Leiomyosarcoma differential diagnosis

Jump to navigation Jump to search

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]

Overview

Leiomyosarcoma must be differentiated from other soft tissue tumors, some variants of leimyoma resembles malignant tumor. Other possible differential diagnosis of leimyosarcoma include, epithelioid endometrial stromal sarcoma, alveolar soft part sarcoma, epithelioid angiosarcoma, pleomorphic rhabdomyosarcoma.

Differentiating Leiomyosarcoma from other Diseases

The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms.[1][2][3]

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histology
Ultrasound CT scan MRI
Uterine Leiomyosarcoma[4][5]
  • Abnormal vaginal bleeding (Postmenopausal or intermenstrual bleeding or bleeding from uterus or vagina)
  • Pressure or pain pelvic or abdomen
  • Vaginal dyscharge
  • Change in bladder or bowel habits
  • Fatigue
  • Fever
  • Malaise
  • Weight loss
  • Lump protruding from vagina
  • Mass in abdomen or pelvic
  • Tendenrness on palpating pelvic or Abdomen
  • Lymphadenopathy
  • Deep myometrial invasion
Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma.
  • Gross histology:
  • Large, solitary, poorly circumscribed masses (average 10 cm)
  • Typically display a fleshy variegated cut surface with areas of hemorrhage or necrosis
Histology and biopsy
Leimyoma (mitotically active type) CBC Suggestive of Anemia
  • Enlarged uterus with multiple whorled mass lesions, largest of size 8.6×7.1 cm, not extending into the abdomen
  • An enlarged uterus and a deformed uterine contour are the most common CT findings of leiomyomas
  • Leiomyomas usually have a uniformly solid consistency
  • Abscence of cytologic atypia
  • Mild nuclear atypia, up to 10-20 mitosis
  • No tumor cell necrosis
Biopsy and histology -
Hemorrhagic cellular leiomyomas (apoplectic leiomyoma)[6][7]
  • Abdominal pain
- - On microscopic analysis:
  • Zones of recent hemorrhage within nodules of hypercellular smooth muscle.
  • Coagulative necrosis (red degeneration)
  • Mitotic figure not exceeding 2/10 HPF, mostly located in the perihemorrhagic areas On gross examination:
  • Features of multiple hemorrhagic area
  • Necrosis
  • Cyst formation
  • Softening, or color different than the usual leiomyoma
Biopsy specimen and histology
Endometrial Cancer
  • Abnormal Vaginal bleeding or post coital bleeding
Enlarged uterus CBC and Clotting studies to r/o anemia and coagulopathy Thickened endometrial line on ultrasound. Thickened endometrial line on CT Thickened endometrial line on MRI In well-differentiated forms, endometrioid adenocarcinoma produces small, round back-to-back glands without intervening stroma with varying degrees of glandular complexity are demonstrated by luminal infolding, budding, papillae (with or without psammoma bodies), and cribriforming. In grade 1 lesions, nuclei of the lining epithelial cells are uniform and oval to cylindrical, with minimal atypia and small discrete nucleoli. The cellular axes are perpendicular to the basement membrane, and stratification may or may not be present. Typically, high-grade tumors (with significant solid components) display an increased amount of nuclear atypia, as demonstrated by pleomorphism, irregular chromatin clumping, and prominent nucleoli  Biopsy under hysteroscopic guidance -
PEComa
  • Association with lymphangiomyomatosis and tuberous sclerosis
Epitheloid angiosarcoma[8]
  • Painful, enlarging soft tissue masses
  • Long bone fractures
  • Arteriovenous shunting and subsequent high-output cardiac failure symptoms such as dypnea on exertion.
Microscopic histology:
  • Nodules, and trabeculae of infiltrative epithelioid to spindled cells
  • Eosinophilic cytoplasm.

References

  1. Cotton PB, Shorvon PJ (1984) Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease. Clin Gastroenterol 13 (2):383-403. PMID: 6378443
  2. Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R (1993) Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg 218 (5):583-92. PMID: 8239772
  3. Kimura T, Kamiura S, Yamamoto T, Seino-Noda H, Ohira H, Saji F (2004) Abnormal uterine bleeding and prognosis of endometrial cancer. Int J Gynaecol Obstet 85 (2):145-50. DOI:10.1016/j.ijgo.2003.12.001 PMID: 15099776
  4. Santos, Pedro; Cunha, Teresa Margarida (2015). "Uterine sarcomas: clinical presentation and MRI features". Diagnostic and Interventional Radiology. 21 (1): 4–9. doi:10.5152/dir.2014.14053. ISSN 1305-3825.
  5. Hata, Kohkichi; Hata, Toshiyuki; Makihara, Ken; Aoki, Showa; Takamiya, Osamu; Kitao, Manabu; Harada, Yuji; Nagaoka, Saburo (1990). "Sonographic Findings of Uterine Leiomyosarcoma". Gynecologic and Obstetric Investigation. 30 (4): 242–245. doi:10.1159/000293278. ISSN 1423-002X.
  6. Myles JL, Hart WR (November 1985). "Apoplectic leiomyomas of the uterus. A clinicopathologic study of five distinctive hemorrhagic leiomyomas associated with oral contraceptive usage". Am. J. Surg. Pathol. 9 (11): 798–805. PMID 4073354.
  7. . doi:10.1097/PAS.0000000000000569. Check |doi= value (help). Missing or empty |title= (help)
  8. . doi:10.1043/1543-2165-135.2.268. Check |doi= value (help). Missing or empty |title= (help)


Template:WikiDoc Sources