Avoiding treatment of leiomyosarcomas: the role of magnetic resonance in focused ultrasound surgery

Objective: To report early diagnosis of a uterine leiomyosarcoma during screening for magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) for leiomyomas. Design: Case report. Setting: University hospital conducting an institutional review board-approved clinical trial. Patient(s): A 47-year-old premenopausal woman with presumed symptomatic leiomyomas for 5 years and minimal interval growth. Intervention(s): Magnetic resonance imaging screening protocol used as a routine part of MRgFUS treatment protocol. Main Outcome Measure(s): Surgical pathology report. Result(s): The diagnosis of leiomyosarcoma was suspected at the time of screening, and inadvertent treatment of a leiomyosarcoma was avoided. The patient underwent hysterectomy performed by her referring physician and confirmed the diagnosis of leiomyosarcoma. Conclusion(s): The possibility of inadvertent treatment of malignant disease and thus delayed diagnosis exists with all non-excisional therapies for uterine leiomyomas. The pretreatment imaging before MRgFUS in this case led to an expedited diagnosis of malignancy. Although this did not lead to a change in prognosis for this patient, careful review of magnetic resonance imaging before MRgFUS may allow early diagnosis for uterine malignancies.