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Magnetic resonance imaging of peritoneal leiomyosarcomatosis

Sub-Department of Academic Radiology, University Hospital, Nottingham, UK

This excerpt was created in the absence of an abstract.

Diffuse peritoneal and omental metastatic disease is a well recognized phenomenon and usually results from primary gastrointestinal tract or epithelial ovarian tumours. Leiomyosarcoma, an uncommon malignant neoplasm of smooth muscle origin that tends to arise in the genitourinary tract, retroperitoneum, alimentary tract or soft tissues, only infrequently gives rise to peritoneal or omental metastases. We report a patient with a primary high-grade leiomyosarcoma of the uterus, who subsequently developed diffuse peritoneal metastatic disease, demonstrated by magnetic resonance imaging (MRI) and confirmed surgically. These unusual MRI appearances do not appear to have been reported previously.

A previously well 43-year-old woman presented with polymenorrhagia and was found clinically to have a uterus enlarged to 12–14 weeks' gestational size. She underwent a routine hysterectomy, and at laparotomy an enlarged fibroid uterus (15 cm x 9 cm x 7 cm) was removed and a right haemosalpinx resected. The ovaries were normal and were conserved. Histological examination of the resected uterus showed a highgrade (mitotic count of more than 10/10 high-power field) leiomyosarcoma in a partially necrotic pedunculated fibroid of 5 cm diameter situated within the upper uterine cavity. There were several foci of myometrial invasion, the deepest extending to 0.3 cm from the serosal surface. Some regions of hyalinization and necrosis were present. Islands of tumour abutted but were not invading thin-walled blood vessels. The histology of the right fallopian tube showed chronic salpingitis only.

Key Words: Leiomyosarcoma • Magnetic resonance imaging • Peritoneal tumour

Received for publication May 2, 1991. Accepted for publication June 13, 1991.