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Case report highlights preoperative misdiagnosis of uterine leiomyosarcoma and intravenous leiomyomatosis, suggesting better imaging differentiation.
Rationale: Intravenous leiomyomatosis (IVL) and uterine leiomyosarcoma (ULMS) share overlapping imaging features, leading to frequent preoperative misdiagnosis. Accurate differentiation is critical for appropriate surgical management. Patient concerns: Case 1 is a 48-year-old woman with intermittent vaginal bleeding. Case 2 is a 52-year-old woman with exertional dyspnea for 8 months. Diagnoses: Preoperative computed tomography venography suggested IVL in both cases. Final pathology showed case 1 for low-grade endometrial stromal sarcoma with vascular invasion and case 2 for ULMS. Interventions: Case 1 under hysterectomy, bilateral salpingoo-opherectomy, ureteral replantation, tumor resection. Case 2 under resection of uterus, adnexa, right kidney, and intravascular tumor. Outcomes: Both cases showed a fine postoperative condition with no severe adverse reactions. Lessons: Intraoperative pathology is essential for distinguishing ULMS from IVL when imaging is inconclusive.
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Yang et al. (2025) studied this question.
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