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Fig. 4. —73-year-old woman with uterine leiomyosarcoma. Sagittal gadolinium-enhanced T1-weighted spin-echo image (TR/TE, 200/20) shows massive uterine enlargement (arrows) with irregular central zones of low signal intensity, suggesting extensive tumor necrosis (N). Uterine leiomyosarcoma should be suspected if rapid uterine enlargement occurs, especially in post-menopausal women. Because most leiomyosarcomas are located in myometrium, endometrial biopsy is not as useful as in other sarcomas, but it may establish diagnosis in as many as one third of patients in whom lesion is submucosal.





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