{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:44:13Z","timestamp":1790700253596,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To correlate the ultrasound appearance of highly vascularized uterine myomas with their histopathological diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational study of patients with a preoperative ultrasound diagnosis of a highly vascularized uterine myoma (color score of 3 or 4, according to the Morphological Uterus Sonographic Assessment (MUSA) criteria), characterized by circumferential and intralesional vascular pattern, who underwent myomectomy or hysterectomy. For each patient, ultrasound characteristics were recorded at baseline, including the number of lesions, the size, echogenicity and border regularity of the lesion, presence of cystic areas and shadowing within the myoma, and visualization of the endometrium. Ultrasound features were correlated with the definitive histological diagnosis. Ultrasound features were then compared between malignant and benign lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 70 patients with highly vascularized uterine myomas on power\/color Doppler. Their mean age was 46.5\u2009\u00b1\u200911.4\u2009years and 13 (18.6%) were postmenopausal. At histological examination, 65 (92.9%) uterine myomas were benign lesions, comprising 32 typical leiomyomas, 29 leiomyoma variants and four adenomyomas. The remaining five (7.1%) uterine myomas were malignant masses, comprising two uterine sarcomas, one leiomyosarcoma, one neuroendocrine tumor and one uterine smooth muscle tumor of uncertain malignant potential (STUMP). The mean age of patients with a malignant lesion was significantly higher than the age of those with a benign lesion (64.8\u2009\u00b1\u200916.0 <jats:italic>vs<\/jats:italic> 42.4\u2009\u00b1\u20095.1; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Four out of five patients with a malignant lesion were over 45\u2009years old. Ultrasound demonstrated cystic areas within the lesion in 10\/32 (31.3%) typical leiomyomas, 16\/29 (55.2%) leiomyoma variants, all four adenomyomas and in the cases of STUMP and leiomyosarcoma. Lesion borders were regular in 64\/65 (98.5%) benign lesions and 2\/5 (40%) malignant lesions (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). No significant differences were observed between benign and malignant lesions with respect to echogenicity, presence of shadowing and size. The endometrium was visible in 55\/65 women with  benign lesions and in  2\/5 with  malignant lesions (<jats:italic>P<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results showed that ultrasound features of uterine myomas, such as circumferential and intralesional vascularity, cystic areas and lesion borders,  are important parameters for differential diagnosis, especially when combined with the patient's age. Such features could be useful to differentiate typical myomas from benign variants and malignant lesions in a preoperative setting and to select patients that may benefit from conservative management rather than surgery. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24855","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T08:59:09Z","timestamp":1641977949000},"page":"269-276","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8394-1994","authenticated-orcid":false,"given":"C.","family":"Russo","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Obstetrics and Gynecological Unit University of Rome \u2018Tor Vergata\u2019  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Camilli","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Obstetrics and Gynecological Unit University of Rome \u2018Tor Vergata\u2019  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0756-535X","authenticated-orcid":false,"given":"F. G.","family":"Martire","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Obstetrics and Gynecological Unit University of Rome \u2018Tor Vergata\u2019  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3272-978X","authenticated-orcid":false,"given":"A.","family":"Di Giovanni","sequence":"additional","affiliation":[{"name":"Endoscopica Malzoni, Center for Advanced Endoscopic Pelvic Surgery  Avellino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Lazzeri","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Malzoni","sequence":"additional","affiliation":[{"name":"Endoscopica Malzoni, Center for Advanced Endoscopic Pelvic Surgery  Avellino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Zupi","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-201X","authenticated-orcid":false,"given":"C.","family":"Exacoustos","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Obstetrics and Gynecological Unit University of Rome \u2018Tor Vergata\u2019  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.01.007"},{"key":"e_1_2_7_3_1","first-page":"47","article-title":"Classifying, staging, and treating uterine sarcomas","volume":"18","author":"Forney J","year":"1981","journal-title":"Contemp Obstet Gynec"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1438.2007.01125.x"},{"key":"e_1_2_7_5_1","first-page":"233","volume-title":"Pathology and Genetics of Tumours of the Breast and Female Genital Organs","author":"Hendrickson MR","year":"2003"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0b013e3181a2b8d3"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181a02d1c"},{"key":"e_1_2_7_8_1","first-page":"8136","article-title":"Uterine smooth muscle tumors of uncertain malignant potential (STUMP): pathology, follow\u2010up and recurrence","volume":"7","author":"Dall'Asta A","year":"2014","journal-title":"Int J Clin Exp Pathol"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4757-1942-0_13"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19881115)62:10<2239::AID-CNCR2820621028>3.0.CO;2-Y"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2014-0361"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14806"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.20386"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20270"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2019.07.007"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.236035033"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12325"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000019787"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.11.011"},{"key":"e_1_2_7_20_1","volume-title":"WHO classification of tumours of female reproductive organs","author":"Kurman RJ","year":"2014"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.20075"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-020-07003-z"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2017.1330323"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11155"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics10100735"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2019.06.013"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2006.7.4.281"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2005.04.021"}],"container-title":["Ultrasound in Obstetrics &amp; 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