Suspicious myometrial mass on ultrasonography and MRI does not necessarily mean a sarcoma on histology
© Springer-Verlag 2009
Received: 10 March 2009
Accepted: 1 April 2009
Published: 29 April 2009
We report an unusual ultrasonographic and magnetic resonance imaging (MRI) presentation of a myometrial mass in a 38-year-old woman hoping to conceive. Hysterectomy had been proposed elsewhere because of the suspicious nature of the mass, but the patient was seeking a second opinion. This atypical formation looked consistent with either hydropic degeneration of a uterine myoma or leiomyosarcoma, but preoperative differential diagnosis was impossible. Laparoscopic tumorectomy was performed and histology confirmed a degenerating uterine myoma. We, therefore, show that unusual ultrasonographic and MRI findings do not necessarily require radical surgery, even if sarcoma cannot be excluded preoperatively, especially in patients who wish to conceive.
A 38-year-old woman with an unusual myometrial mass presented to our department for a second opinion, having been advised to have a hysterectomy in another institution. The patient was nulliparous but hoped to conceive in the future and had no symptoms. Clinical examination revealed a mobile uterus with a 6- to 7-week uterine volume.
In case of preoperative diagnosis of leiomyosarcoma, hysterectomy and bilateral salpingo-oophorectomy by laparotomy are the gold standard . In our case, MRI presentation of a well-circumscribed mass was consistent with hydropic degeneration of a myoma, although leiomyosarcoma could not be excluded preoperatively. No lymph node invasion or peritoneal carcinosis was suspected on MRI.
Laparoscopy was, therefore, planned to assess our diagnosis. The peritoneal cavity was closely inspected to exclude peritoneal carcinosis. The uterine serosa was opened and a relatively well-delimited plane of cleavage was found. We believe that the risk of myometrial incision and associated peritoneal dissemination in case of sarcoma would have been similar by laparotomy or laparoscopy. During dissection, the macroscopic aspect of the formation was wholly consistent with a myoma. In case of suspected malignancy, extemporaneous histological analysis would have been required. Every precaution was taken to avoid rupturing the mass and a LapSac® was used to remove it in order to avoid morcellation in the peritoneal cavity.
Clinicians should be aware that unusual ultrasonographic and MRI findings do not necessarily require radical surgery, even if sarcoma cannot be excluded preoperatively, especially in patients who wish to conceive. Furthermore, as myomas are remarkably common, we believe that it is crucial to be familiar with unusual ultrasonographic and MRI presentations that may occur in case of degeneration.
The authors thank Mira Hryniuk for reviewing the English grammar and syntax of the manuscript.
Disclosure of interests
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