II. Epidemiology
- Onset typically over age 55 years (although younger ages may be affected)
III. Pathophysiology
- Aggressive, Smooth Muscle connective tissue tumor
- Neoplastic spindle cell proliferation
- Malignant variant of leiomyoma (e.g. Uterine Fibroid)
- May represent up to 0.23% of Uterine Fibroids
- Identified in 13 of every 10,000 women undergoing surgery for preseumed fibroids
IV. Risk Factors: Uterine Leiomyosarcoma
- Age over 45 years old (OR 20)
- Post-Menopause (OR 9.7)
- History of pelvic radiation
- Tamoxifen use
- Genetic Syndromes (hereditary Retinoblastoma, Li-Fraumeni Syndrome)
V. Findings
- Expanding mass on the limbs, head, neck, Abdomen or retroperioneum
- Symptoms are related to location of mass (e.g. Abdominal Pain)
VI. Imaging
- CT with Contrast
- Heterogeneous mass
- MRI Findings (Uterine Leiomyosarcoma )
- Intramural Hemorrhage (OR 21)
- Endometrial thickening (OR 11)
- T2-Weighted signal heterogeneity (OR 10)
- Non-myometrial origin (OR 4.9)
- Tomassin-Naggara (2013) Eur Radiol 23(8):2306-14 [PubMed]
VII. Management
- Refer for core needle biopsy and surgical resection