Overlap of Suspicious and Non-Suspicious Features in the Ultrasound Evaluations of Leiomyosarcoma: A Single-Center Experience

Abstract

Leiomyosarcoma (LMS) is a rare type of mesenchymal tumor. Suspecting LMS before surgery is crucial for proper patient management. Ultrasound is the primary method for assessing myometrial lesions. The overlapping of clinical, laboratory, as well as ultrasound features between fibroids and LMS makes differential diagnosis difficult. We report our single-center experience in ultrasound imaging assessment of LMS patients, highlighting that misleading findings such as shadowing and absent or minimal vascularization may also occur in LMS. To avoid mistakes, a comprehensive evaluation of potentially overlapping ultrasound features is necessary in preoperative ultrasound evaluations of all myometrial tumors.

Keywords: gynecological ultrasound; leiomyosarcoma; myometrial tumors.

Figure 1

Ultrasound images of LMS patients of our series. Panel (A). single myometrial tumor with in-homogeneous echogenicity of the solid tissue, irregular tumor borders, and moderate intralesional vascularization, without cystic areas and with fan-shaped shadowing. The lesion had a soft consistency at probe pressure. Panel (B). myometrial tumor with inhomogeneous echogenicity of the solid tissue, irregular tumor borders, and irregular cystic areas with anechoic content, with fan-shaped shadowing. The vascularization was minimal and intralesional. The lesion had a soft consistency under probe pressure. Panel (C). single myometrial tumor with in-homogeneous echogenicity of the solid tissue, irregular tumor borders, and irregular cystic areas with low-level content and shadows. The vascularization was minimal and intralesional. The lesion had a soft consistency under probe pressure. Panel (D). single myometrial tumor with in-homogeneous echogenicity of the solid tissue, irregular tumor borders, irregular cystic areas with anechoic content, and shadows. The vascularization was moderate and intralesional. The lesion had a soft consistency under probe pressure. Panel (E). single myometrial tumor with inhomogeneous echogenicity of the solid tissue, irregular tumor borders, irregular cystic areas with anechoic content, and absence of shadows. The vascularization was minimal and intralesional. The lesion had a soft consistency under probe pressure. Panel (F). myometrial tumor with in-homogeneous echogenicity of the solid tissue, irregular tumor borders, irregular cystic areas with low-level content, and absence of shadows. The vascularization was moderate and intralesional. The lesion had a soft consistency under probe pressure. Panel (G). single myometrial tumor with inhomogeneous echogenicity of the solid tissue, irregular cystic areas with anechoic content, without shadows, and with minimal intralesional vascularization. The lesion had regular tumor borders and a soft consistency under probe pressure.