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Saraei P, Heshmati A, Hosseini S. Small-cell neuroendocrine carcinoma of the female genital tract: A comprehensive overview. J Neuroendocrinol 2024; 36:e13394. [PMID: 38626758 DOI: 10.1111/jne.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
Small-cell neuroendocrine carcinomas (SCNECs) of the female genital tract are rare and aggressive tumors that are characterized by a high rate of recurrence and poor prognosis. They can arise from various sites within the female genital tract, including the cervix, endometrium, ovary, fallopian tube, vagina, and vulva. They are composed of cells with neuroendocrine features, such as the ability to produce and secrete hormones and peptides, and a high mitotic rate. Immunohistochemical staining for neuroendocrine markers, such as chromogranin A, synaptophysin, and CD56, can aid in the diagnosis of these tumors. This article provides an overview of the epidemiology, etiology, and risk factors associated with these tumors, as well as their clinical presentation, cellular characteristics, diagnosis, and finally the current treatment options for SCNECs, including surgery, chemotherapy, and radiation therapy, alone or in combination.
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MESH Headings
- Humans
- Female
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Small Cell/therapy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/epidemiology
- Carcinoma, Small Cell/pathology
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/epidemiology
- Risk Factors
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Affiliation(s)
- Pouya Saraei
- Department of Medical Physics, Medicine School, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Heshmati
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Emerging Therapeutic Concepts and Latest Diagnostic Advancements Regarding Neuroendocrine Tumors of the Gynecologic Tract. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121338. [PMID: 34946283 PMCID: PMC8703600 DOI: 10.3390/medicina57121338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022]
Abstract
Neuroendocrine neoplasms (NENs) are particularly rare in all sites of the gynecological tract and include a variety of neoplasms with variable prognosis, dependent on histologic subtype and site of origin. Following the expert consensus proposal of the International Agency for Research on Cancer (IARC), the approach in the latest World Health Organization (WHO) Classification System of the Female Genital Tumours is to use the same terminology for NENs at all body sites. The main concept of this novel classification framework is to align it to all other body sites and make a clear distinction between well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The previous WHO Classification System of the Female Genital Tumours featured more or less the same principle, but used the terms ‘low-grade neuroendocrine tumor’ and ‘high-grade neuroendocrine carcinoma’. Regardless of the terminology used, each of these two main categories include two distinct morphological subtypes: NETs are represented by typical and atypical carcinoid and NEC are represented by small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC). High-grade NECs, especially small cell neuroendocrine carcinoma tends to be more frequent in the uterine cervix, followed by the endometrium, while low-grade NETs usually occur in the ovary. NENs of the vulva, vagina and fallopian tube are exceptionally rare, with scattered case reports in the scientific literature.
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Hu R, Jiang J, Song G, Zhu C, Chen L, Wang C, Wang X. Mixed large and small cell neuroendocrine carcinoma of the endometrium with serous carcinoma: A case report and literature review. Medicine (Baltimore) 2019; 98:e16433. [PMID: 31335697 PMCID: PMC6709041 DOI: 10.1097/md.0000000000016433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Endometrial neuroendocrine carcinoma is a rare histological subtype of endometrial cancer, divided into low-grade neuroendocrine carcinoma (carcinoid) and high-grade neuroendocrine carcinoma (small cell and large cell neuroendocrine carcinoma). It is characterized by high invasiveness and poor prognosis. L/SCNEC is an extremely rare pathological type of endometrial carcinoma, and the number of reports on this condition is few globally. PATIENT CONCERNS A 54-year-old Chinese female presented with vaginal bleeding. DIAGNOSES Outpatient hysteroscopy and endometrial biopsy were performed, and the pathological examination revealed that cervix was invaded by endometrial malignancy. The patient underwent a laparoscopic radical hysterectomy was diagnosed with the mixed large and small cell neuroendocrine carcinoma (L/SCNEC) of the endometrium combined with serous carcinoma III C2 (FIGO2009). INTERVENTIONS Chemotherapy-radiotherapy-chemotherapy "sandwich" treatment was performed as postoperative therapy. OUTCOMES After three chemotherapy circles, the patient showed no evidence of further disease progression. LESSONS L/SCNEC is a rare and invasive disease. Once diagnosed, comprehensive treatments including surgery, radiotherapy, and chemotherapy can prolong the survival of patients and improve the prognosis.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Biopsy/methods
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/physiopathology
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/physiopathology
- Carcinoma, Small Cell/therapy
- Chemotherapy, Adjuvant/methods
- Combined Modality Therapy
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/physiopathology
- Cystadenocarcinoma, Serous/therapy
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/physiopathology
- Endometrial Neoplasms/therapy
- Endometrium/pathology
- Female
- Humans
- Hysterectomy/methods
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Staging
- Treatment Outcome
- Uterine Hemorrhage/diagnosis
- Uterine Hemorrhage/etiology
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Affiliation(s)
| | | | - Guangyao Song
- Department of Pathology, Dalian Gynecology and Obstetrics Hospital Affiliated to Dalian Medical University, Liaoning, Dalian, China
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The effect of autoimmune retinopathy on retinal vessel oxygen saturation. Eye (Lond) 2018; 32:1455-1462. [PMID: 29786086 DOI: 10.1038/s41433-018-0122-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/28/2018] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To study the retinal vessel oxygen saturation alterations in patients with autoimmune retinopathy (AIR) and patients with autoimmune retinopathy associated with retinitis pigmentosa (AIR-RP) in comparison with healthy controls and patients with isolated retinitis pigmentosa (RP). DESIGN Prospective, cross-sectional, and non-interventional study. SUBJECTS Retinal vessel oximetry (RO) was performed on a total of 139 eyes: six eyes suffering from AIR and four eyes with AIR-RP were compared to 59 healthy control eyes and to 70 eyes with RP. METHODS A computer-based program of the retinal vessel analyser unit (IMEDOS Systems UG, Jena, Germany) was used to evaluate retinal vessel oxygen saturation. The mean oxygen saturation in the first and second branch retinal arterioles (A-SO2) and venules (V-SO2) were measured and their difference (A-V SO2) was calculated. In addition, we measured the diameter of the retinal arterioles (D-A) and venules (D-V). MAIN OUTCOME MEASURES Oxygen metabolism is altered in patients with isolated AIR and AIR-RP. RESULTS Both, AIR and AIR-RP groups, differed from healthy controls showing significantly higher V-SO2 values and significantly lower A-V SO2 values (p < 0.025). In addition, the AIR-RP group could be differentiated from eyes suffering from isolated RP by means of significantly higher V-SO2 values. Comparing retinal vessel diameters, both, the AIR and AIR-RP groups, presented with significant arterial (p = 0.05) and venular (p < 0.03) vessel attenuation than the healthy control group. CONCLUSIONS Based on our results, in analogy to patients suffering from RP, oxygen metabolism seems to be altered in AIR patients.
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Abstract
Neuroendocrine carcinoma (NECa) of the endometrium is an uncommon tumor. In this study, we present the clinicopathologic features of 25 such cases. The patients ranged in age from 37 to 87 years (median, 57 y) and most commonly presented with vaginal bleeding. The tumors were either pure NECa (10) or mixed with other histotypes (15), most commonly endometrioid carcinoma. The NECas were large cell type (15), small cell type (4), or a mixture of both (6). NECa was underrecognized in 89% of referral/consultation cases. All tumors were positive for ≥1 neuroendocrine marker (chromogranin, synaptophysin, CD56). Additional immunohistochemical (IHC) studies were obtained in 18 cases, with positive results as follows: keratin cocktail (17), diffuse p16 (6), PAX-8 (6), CD117 (6), and TTF-1 (1). Mismatch-repair protein expression by IHC was abnormal in 8 of 18 cases (6 MLH1/PMS2 loss; 1 MSH2/MSH6 loss; 1 MSH6 loss). According to FIGO staging, cases were distributed as follows: I (6), II (2), III (10), and IV (7). All patients underwent surgical treatment, and 20 patients received adjuvant therapy. Twelve patients died of disease (mean survival 12.3 mo). Eleven patients were alive 5 to 134 months after diagnosis, including 7 who achieved a 5-year survival (3 stage I; 4 stage III). In summary, most of our endometrial NECas were large cell type, mixed with other histotypes, and underrecognized. These tumors tend to be PAX-8 negative and may be associated with microsatellite instability. The recognition of NECa may have an impact on the treatment of the patients affected by this disease. Although NECa usually has an aggressive behavior, 28% of our patients survived at least 5 years.
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Leursen G, Gardner CS, Sagebiel T, Patnana M, de CastroFaria S, Devine CE, Bhosale PR. Magnetic Resonance Imaging of Benign and Malignant Uterine Neoplasms. Semin Ultrasound CT MR 2015; 36:348-60. [PMID: 26296485 DOI: 10.1053/j.sult.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Benign and malignant uterine masses can be seen in the women. Some of these are asymptomatic and incidentally discovered, whereas others can be symptomatic. With the soft tissue contrast resolution magnetic resonance imaging can render a definitive diagnosis, which can further help streamline patient management. In this article we show magnetic resonance imaging examples of benign and malignant masses of the uterus and their treatment strategies.
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Affiliation(s)
- Gustavo Leursen
- Department of Abdominal Radiology, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Tara Sagebiel
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | - Madhavi Patnana
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | | | | | - Priya R Bhosale
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX.
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Abstract
Tumors of the diffuse neuroendocrine cell system (DNES) may arise in any component of the gynecologic tract, including the vulva, vagina, cervix, endometrium, and ovary. Overall such tumors in the gynecologic tract are rare, constituting only 2% of gynecologic cancers, comprising a spectrum of tumors of variable biologic potential. Due to the rarity of such tumors, pathologists experience may be limited and these may present diagnostic challenges. Currently the nomenclature employed is still that of the pulmonary classification systems, carcinoid, atypical carcinoid, small and large cell neuroendocrine carcinoma that broadly correlates to low/grade 1, intermediate/grade 2, and high grade/grade 3 of the WHO gastroenteropancreatic neuroendocrine tumors classification. Furthermore in keeping with the lung, proliferative rate is assessed based on mitotic index rather than Ki-67 staining. In this review we cover select neuroendocrine tumors of the gynecologic tract.
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Affiliation(s)
- Marjan Rouzbahman
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Kaneko S, Tsukamoto Y, Abe K, Yonamine M, Hasegawa S, Hikida H. A case of MPO- and PR3-ANCA-negative pauci-immune renal-limited small-vessel vasculitis associated with endometrial neuroendocrine small cell carcinoma. CEN Case Rep 2013; 2:123-127. [PMID: 28509232 DOI: 10.1007/s13730-012-0057-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 12/24/2012] [Indexed: 10/27/2022] Open
Abstract
A 69-year-old woman was admitted to our hospital for rapid increase in serum creatinine level with microscopic hematuria and nephrotic-range proteinuria. Three months prior to admission, she became aware of atypical genital bleeding, leading her gynecologist to suspect endometrial cancer. Light microscopy examination of renal biopsy revealed crescentic glomerulonephritis with peritubular capillaritis. Immunofluorescence microscopic examination did not detect any significant staining, and no electron-dense deposits were detected by electron microscopy. No autoantibodies, including anti-myeloperoxidase- or anti-proteinase3-anti-neutrophil cytoplasmic antibodies were detected. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and was found to have endometrial neuroendocrine small cell carcinoma (NSCC), stage 1B. In her clinical course, her serum creatinine level gradually improved without immunosuppression therapy. Endometrial NSCC is a rare endometrial malignancy. This is the first case report of vasculitis associated with NSCC originating from the uterus.
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Affiliation(s)
- Shuzo Kaneko
- Department of Nephrology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan.
| | - Yusuke Tsukamoto
- Department of Nephrology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan
| | - Kazuya Abe
- Department of Obstetrics and Gynecology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan
| | - Masayuki Yonamine
- Department of Obstetrics and Gynecology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan
| | - Sumiko Hasegawa
- Department of Obstetrics and Gynecology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan
| | - Hiromi Hikida
- Department of Obstetrics and Gynecology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan
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Matsumoto H, Takai N, Nasu K, Narahara H. Small cell carcinoma of the endometrium: a report of two cases. J Obstet Gynaecol Res 2011; 37:1739-43. [PMID: 21790887 DOI: 10.1111/j.1447-0756.2011.01593.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary small cell carcinoma of the endometrium is rare and has an extremely poor prognosis. This report describes two cases of small cell carcinoma of the endometrium diagnosed as stage III. Case 1 was diagnosed as stage IIIc. She underwent surgery and chemotherapy. For a locally recurrent tumor, she received radiotherapy. She has been well with no evidence of disease for 4 years. Case 2 was diagnosed as stage IIIa. She underwent surgery. The tumor recurred soon after the surgery, and she died 33 days after the surgery. In the literature, the median survival reported for patients with stage III and IV is only 5 months. Case 1 is the 4th case showing long-term survival with advanced-stage disease. The optimal treatment for this rare tumor has not been established. Considering its rarity and variability, it is difficult to establish an evidence-based therapeutic regimen.
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Affiliation(s)
- Harunobu Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.
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Clear cell carcinoma of the endometrium causing paraneoplastic retinopathy: case report and review of the literature. Case Rep Obstet Gynecol 2011; 2011:631929. [PMID: 22567514 PMCID: PMC3335617 DOI: 10.1155/2011/631929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 06/21/2011] [Indexed: 11/18/2022] Open
Abstract
We reviewed the literature for cases in which gynecologic malignancies caused paraneoplastic retinopathy and ultimately led to blindness. Twenty-eight cases were derived from the literature, and one unique case is described from our institution. Of these 28 cases, 14 patients were diagnosed with endometrial cancer, 7 with ovarian cancer, 5 with cervical cancer, 1 fallopian tube cancer and 1 with concomitant endometrial and ovarian cancers. The average age of patients at the time of diagnosis was 64 years (range, 35-89 years). Typically, ocular manifestations antedate symptoms of the underlying carcinoma by 3-12 months. Information regarding the interval from visual symptoms to time of death is limited, but ranges from several months to several years. Our report is the first to document a clear cell carcinoma of the endometrium causing paraneoplastic retinopathy and is the first to review all gynecologic malignancies associated with visual paraneoplastic syndromes.
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Small cell carcinomas and large cell neuroendocrine carcinomas of the endometrium and cervix: polypoid tumors and those arising in polyps may have a favorable prognosis. Int J Gynecol Pathol 2008; 27:333-9. [PMID: 18580310 DOI: 10.1097/pgp.0b013e31815de006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report 5 polypoid high-grade neuroendocrine carcinomas of the uterus, 2 small cell carcinomas of the endometrium, and 3 large cell neuroendocrine carcinomas, 2 from the cervix and 1 from the endometrium. The 2 small cell carcinomas of the endometrium arose from and were confined to endometrial polyps, one of which also showed foci of endometrioid adenocarcinoma. The myometrium was free of tumor, despite extensive sampling. The 3 large cell neuroendocrine carcinomas, 2 from the cervix and 1 from the endometrium, were polypoid but did not originate in polyps. Two of these tumors infiltrated myometrium, and one did not. The age of the 5 patients ranged from 25 to 66 years (mean age, 43 years). Four patients presented with vaginal bleeding. One pregnant woman had the largest polypoid tumor discovered during a routine gynecologic examination. Tumor sizes ranged from 2.7 to 10 cm. All 5 patients were treated by radical hysterectomy and 4 received adjuvant chemotherapy. Only 2 patient had pelvic lymph node metastasis. All patients are alive and disease-free from 9 months to 7 years after treatment (mean survival, 47 months). All 5 tumors labeled with chromogranin and synaptophysin and 4 with CD56. Two small cell carcinomas and 2 large cell neuroendocrine carcinomas accumulated p53 protein. Two small cell carcinomas and 2 large cell neuroendocrine carcinomas expressed p16. Our findings suggest that stage of disease and a polypoid gross feature are the best predictors for outcome in small cell carcinomas and large cell neuroendocrine carcinomas of the uterus.
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Tamai K, Koyama T, Saga T, Mikami Y, Fujii S, Togashi K. Small cell carcinoma of the uterine corpus: MR imaging and pathological correlation. J Comput Assist Tomogr 2007; 31:485-9. [PMID: 17538301 DOI: 10.1097/01.rct.0000243452.33610.d4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Small cell carcinoma of the uterine corpus is a rare but aggressive neoplasm showing neuroendocrine differentiation; its radiological findings are not well described. We report the magnetic resonance features of 3 cases with pathological correlation. Small cell carcinoma is shown as a bulky endometrial tumor of heterogeneous appearance on T2-weighted images, frequently associated with diffuse myometrium invasion and early extrauterine spread. Irregular enhancement with multifocal unenhanced areas of the thickened myometrium on contrast-enhanced T1-weighted images may represent the infiltrative nature of the tumor with extensive necrosis.
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Affiliation(s)
- Ken Tamai
- Department of Diagnostic Imaging and Nuclear, Graduate School of Medicine, Kyoto University, Japan
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Abstract
Magnetic Resonance Imaging (MRI) is the criterion standard in the assessment and staging of uterine cancer because of the high tissue contrast between glandular lining and inner and outer muscle layers of the uterine corpus and cervix on T2-weighted scans. It is also an essential tool in monitoring treatment response and in assessing disease recurrence in these patients. The key to a successful examination lies in good patient preparation, use of antiperistaltic agents, and a meticulous scanning technique. Endometrial carcinomas are the most common uterine malignancy, occurring in a primarily postmenopausal population. Dynamic contrast-enhanced scans may be required in addition to T2-weighted images to assess the presence of myometrial invasion in this age group. Cervical cancers occur in a younger population and are readily assessed with T2-weighted imaging. Use of an endovaginal receiver coil allows high spatial resolution imaging of the cervix, which is particularly useful when assessing patients for fertility-sparing procedures such as trachelectomy. Uterine sarcomas are 1% to 3% of all uterine malignancies and usually arise from a mixture of homologous and heterologous elements. Rarely, lymphoma, small cell carcinoma and metastatic deposits involve the uterus. This review summarizes the optimal scanning techniques for demonstrating uterine malignancy and discusses the role of imaging and the MRI appearances of uterine tumors.
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Affiliation(s)
- Camilla R Whitten
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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