Sonographic imaging in uterine sarcoma: a narrative review of literature

Uterine sarcomas include a heterogeneous group of tumors with an aggressive clinical behavior and poor prognosis. Sarcomas are rare and they represent 1% of all gynecological malignancies and 3–7% of all invasive uterine cancers. According to 2011 Word Health Organization (WHO) sarcomas comprise three main histotypes: leiomyosarcoma, endometrial stroma sarcoma, and undifferentiated endometrial sarcoma. In the majority of uterine sarcomas diagnosis is incidentally carried out during surgery or at pathology in patients with sonographic suspicion of fibroids. The correct differential diagnosis between benign myoma and sarcoma is mandatory for a correct surgical treatment. In past, several retrospective papers were published. These studies present few cases and ultrasound markers have never been coded. In 2019 a series of 195 cases were published, this study proposes ultrasound markers associated with clinical symptoms and signs. All sarcomas were described as a large solid lesion with inhomogeneous echogenicity, cystic irregular areas. Leiomyosarcomas, endometrial stromal sarcomas and undifferentiated endometrial sarcomas rarely have internal shadows and fan shaped shadowing. An incorrect diagnosis was made in one fifth of all sarcoma cases. Undifferentiated endometrial sarcomas were correctly diagnosed more often than leiomyosarcomas and endometrial stromal sarcomas. Many patients were symptomatic and the most common symptoms were abnormal vaginal bleeding and pelvic pain. Ultrasound diagnosis of sarcomas is difficult and an incorrect diagnosis is common. In this paper we describe the ultrasound features of sarcomas by re-evaluating the