Imaging of gynecological disease: clinical and ultrasound characteristics of uterine sarcomas

OBJECTIVE: To describe the clinical and ultrasound characteristics of uterine sarcomas. METHODS: This is a retrospective multicenter study. From the databases of 13 ultrasound centers, we identified patients with a histological diagnosis of uterine sarcoma with available ultrasound reports and ultrasound images who had undergone preoperative ultrasound examination between 1996 and 2016. As a first step, each author collected information from the original ultrasound reports on predefined ultrasound features of the tumors from his/her own center and by checking the ultrasound images to find information on variables not described in the original report. As a second step, 16 ultrasound examiners reviewed electronic ultrasound images in a consensus meeting and described them using a predetermined terminology. RESULTS: We identified 116 patients with a leiomyosarcoma, 48 with endometrial stromal sarcoma, and 31 with undifferentiated endometrial sarcoma. Median age of the patients was 56 (range, 26-86) years. Most patients were symptomatic at diagnosis (164/183, 89.6%), the most frequent presenting symptom being abnormal vaginal bleeding (91/183, 49.7%). Patients with endometrial stromal sarcoma were younger than patients with leiomyosarcoma or undifferentiated endometrial sarcoma (median age 46 years vs 57 vs 60). The results of the first and second step of analysis were similar. According to the assessment by the original ultrasound examiners, the median largest tumor diameter was 91 (range 7-321) mm. Visible normal myometrium was reported in 149/195 (76.4%) cases, and 80% (156/195) of lesions were solitary. Most sarcomas were solid masses (>80% solid tissue) (155/195, 79.5%) and most manifested inhomogeneous echogenicity of the solid tissue (151/195, 77.4%), one sarcoma was multicystic without solid components. Cystic areas were described in 87/195 (44.6%) tumors and most cyst cavities had irregular walls (67/87, 77.0%). Internal shadowing was observed in 42/192 (21.9%) sarcomas and fan shaped shadowing in 4/192 (2.1%). Moderate or rich vascularization was found on color Doppler in 127/187 (67.9%) cases. In 153/195 (78.5%) sarcomas the original ultrasound examiner suspected malignancy. CONCLUSIONS: Uterine sarcomas typically appear as solid masses with inhomogeneous echogenicity, sometimes with irregular cystic areas but rarely with fan shaped shadowing. Most are moderately or very well vascularized. This article is protected by copyright. All rights reserved