According to the World Health Organization (WHO) criteria for uterine smooth muscle, tumors have historically been distinct in benign leiomyomas, leiomyomas variants, and malignant leiomyosarcomas based on cytological atypia, mitotic rate, and presence or absence of tumor cell necrosis. Ultrasound, especially new techniques such as three-dimensional (3D)/four-dimensional (4D) ultrasound and 3D/4D color Doppler, is an excellent tool in the hands of ultrasonographers in the detection of atypical myomas and potential malignancy in uterine fibroids. Preoperative detection of malignancy in leiomyoma is a challenge for the ultrasonographer. It is very important to define an atypical leiomyoma by ultrasound examination because of its specificity, this type of leiomyoma can mimic leiomyosarcomas and can be precursors for the development of leiomyosarcoma.
Lethaby A, Vollenhoven B. Fibroids (uterine myomatosis, leiomyomas). BMJ Clin Evid 2015;2015:0814. PMID: 26032466. PMCID: PMC4451527.
Ip PP, Tse KY, Tam KF. Uterine smooth muscle tumors other than the ordinary leiomyomas and leiomyosarcomas: a review of selected variants with emphasis on recent advances and unusual morphology that may cause concern for malignancy. Adv Anat Pathol 2010;17(2):91–112. DOI: 10.1097/PAP.0b013e3181cfb901
Hanby AM, Walker C, Tavassoli FA, et al. Pathology and genetics: tumours of the breast and female genital organs. WHO Classification of Tumours series - volume IV. Lyon, France: IARC Press Breast Cancer Res 2004. DOI: 10.1186/bcr788
Kurman RJ, Carcangiu ML, Herrington CS, et al. WHO classification of tumours of female reproductive organs, 2014 WHO Classification of Tumours of Female Reproductive Organs; 4th Edition, Volume 64th Lyon, France: International Agency for Research on Cancer. ISBN-13-978-92-832-2435-8; NLM ID: 101656343.
Hodge JC, Pearce KE, Clayton AC, et al. Uterine cellular leiomyomata with chromosome 1p deletions represent a distinct entity. Am J Obstet Gynecol 2014;210(6):572.e1–572.e7. DOI: 10.1016/j.ajog.2014.01.011
Exacoustos C, Romanini ME, Amadio A, et al. Can gray-scale and color Doppler sonography differentiate between uterine leiomyosarcoma and leiomyoma? J Clin Ultrasound 2007;35(8):449–457. DOI: 10.1002/jcu.20386
Van den Bosch T, Dueholm M, Leone FP, et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol 2015;46(3):284–298. DOI: 10.1002/uog.14806
Timmerman D, Valentin L, Bourne TH, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000;16(5):500–505. DOI: 10.1046/j.1469-0705.2000.00287.
Ly A, Mills AM, McKenney JK, et al. Atypical leiomyomas of the uterus: a clinicopathologic study of 51 cases. Am J Surg Pathol 2013;37(5):643–649. DOI: 10.1097/PAS.0b013e3182893f36
Jiang GH, Zhang LY, Li GY, et al. [Atypical magnetic resonance imaging vs pathological findings of leiomyoma in the female reproductive system]. Nan Fang Yi Ke Da Xue Xue Bao 2009;29(2):301–304. PMID: 19246306.
Minsart AF, Ntoutoume Sima F, Vandenhoute K, et al. Does three-dimensional power Doppler ultrasound predict histopathological findings of uterine fibroids? A preliminary study. Ultrasound Obstet Gynecol 2012;40(6):714–720. DOI: 10.1002/uog.11155
Bonneau C, Thomassin-Naggara I, Dechoux S, et al. Value of ultrasonography and magnetic resonance imaging for the characterization of uterine mesenchymal tumors. Acta Obstet Gynecol Scand 2014;93(3):261–268. DOI: 10.1111/aogs.12325
Bacanakgil BH, Deveci M, Karabuk E, et al. Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: Clinicopathologic-Sonographic Characteristics, Follow-Up and Recurrence. World J Oncol 2017;8(3):76–80. DOI: 10.14740/wjon1031w
Leone FP, Timmerman D, Bourne T, et al. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 2010;35(1):103–112. DOI: 10.1002/uog.7487.
Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol 1994;18(6):535–558. PMID: 8179071.
Dall'Asta A, Gizzo S, Musarò A, et al. Uterine smooth muscle tumors of uncertain malignant potential (STUMP): pathology, follow-up and recurrence. Int J Clin Exp Pathol 2014;7(11): 8136–8142.
Ip PP, Cheung AN, Clement PB. Uterine smooth muscle tumors of uncertain malignant potential (STUMP): a clinicopathologic analysis of 16 cases. Am J Surg Pathol 2009;33(7):992–1005. DOI: 10.1097/PAS.0b013e3181a02d1c
Gizzo S, Di Gangi S, Bertocco A, et al. Levonorgestrel intrauterine system in adjuvant tamoxifen treatment: balance of breast risks and endometrial benefits–systematic review of literature. Reprod Sci 2014;21(4):423–431. DOI: 10.1177/1933719113503408
Pritts EA, Vanness DJ, Berek JS, et al. The prevalence of occult leiomyosarcoma at surgery for presumed uterine fibroids: a meta-analysis. Gynecol Surg 2015;12(3):165–177. DOI: 10.1007/s10397-015-0894-4
Raine-Bennett T, Tucker LY, Zaritsky E, et al. Occult Uterine Sarcoma and Leiomyosarcoma: Incidence of and Survival Associated With Morcellation. Obstet Gynecol 2016;127(1): 29–39. DOI: 10.1097/AOG.0000000000001187
Kurjak A, Kupesic S, Shalan H, et al. Uterine sarcoma: a report of 10 cases studied by transvaginal color and pulsed Doppler sonography. Gynecol Oncol 1995;59(3):342–346. DOI: 10.1006/gyno.1995.9965.
Kim JH, Kim HJ, Kim SH, et al. Sonographic and Clinical Characteristics of Uterine Sarcoma Initially Misdiagnosed as Uterine Fibroid in Women in the Late Reproductive Age. J Menopausal Med 2019;25(3):164–171. DOI: 10.6118/jmm.19007