Uterine sarcomas: clinical presentation and MRI features

摘要

Uterine sarcomas are a rare heterogeneous group of tumorsof mesenchymal origin, accounting for approximately 8%of uterine malignancies. They comprise leiomyosarcoma,endometrial stromal sarcoma, undifferentiated endometrialsarcoma, and adenosarcoma. Compared with the more commonendometrial carcinomas, uterine sarcomas behave moreaggressively and are associated with a poorer prognosis. Dueto their distinct clinical and biological behavior, the InternationalFederation of Gynecology and Obstetrics introduced anew staging system for uterine sarcomas in 2009, categorizinguterine carcinosarcoma as a variant of endometrial carcinoma,rather than a pure sarcoma. Magnetic resonance imaging(MRI) has a developing role in the assessment of thesemalignancies. Features such as tumor localization, irregularor nodular margins, necrosis, rapid growth, intense contrastenhancement, and restriction at diffusion-weighted imagingcan suggest the diagnosis and help differentiate from morecommon leiomyomas and endometrial carcinoma. MRI istherefore extremely useful in preoperative detection andstaging and, consequently, in determination of appropriatemanagement. This pictorial review aims to discuss the clinicalfeatures of uterine sarcomas, as well as their most commonappearances and distinct characteristics in MRI.