Smooth muscle tumors of the uterus: possibilities of preoperative diagnosis using imaging techniques

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Abstract

The significance of preserving the reproductive potential of the female population is currently high all over the world. Uterine fibroids and leiomyosarcoma have become diagnosed more often in young patients; moreover, uterine leiomyosarcoma is characterized by an extremely aggressive course and an unfavorable prognosis. Successful preoperative diagnosis is crucial for further treatment planning. There are improvements in reconstructive plastic organ-preserving operations, at the same time minimally invasive techniques are preferred: myomectomy is more often performed through laparoscopic techniques, robot-assisted surgery, and hysteroscopic methods. In most cases, the final diagnosis is made only after surgical treatment, so the lack of morphological verification can lead to an unfavorable course of the disease.

The objective of this study is to analyze various imaging techniques, including ultrasound, magnetic resonance imaging, positron emission tomography, which are described in the scientific medical literature and devoted to modern aspects of preoperative differential diagnosis of benign and malignant smooth muscle tumors of the uterus. There are currently no clear diagnostic criteria that can improve the accuracy of preoperative diagnosis of uterine smooth muscle tumors of uncertain or obvious malignant potential.

Conclusion: Although a comprehensive approach with the use of various imaging techniques does not completely solve the issues of early diagnosis of uterine sarcoma, it makes it possible to obtain important information at the preoperative stage necessary to determine the correct management tactics for this category of patients.

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About the authors

Larisa B. Ivanova

A.S. Loginov Moscow Clinical Scientific Center, Moscow Department of Health

Author for correspondence.
Email: l.ivanova@mknc.ru
ORCID iD: 0000-0002-3307-5733

PhD, Head of the Laboratory of Gynecology of the Department of Pelvic Oncosurgery

Russian Federation, Moscow

Marina A. Chekalova

Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Federal Medical and Biological Agency of Russia

Email: ch2me@yandex.ru
ORCID iD: 0000-0002-5565-2511

Dr. Med. Sci., Professor at the Department of Radiology and Ultrasound Diagnostics

Russian Federation, Moscow

Irina Yu. Davydova

A.S. Loginov Moscow Clinical Scientific Center, Moscow Department of Health

Email: i.davydova@mknc.ru

Dr. Med. Sci., Leading Researcher at the Department of Pelvic Organ Oncosurgery

Russian Federation, Moscow

Ramiz K. Valiev

A.S. Loginov Moscow Clinical Scientific Center, Moscow Department of Health

Email: r.valiev@mknc.ru

PhD, Head of the Department of Pelvic Organ Oncosurgery

Russian Federation, Moscow

Mukhamed N. Saryev

A.S. Loginov Moscow Clinical Scientific Center, Moscow Department of Health

Email: m.saryyev@mknc.ru

oncologist at the Department of Pelvic Organ Oncosurgery

Russian Federation, Moscow

Varvara S. Kryazheva

Kommunarka Moscow Multifunctional Clinical Center, Moscow Department of Health

Email: salvaje2005@yandex.ru
ORCID iD: 0000-0003-0934-7011

PhD, doctor of ultrasound diagnostics

Russian Federation, Moscow

Behruz P. Olimov

A.S. Loginov Moscow Clinical Scientific Center, Moscow Department of Health

Email: AlimovBP90@gmail.com
ORCID iD: 0000-0002-8467-6942

PhD, radiologist at the Roentgenodiagnostic Department

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Large-sized tumor nodule occupying a large part of the uterine body (a), unchanged structure of myometrium is determined on the periphery of the nodule (b) (photo from the archive of A.S. Loginov ICRC)

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3. Fig. 2. Ultrasound tomogram of a subserosal myomatous node (photo from the archive of A.S. Loginov ICRC)

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4. Fig. 3. A heterogeneous solid nodule of leiomyosarcoma with a sign of "blurred" structure is presented on ultrasound tomogram (photo from the archive of A.S. Loginov ICRC)

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5. Fig. 4. Combination of leiomyosarcoma nodule (a) with interstitial myomatous nodule located on the anterior uterine wall (b) (photo from the archive of the A.S. Loginov ICRC)

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6. Fig. 5. Sagittal MRI T2W slice of leiomyosarcoma showing features such as irregular borders passing through the uterine serosa (white arrows), additional ectopic lesions [17]

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7. Fig. 6. Sagittal MPT T2 slice of myoma demonstrating smooth margins [17]

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8. Fig. 7. Typical MRI picture of uterine leiomyoma in sagittal and axial T2W slices showing low SI signal intensity anterior to the uterus (u), separating from the ovaries (o) and corresponding to a subserosal myoma [17]

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9. Fig. 8. Comparison of DWI of benign (a, b) and malignant (c, d) entities: axial DWI (a) and ACD (b) of high-cell leiomyoma and axial DWI (c) and ACD (d) of leiomyosarcoma. The DWI contour is useful for demonstrating the irregular contour of malignancy

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10. Fig. 9. Recurrent pelvic mass (irregular oval-shaped cystic-solid mass of 95x91x83 mm with heterogeneous accumulation of RBCs (photo from the archive of A.S. Loginov ICRC))

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11. Fig. 10. PET image shows intense FDG uptake in a large 8.5 cm uterine subserosal solid mass with SUVmax 2 [23]

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