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MR Imaging of Uterine Sarcomas

A. Sahdev1, S. A. Sohaib2, I. Jacobs3, J. H. Shepherd3, D. H. Oram3 and R. H. Reznek4

1 Department of Radiology, St. Bartholomews Hospital, West Smithfield, London, EC1A 7BE, England.
2 Department of Radiology, Royal Marsden Hospital, Downs Rd., Sutton, Surrey, SM2 5PT, England.
3 Department of Oncological Gynaecology, St. Bartholomews Hospital, West Smithfield, London, EC1A 7BE, England.
4 Department of Academic Radiology, St. Bartholomews Hospital, West Smithfield, London, EC1A 7BE, England.



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  		Fig. 1. —Leiomyosarcoma in 64-year-old woman presenting with uterine mass. Sagittal T2-weighted MR image (TR/TE, 4000/105; echo train, 8) shows large mass of mixed signal intensity replacing uterus. High-signal-intensity pockets are scattered throughout mass and coalesce anteriorly. Balloon catheter is present in urinary bladder.

 


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  		Fig. 2. —Recurrent leiomyosarcoma in 84-year-old woman with pelvic mass. Sagittal T2-weighted MR image (TR/TE, 4000/110; echo train, 8) shows large lobulated mass with areas of low, intermediate, and very high signal intensities. As in all other similar masses, areas of high signal intensity corresponded histologically with areas of cystic necrosis, whereas areas of low signal intensity were hemorrhage.

 


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  		Fig. 3. —Recurrent endometrial stromal sarcoma in 24-year-old woman. On axial T2-weighted MR image (TR/TE, 4000/105; echo train, 8), pelvic recurrence (curved arrow) is seen adjacent to left iliac vessels. This shows similar T2-weighted MR imaging features as leiomyosarcomas. Strands of tumor extended posteriorly (not seen on image) into confluent presacral mass (straight black arrow), infiltrating sacral neural foraminae and sacral canal (white arrow).

 


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  		Fig. 4. —Recurrent mixed müllerian tumor in 71-year-old woman. Axial T2-weighted MR image (TR/TE, 4000/110; echo train, 8) shows recurrent pelvic mass in right hemipelvis (straight solid arrows). Note ascites in pelvis. Omentum is markedly thickened by tumor infiltration (open arrow). Peritoneal tumor implants are also present (curved arrow).

 


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  		Fig. 5. —34-year-old woman with atypical uterine leiomyosarcoma. Sagittal T2-weighted MR image (TR/TE, 4000/100; echo train, 8) shows large mass with single central area of high signal intensity. Appearance of leiomyosarcoma resembles benign leiomyoma undergoing hyaline degeneration. Nabothian follicles (arrow) are noted in cervix.

 


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  		Fig. 6A. —68-year-old woman with rhabdosarcoma of cervix. Sagittal (A) and axial (B) T2-weighted MR images (TR/TE, 4000/105; echo train, 8) show large cervical mass with intermediate signal whorled background T2-weighted signal intensity with scattered small pockets of high T2-weighted signal intensity within mass. Vaginal wall is stretched around rhabdosarcoma (black arrows). Urinary bladder is compressed anteriorly by large cervical sarcoma (white arrows).

 


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  		Fig. 6B. —68-year-old woman with rhabdosarcoma of cervix. Sagittal (A) and axial (B) T2-weighted MR images (TR/TE, 4000/105; echo train, 8) show large cervical mass with intermediate signal whorled background T2-weighted signal intensity with scattered small pockets of high T2-weighted signal intensity within mass. Vaginal wall is stretched around rhabdosarcoma (black arrows). Urinary bladder is compressed anteriorly by large cervical sarcoma (white arrows).

 


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  		Fig. 7. —71-year-old woman with uterine mixed müllerian tumor. Sagittal T2-weighted MR image (TR/TE, 4000/105; echo train, 8) shows large endometrial mass (arrowheads) expanding endometrial cavity. Appearance of tumor is indistinguishable from endometrial carcinoma, hyperplasia, or polyps. Metastatic deposit of tumor is present in pouch of Douglas (arrow) surrounded by free fluid.

 

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