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Objective Our objective is to assess the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (MRI) in identifying the depth of myometrial invasion and cervical stromal involvement in endometrial carcinoma (EC) along with nodal status and its correlation with surgical and histopathological (HP) findings. Materials and methods We performed a retrospective study on female patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Patients with endometrial carcinoma (CA) were searched from the electronic record system, and a total of 188 patients fulfilling the study criteria were selected. All the patients were evaluated using a 1.5T MRI and underwent a hysterectomy. The outcome of preoperative MRI was correlated with histopathology results, keeping pathology as the gold standard. Results A total of 188 patients were included in the study, with a mean age of 56.67 ± 12.47 years. Of the patients, 72 (38.3%) were diagnosed with stage 1a. The second common stage was 1b, seen in 43 (22.9%) patients. It was found that the staging of endometrial CA on MRI and HP were significantly correlated for myometrial invasion (stage 1a and 1b), cervical stromal involvement (stage 2b), serosal and adnexal (stage 3a), vaginal (stage 3b), and nodal (stage 3c) involvement as shown by their p-values of <0.01. However, in cases of parametrial invasion (stage 3b), bladder involvement, and rectal involvement (stage 4), MRI showed decreased sensitivity as shown by their p-values of 0.833, 0.87, and 0.9, respectively. Conclusion Preoperative MRI can predict local disease and low-risk patients accurately, thereby helping in proper surgical planning and avoiding more extensive surgery such as lymphadenectomy in these patients.
RESUMO
Leiomyoma (fibroid) is the most common benign tumour of the uterus in reproductive age. Its treatment is easy and employs a surgical resection, usually without complications. However, it may show an atypical behaviour and result in intravenous leiomyomatosis (IVL) extending into the regional and systemic veins, thus reaching the heart; and may extend into the pulmonary arteries. The symptoms of IVL are non-specific, resulting in underdiagnosis and misdiagnosis of the disease entity and so the condition is underreported. Cross sectional imaging plays an important role in correct diagnosis of the condition, resulting in reduced morbidity and mortality of the patient and saving surgeons from unwanted complications. It typically originates from the uterus and may involve ovarian/uterine veins. We report a 45-year female who presented with right hypochondial pain for which she was diagnosed as cholelithiasis. She was also diagnosed with a left adnexal mass on ultrasonography (USG) for which she underwent a CECT abdomen and pelvis and was diagnosed as a case of subserosal fibroid with IVL extending into left gonadal vein, and inferior vena cava (IVC). Intracardiac extension was confirmed on 2-D echocardiography. This is first reported case of IVL from Balochistan, Pakistan.
