回顾性研究中，我们检查了在福岛红十字医院接受术前 MRI 检查的 170 名患有子宫肿瘤的患者的术前 MRI 结果与术后病理结果之间的关系。在 4 例肉瘤/平滑肌肿瘤恶性潜能不明（STUMP）中，T1 加权成像（T1WI）（75%）、T2 加权成像（T2WI）、弥散加权成像（DWI）和对比增强（CE）（100%）发现异常的频率很高。另一方面，在普通平滑肌瘤的情况下，异常发现的频率较低。变性和细胞性平滑肌瘤的高 DWI 信号强度的发生率分别为 31%和 64%，CE 阳性率分别为 31%和 57%。表观扩散系数（ADC）值似乎可用于区分变性平滑肌瘤和肉瘤。子宫肉瘤的 MRI 图像上相对特征性的发现可能与变性平滑肌瘤和细胞性平滑肌瘤重叠，仅凭影像学检查难以诊断肉瘤。然而，区分肉瘤与普通、变性和细胞性平滑肌瘤的发现值得关注，以避免忽视肉瘤。
