Hélage Siegfried, Laponche Claudia, Homps Margaux, Buy Jean-Noël, Just Pierre-Alexandre, Jacob Denis, Ghossain Michel, Dion Élisabeth
Department of Radiology, Hôtel-Dieu de Paris (AP-HP), Paris, France.
Department of Pathology, Hôpital Cochin (AP-HP), Paris, France.
Case Rep Radiol. 2025 Apr 25;2025:5388015. doi: 10.1155/crra/5388015. eCollection 2025.
Uterine sarcomas are uncommon malignant tumors with a grim prognosis, accounting for less than 1% of all gynecologic malignancies. Radiological series often include a limited number of patients, and diagnostic approaches can vary. While the presence of low T2 signal intensity in leiomyomas on MRI has been proposed as a criterion to exclude sarcoma, exceptions to this rule exist. We present two cases that challenge this notion. The first patient was a 48-year-old woman presenting with metrorrhagia. MRI revealed a large intramural leiomyoma characterized by extensive hypointensity on T2-weighted imaging (T2WI) and a small intraleiomyoma focus with intermediate signal intensity. Histopathological examination confirmed leiomyosarcoma. The second patient was a 51-year-old woman presenting with menometrorrhagia. MRI showed a subserosal myoma with zones of T2WI hypointensity interspersed with a region of intermediate signal intensity. Histopathological examination confirmed low-grade endometrial stromal sarcoma. In both cases, diffusion-weighted imaging (DWI) revealed an intratumoral zone of restricted diffusion, with an apparent diffusion coefficient (ADC) value ≤ 0.86 × 10 mm/s. MRI is crucial for distinguishing leiomyomas from sarcomas. We propose combining T2WI and DWI with ADC for this purpose, noting limitations in each sequence's reliability. Suggestive MRI criteria for malignancy in sarcomas are identified, emphasizing the need for comprehensive imaging analysis. In characterizing uterine smooth muscle tumors, particularly when analyzing leiomyoma variants, DWI emerges as the dominant sequence, with T2WI serving as a secondary sequence. ADC values aid in histopathological hypothesis, but caution is warranted due to overlap with benign lesions. This approach may refine preoperative diagnosis and guide therapeutic management.
子宫肉瘤是罕见的恶性肿瘤，预后较差，占所有妇科恶性肿瘤的比例不到1%。放射学研究通常纳入的患者数量有限，诊断方法也可能各不相同。虽然MRI上平滑肌瘤的低T2信号强度被提议作为排除肉瘤的标准，但也存在该规则的例外情况。我们报告两例对这一观点提出挑战的病例。首例患者为一名48岁女性，表现为月经过多。MRI显示一个大的肌壁间平滑肌瘤，在T2加权成像（T2WI）上表现为广泛的低信号，以及一个小的平滑肌瘤内灶，信号强度中等。组织病理学检查证实为平滑肌肉瘤。第二例患者为一名51岁女性，表现为月经过多。MRI显示一个浆膜下肌瘤，T2WI低信号区与中等信号强度区相间分布。组织病理学检查证实为低级别子宫内膜间质肉瘤。在这两例病例中，扩散加权成像（DWI）均显示肿瘤内有扩散受限区域，表观扩散系数（ADC）值≤0.86×10⁻³mm²/s。MRI对于区分平滑肌瘤和肉瘤至关重要。我们建议为此目的将T2WI和DWI与ADC相结合，同时指出每个序列可靠性的局限性。确定了提示肉瘤恶性的MRI标准，强调了全面成像分析的必要性。在对子宫平滑肌肿瘤进行特征性描述时，尤其是在分析平滑肌瘤变体时，DWI成为主要序列，T2WI作为次要序列。ADC值有助于组织病理学推测，但由于与良性病变存在重叠，需谨慎使用。这种方法可能会优化术前诊断并指导治疗管理。
