Leiomyosarcoma of the uterus

The large, heterogeneous multiloculated solid-cystic midline pelvic mass measures approximately 18 x 12 x 12 cm. Some of the locules demonstrate intrinsic high T1 signal and low ADC values, reflecting regions of hemorrhage and/or proteinaceous fluid. The solid components of the lesion show intense gadolinium enhancement.

Normal cervix and uterus are not identified.

Anteriorly, although the fat plane between the mass and the bladder is effaced, the margin with the bladder appears preserved, without convincing evidence of bladder wall invasion.

The rectum is displaced to the right, and the sigmoid colon is draped over the lesion; tumor has extensively replaced the mesorectal fat, and extensively abuts the anterior margin of the presacral fascia, without invasion of the presacral space. 

The left ovary lies superior to the mass; it is uncertain whether the ovary is adherent. The right ovary is separate from the lesion appearing normal in size and signal.

The left internal and external iliac veins are compressed, with no evidence of thrombus elsewhere in the venous system. There is no definite ureteric obstruction.

There are no concerning lymph nodes.

No evidence of omental/peritoneal or bony metastases.

A small multiloculated 28 x 9 x 27 mm rim enhancing cystic lesion projects laterally through the greater sciatic notch in contact with the sciatic nerve; the nature of the lesion is uncertain, but it may represent fluid within herniated peritoneum.

Postsurgical changes are noted in the lower anterior abdominal wall.