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. 2022 Sep 15:9:917399.
doi: 10.3389/fcvm.2022.917399. eCollection 2022.

Diagnostic value of dual-energy CT and clinicopathological and imaging feature analysis of mixed endometrial stromal and smooth muscle tumors with intracardiac extension

Yi-Yang Liu  1   2 , Zhan Yu  1 , Rui Wang  1   2 , Kui-Sheng Chen  3 , Song-Wei Yue  1 , Jun Li  1 , Xue-Mei Gao  4 , Chang-Mao Ding  1 , Zi-Xin Wu  5 , Xi Zhao  6 , Jian-Bo Gao  1   2
Affiliations

Diagnostic value of dual-energy CT and clinicopathological and imaging feature analysis of mixed endometrial stromal and smooth muscle tumors with intracardiac extension

Yi-Yang Liu et al. Front Cardiovasc Med. .

Abstract

Objective: To describe the clinicopathological and imaging features of mixed endometrial stromal and smooth muscle tumors with intracardiac extension and to explore the diagnostic value of dual-energy computed tomography (DECT) for this rare entity.

Materials and methods: This retrospective study analyzed the clinicopathological data and images of a 41-year-old female patient with pathologically documented mixed endometrial stromal and smooth muscle tumors with intracardiac extension who had undergone DECT examination. Seven virtual monoenergetic images (VMIs) in 10-kiloelectron volt (keV) intervals (range = 40-100 keV), iodine density (ID) maps, and Z effective (Zeff) maps were reconstructed, and lesion conspicuity was assessed. Tumor homology was analyzed using quantitative DECT parameters and energy spectrum attenuation curve.

Results: The patient complained of a 10-day history of bilateral lower extremity edema. Computed tomography showed a hypoattenuating filling defect located within the paracervical vein that extended into the right atrium to the ventricle through the right iliac veins and inferior vena cava (IVC). Intracardiac and intravenous lesions mainly demonstrated moderate progressive enhancement, with localized non-enhancing necrotic areas on contrast-enhanced CT. Multiple nodules showing progressive enhancement (long-T1 signal, long-T2 signal) were observed at the fundus of the uterus on dynamic contrast-enhanced magnetic resonance imaging (MRI), which were deemed the primary lesions of the tumor. Overall, the tumor was characterized by a small primary lesion with extensive vascular extension. In addition, the 40 keV VMIs reconstructions were found to provide best visualization for the early detection of tumors.

Conclusion: Although a definitive diagnosis of MESSMT with intracardiac extension requires confirmation by histopathological examination, imaging examination can be used to characterize the extent of the lesion. The dual-energy dataset facilitates tumor visualization and homology evaluation.

Keywords: MESSMT; diagnosis; dual-energy CT; intracardiac extension; intravascular extension.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Coronal reformatted computed tomography (CT) image of the chest, abdomen and pelvis. (A–F) Hypoattenuating filling defect located within the right iliac veins across the inferior vena cava (IVC) into the right atrium. Contrast-enhanced CT images show that intravenous lesions demonstrated mainly moderate progressive enhancement, with localized non-enhancing necrotic areas (arrow). A circular enhanced thick-walled cystic lesion at the right of the uterine body is incidentally noted (arrowhead). (A,D) Unenhanced phase image. (B,E) Arterial phase of contrast enhancement image. (C,F) Portal phase of contrast enhancement image.
FIGURE 2
FIGURE 2
Axial computed tomography (CT) image of the heart. (A–F) Hypoattenuating filling defect located within the right atrium across the tricuspid valve into the right ventricle. Intracardiac lesions demonstrated mainly moderate progressive enhancement, with localized non-enhancing necrotic areas (arrow) on contrast-enhanced CT. (A,D) Unenhanced phase image. (B,E) Arterial phase of contrast enhancement image. (C,F) Portal phase of contrast enhancement image.
FIGURE 3
FIGURE 3
Pelvic magnetic resonance imaging (MRI) image. (A–C) Multiple tortuous and dilated vascular structures at the fundus of the uterus (arrowhead) and the parametrium (arrow). (D) Multiple nodules of varying sizes were observed at the fundus of the uterus (arrow). (E,F) After gadolinium-based contrast material injection, progressively enhanced lesions were noted within the lumen (arrowhead and arrow in E), and the nodules also presented progressive enhancement (arrow in F).
FIGURE 4
FIGURE 4
Axial dual-energy computed tomography (CT) images show tortuous and enlarged paracervical veins. (A–G) 40–100 keV VMIs (10-keV interval). (H) Iodine density map. (I) Z effective map.
FIGURE 5
FIGURE 5
Right atrium, inferior vena cava (IVC) at the renal venous level, and IVC at the inferior mesenteric artery level-derived energy spectrum curve. The curves of each color represent the energy spectrum curves of each ROI. (A) Green: right atrial lesions. (B) Yellow: lesions of the IVC at the renal venous level. (C) White: lesions of the IVC at the inferior mesenteric artery level). (D) The energy spectrum curves represent the CT values of the ROI under different keV conditions.
FIGURE 6
FIGURE 6
Microscopic examination of intracardiac and intravenous mass. (magnification, ×100). (A) Hematoxylin-eosin (HE) staining of the tumor cells. Immunohistochemical staining for CD10 (B), SMA (C), Desmin (D), ER (E), and PR (F).
FIGURE 7
FIGURE 7
Microscopic examination of uterine lesion (magnification, ×100). (A) HE staining of the tumor cells. Immunohistochemical staining for SMA (B), CD10 (C), and Desmin (D).
See this image and copyright information in PMC

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