A diagnosis of uterine sarcoma is confirmed by histological examination fol- lowing myomectomy or hysterectomy for a presumed fibroid. However, a careful ultrasound evaluation may also identify features suggestive of sarcoma5—typically, mixed echogenic and poor echogenic areas with central necrosis.6 Color Doppler can reveal irregular vessel distribution, low imped- ance to flow, and high peak systolic velocity.6 If a sarcoma is suspected after ultrasound evaluation, an MRI can be helpful in further evaluation.7
How best to manage uterine fibroids?
Small fibroids that are asymptomatic or cause only minor problems are not usually treated. However, if a fibroid is large or results in pain or excessive bleeding, further management may be needed. Management of fibroids may be nonsurgical or surgical (TABLE).1,3,8 Factors that affect management choices include the patient’s desire to become pregnant or preserve her uterus, symptom severity, and tumor characteristics.
A good outcome for our patient
Based on our patient’s KUB x-ray, we suspected malignancy, so we consulted a gynecologist for a sonographic examination. The ultrasound revealed a heterogeneous mass with calcification.
The patient underwent a hysterectomy. The solitary soft tissue mass that was removed measured 13 cm in diameter and weighed 2100 g (FIGURE 2). Histopathological analysis revealed that the fibroid was madeup of myometrium and fibrous connective tissue. After hospital discharge, the patient resumed all of her normal activities with no recurrence.
CORRESPONDENCE
Jhen-Guo Lin, MD, Department of Obstetrics and Gynecology, Taoyuan Armed Forces General Hospital, No. 168, Zhongxing Road, Longtan Township, Taoyuan County 32551, Taiwan (ROC); mick_2000ndmc@yahoo.com.tw