OP17.03: Outcomes of leiomyomas with variant ultrasound morphology “differentiating apples from apples”

Leiomyomas exhibit typical morphological features on ultrasound. Variant ultrasound morphology poses diagnostic challenges due to overlap in imaging findings of benign and malignant leiomyomas. It's not apples and oranges, but it's a fruit salad! We must pick the cherries from this salad. The aim was to evaluate the outcomes of leiomyomas with variant ultrasound morphology. Retrospective analysis of 1059 patients with sonographic diagnosis of leiomyomas done. Patients with variant ultrasound morphology were compared to typical leiomyomas. As per MUSA criteria, the following sonographic pointers were used. Benign-pointers: well-defined lesions with regular margins, perilesional-vascularity, shadowing and calcification. Malignant-pointers: inhomogeneous margins, cystic changes, absent shadowing, calcification, colour score of 3-4. Patients were categorised into two groups benign and malignant pointers on ultrasound. Outcomes were based on HPE. Out of 1059 patients with leiomyomas, benign pointers on ultrasound were seen in 1049 cases (99.01%) and malignant pointers in 10-cases (0.94%). 10 cases showed Irregular margins (n = 6) colour score 3-4 (n = 8) cystic areas(n = 7) absent calcification (n = 10) and absent shadowing (n = 7). 11 (1.04%) out of the 1049, preoperatively having benign pointers had features suggestive malignancy on HPE,10(100.00%) patients having malignant pointers in pre-op ultrasound had malignancy on HPE out of which 5 had leiomyosarcoma, 3 low-grade endometrial sarcomas and 2 undifferentiated endometrial sarcomas. Study helps in defining morphology of leiomyoma variants. This helps optimising management strategies thereby facilitating the differentiation of “apples from apples”. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.