OBGY Radiology


Case 14
A 23-year-old female, newly-married, presents with lower abdominal pain of 2 months duration. No period irregularity. No dysmenorrhoea. What is the probable diagnosis?
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Imaging Findings

Findings reveal a large cystic mass lesion, with solid areas in the Pouch of Douglas. It does not show a plane of demarcation from the posterior wall of the uterus. Endometrial lining was normal. The right ovary is seen separately, and is normal. A cystic lesion is seen in the left ovary. No lymphadenopathy or any other abdominal focal lesion was noted.

Diagnosis

Large subserous uterine mass lesion with cystic spaces within.
Histopath: Low-grade uterine sarcoma

Discussion:

Uterine sarcomas are rare, accounting for less than 5% of all uterine malignancies, out of which endometrial stromal sarcomas account for 10-15% of all uterine sarcomas. Diagnosis is seldom made pre-operatively. Extrauterine spead takes place in the form of pale yellow, worm-like , rubbery growth extending through the myometrium into the lymphatic and venous channel of the broad ligament, adnexae, and cardinal ligament.

Treatment is hysterectomy with bilateral oophorectomy to remove the source of estrogen that may stimulate residual sarcomas.

5-years overall survival rate is 60%, while of those detected in Stage I is 88%. Local recurrence occurs predominantly in the pelvis: parametrium, vagina, and bladder.


Dr. Sanjeev Mani, MD
Bandra Holy Family Hospital, Mumbai