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Uterine leiomyosarcoma
#1
Presentation

Chronic pelvic pain with a palpable mass.

Patient Data
AGE: 65 years
GENDER: Female

MRI
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Axial T1

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Axial T2

[Image: IM0014_big_gallery.jpeg]
Sagittal T2

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Coronal T2

[Image: IM0016_big_gallery.jpeg]
Axial T1 fat sat

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Axial T1 C+ fat sat

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Sagittal T1 C+ fat sat

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Axial DWI

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Axial ADC

The MRI sequences demonstrate:

intramural leiomyoma of fundal location measuring 5 x 4.5 x 4 cm of high signal on T1, low signal on T2 with heterogeneous enhancement on postcontrast sequences. Small adjacent intramural leiomyomas are also noted.
large ill-defined lobulated myometrial mass of corporeoisthmic location, lateralized to the left measuring 10 x 9.5 x 8 cm, eliciting an isosignal on T1 and T2 with restricted diffusion and heterogeneous enhancement on postcontrast sequences. There is an extension to the left tube-ovarian region with iliac lymphadenopathies.
Case Discussion
MRI features are suggestive of uterine leiomyosarcoma with uterine fibroids.

The patient went to have a total hysterectomy with bilateral salpingo-oophorectomy. The histopathological exam with immunochemistry analysis confirm the diagnosis of a leiomyosarcoma invading the uterine leiomyoma.
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